Lax Perineum or Loose Vagina

When my patients tell me that they don't feel the same below after delivery of a baby, especially after a few babies, I understand what they mean. The sensation of a lax or loose vagina is manifest in several ways. There may be a feeling of heaviness below, loss of sexual sensation during intercourse, leakage of urine especially when exerting pressure such as coughing or during running, loss of control in defaecation or constipation. Sometimes it is the husband who will say that the wife feels loose during intercourse. Vaginal deliveries can result in a lax perineum and prolapse of the vagina and uterus. It usually occurs when the babies tend to be big or the delivery is assisted. During delivery, the tissues that support the vaginal wall known as the fascia which is made up mainly of collagen tissue may be torn, and although not visible can result in weakening of the vaginal wall. As a result, the bladder and rectum may protrude into the vagina, and the uterus may descend into the vaginal introitus. Kegel excercises and physiotherapy have a minimal effect in improving vaginal prolapse although there is no harm in trying these as the first line management of prolapse. Surgery can be performed with a lazer or by conventional surgery to repair and tighten the vaginal opening. This can be done as a day procedure in some cases. Where prolapse is more severe, repair can be aided with a mesh which is inserted underneath the vaginal mucosa for added support. The most recent advances involve a soft polypropylene mesh developed by AMS known as `Elevate' and these may be used for both front and back wall of the vagina as well as prolapse of the top of the vagina.