As a woman who has birthed 2 very large babies through my vagina, and as a board certified women’s health physical therapist, I feel the need to bring up a few things concerning vaginas and rehabilitation.

Now, I can understand that most people haven’t heard the terms “vagina” and “rehabilitation” in the same sentence, but I can assure you, this is something that’s near and dear to my heart.

I’ve spent my career shedding light on this topic and treating hundreds of women over the past 11 years.

Being pregnant, having a baby, and navigating the waters of motherhood can be… shall we say a challenge. Figuring out feeding, sleeping, and accepting this new identity and reality is no joke.

No one ever tells us about the aftermath: the sweaty nights, the crying at 5 pm, the anxiety, the insatiable hunger while breastfeeding, the nipple cracks, that creepy sound the pump makes (I swear it was talking to me), and the bone deep exhaustion.

But the thing that strikes deep in my heart is that no one prepares you for what’s happening with your vagina after having a baby, regardless if you had a C-section or vaginal delivery.

Until now. I will tell it all to you.

I’ll also compare it to what happens to French vaginas after birth. I’ll show you how much we’re lacking in this country when we care for new mothers… or women in general, I should say, but that’s another convo.

About 1 in 4 women experience pelvic floor disorders after having a baby — either delivered through the sunroof or the lobby, it doesn’t matter.

Pelvic floor dysfunction (PFD) can consist of these lovely, common, but not normal symptoms, like:

Often the message that women receive when they report these issues after childbirth is, “Welp! You just had a baby, what do you expect? This is how it is now!” Which, in so many words, is baloney.

I think of pregnancy, labor, and delivery as a truly athletic event, requiring skilled and comprehensive rehabilitation. Just like an athlete would need rehab if they tore a muscle in their shoulder or ruptured their ACL playing soccer.

Pregnancy and birth can take a major toll on us. We’re asking our bodies to perform feats of strength, endurance, and raw power over a course of 9 months. That’s a long time!

So let’s delve deeper into the pelvic floor and what we need to be doing for our vaginas.

The pelvic floor muscles are a hammock of muscles that sit at the bottom of the pelvis. They sling front to back and side to side (pubic bone to tailbone, and sit-bone to sit-bone).

The pelvic floor muscles have 3 main functions:

  • Support. They hold our pelvic organs, baby, uterus, and placenta in place.
  • Continence. They keep us dry when the bladder is full.
  • Sexual. They aid in orgasm and allow penetration into the vaginal canal.

The pelvic floor muscles are famously known as our Kegel muscles, and they’re made up of the same stuff as our biceps or hamstrings: skeletal muscle.

Pelvic floor muscles are at the same risk for injury, overuse, or trauma — just like any muscle in our body.

What’s more, pregnancy and delivery put a huge amount of strain on pelvic floor muscles, which is why we see such high occurrence of leaking urine, pain, pelvic organ prolapse, and muscle weakness after baby.

There are many conservative and safe ways to manage these issues and actually treat the source. Physical therapy for your vagina is numero uno and should be your first line of defense at the 6-week mark after delivery.

France offers what they call “perineal rehab” as part of their standard of postpartum care. Every person who births a baby in France is offered this, and in some cases the therapist comes to your home (Ahhhh-mazing) to get you started.

Because of socialized medicine, perineal rehab is covered as part of their postpartum healthcare, which is not the case here in the United States.

Most insurance companies don’t reimburse well for the treatment codes and diagnoses related to pelvic floor dysfunction. The cost to obtain treatment can be a huge barrier for women.

Utilizing pelvic floor physical therapy right at the start of the postpartum recovery process can help a woman exponentially, and France has figured that out.

Early intervention provides benefits quickly, such as a decrease in pain with intercourse or tampon use, and decrease in leaking urine, gas, or stool.

Not only that, but early pelvic rehabilitation saves insurance companies and our healthcare system money and resources in the long run. When pelvic floor disorders go untreated, surgery is often required.

Some studies estimate that 11 percent of women will require prolapse surgery before the age of 80.

Pelvic floor surgeries aren’t cheap. Because of the expense and frequency, one study found that direct costs of pelvic surgeries were over $1 billion a year. And that was over 20 years ago.

It doesn’t take a doctorate to see that preventive physical therapy is more cost effective than surgery — especially when the success rate for prolapse surgeries is abysmal and women often require more than one procedure.

Still, the mainstream message women hear about their pelvic health is this: Your pelvic floor dysfunction is a part of life now. The only solutions are surgery, medications, and diapers.

Now, in some cases, yes, surgery is warranted. But in most cases, a lot of pelvic floor issues can be managed and treated with physical therapy.

Physical therapists in France employ similar treatments and interventions to pelvic PTs here in the United States. The difference is that healthcare professionals in France see the value in starting pelvic floor physical therapy ASAP after birth, and treatment is continued until goals are met and symptoms have decreased.

Here in the United States, at the 6-week mark we’re often told, “Everything is fine! You can have sex and exercise and do all the things you were doing before!”

But, in fact, we don’t always feel fine. Much of the time we may be having pain in our vagina or other symptoms.

In France, they utilize pelvic floor rehab to build basic strength and restore function before returning to mainstream exercise programs.

As a result, in France there’s a decrease in leaking urine, pain, and prolapse. Therefore, compared to the United States, France has a lower rate of subsequent pelvic organ prolapse surgeries down the road.

Here’s the bottom line: For new mothers here in the States, we’re neglecting a HUGE component of postpartum care.

Pelvic floor PT has been shown to decrease leaking urine, pain, and prolapse when implemented effectively. It’s safe, low-risk, and much more affordable than surgery.

It’s time the United States started putting more value and concern into a comprehensive rehab program for women, and start to prioritize the vagina.

Every person who gives birth should be offered pelvic floor rehabilitation after having a baby.

We should be taking our cues from France on how to implement this treatment as standard of care for mamas. As a mother, a woman, a healthcare provider, and a board certified women’s health PT, I want this to be available for all mothers who birth.

The more we talk about and provide this type of care, the more it will become normal and not a “niche” practice.

Rehab for your vagina should be as common and non-eyebrow-raising as getting PT for a sprained ankle or shoulder injury. Let’s take a lesson from our French counterparts and put those vaginas on a pedestal. It’s time now.

Marcy is a board certified women’s health physical therapist and has a passion to change the way women are cared for during and after their pregnancies. She’s the proud mama bear to two boys, drives a mini van shamelessly, and loves the ocean, horses, and a good glass of wine. Follow her on Instagram to learn more than you want to know about vaginas, and to find links to podcasts, blog posts, and other publications related to pelvic floor health.