G, a 28-year-old first-time mum, requested caesarean section as a mode of delivery for her baby. She was concerned that natural birth might “permanently tear” her birth canal and cause a “loose” vagina which could affect her sex life subsequently. She was told that a laxed vagina could reduce sensation during intercourse which could lead to diminished sexual satisfaction, decreased sexual self-esteem and may cause a drift in her marital relationship. Caesarean sections (C-section) appeared to be a better option.
Incidence of C-section in Singapore is on the rise
C-section has become a common method for giving birth in countries around the world and Singapore is no exception. In the early 1990s , 10-15% of total births were delivered by C-section. Now, the procedure accounts for an estimated 40-45% of all births and many of these are performed on patient’s request.
How Common IS “Loose Vagina” (Vaginal Laxity)?
Vaginal looseness is considered a form of sexual dysfunction and is a subjective and self-reported sexual health concern. There are no objective measures.
How Could Vaginal Birth Cause Vaginal Laxity? The vaginal walls contain elastic muscles that normally fold up and hold the vagina closed tightly. During childbirth, pregnancy hormones cause these muscles to relax. The vagina is designed to be able to relax and re-tighten repeatedly, without any loss of tone or tissue elasticity. However, there are limits to the elasticity of the muscles and associated tissues. A few risk factors are known to contribute to chronic feelings of vaginal looseness. They include:
Trauma: Pelvic floor muscles which surround and help maintain the position and shape of the vagina are damaged to varying degrees during childbirth.
Age: With aging, there is gradual weakening of the vaginal muscles and tissues.
Multiple vaginal births: With multiple deliveries, there is incomplete recovery of pre-pregnancy vaginal tightness.
Does Vaginal Laxity Affect Long Term Sexual Enjoyment?
Sexual enjoyment is important in maintaining a healthy marital relationship. Many factors can influence sexual satisfaction in women. They include interpersonal relationship, mental and physical health of the couples.
It is generally perceived that normal childbirth resulting in vaginal laxity may have a negative impact on sexual function. Short-term studies have suggested that there is little difference in sexual outcomes at 6 months postpartum when comparing caesarean section with vaginal deliveries. A recent long-term study published in 2022 also had the same conclusion. Researchers in the UK and Sweden looked at the sexual health of women for up to 18 years after giving birth. The study found that sexual enjoyment and sexual frequency are unaffected by the mode of delivery.
So, whether patients give birth vaginally or by C-section, there was no difference in the long-term sex life. Both groups had sex equally as often, and were equally sexually satisfied.
I spent some time explaining to G the advantages of normal vaginal birth including better development of the immune system of her baby and less chances of the baby developing early life infections and non-communicable diseases, including inflammatory diseases, allergies, metabolic diseases and obesity later in life. With strong emotional support from her husband, G finally decided to have a vaginal delivery and had a healthy baby boy weighing 3kg.