After a baby is born, while everyone else is focusing on the newborn, I begin my twelve-point inspection to make sure mom is healthy, part of which involves inspecting the vagina for lacerations. More often than not, there are a few vaginal tears. Occasionally, while I’m in the process of post-delivery vaginal reconstruction, the significant other will comment on the condition of the vagina and request that I “throw in an extra stitch” for him. At this point, I inwardly cringe, but externally keep a straight face and pretend I didn’t hear him. (I do have a colleague with a little more chutzpah who has been known to remark that perhaps he is unfortunately small if he needs an extra stitch.)
Contrary to the common misconception, long-term studies have shown that sexual function and satisfaction are not affected by childbirth, neither vaginal nor Caesarean section. Sexual function is not related to the tightness of the skin, but rather, the underlying muscle tone of the pelvis. So, adding unnecessary tension to the skin at the vaginal opening is not going to improve anyone’s sexual satisfaction – it’s only going to cause the woman pain.
When I am repairing a vagina after childbirth, my main focus is making sure the vaginal muscles are properly put back together so the patient can control her urine and stool properly. In talking with some of my senior colleagues, the origin of the phrase ‘husband stitch’ was likely describing the deep suture that is used to sew together the perineal muscles (commonly called the ‘crown stitch’ by the less vulgar among us) because the muscles themselves are the most important for sexual function.
After your 6-week postpartum visit, when you are cleared to resume sexual relations, if you find that your vaginal muscles are not as toned as they once were, the first step would be to get serious about pelvic floor exercises. Then, if kegels aren’t getting the job done, pelvic physical therapy can sometimes be the solution. Occasionally, the muscles truly do not heal back properly either due to infection or tearing of the stitches. In these cases, there is a surgical procedure to correct this call a perineoplasty, which is resewing the perineal muscles together, not just the skin.
Let’s face it, immediately after a 5-inch baby head stretches through a 1.5 inch vaginal opening, things don’t exactly look the same. But much like baby weight, stretch marks, and the swollen uterus, the vaginal tissue can get back to normal shape if you give it some time and effort. No “extra stitch” required.