Dear Patrick: I gave birth to my first child three months ago. He was an unusually large baby, and during labor, my perineum tore. According to my OB-GYN, there was no time to do an episiotomy. It has been really difficult to pick the baby up and take care of him when I have stitches between my legs; every movement is painful. At first my husband was sympathetic and gave me extra help, but now he is starting to ask me when we can resume having sex, and he “forgets” to pick up the baby and change him, etc. I don’t know if I should still be in this much pain. The stitches came out a while ago but I don’t feel much better.
I am not a doctor and cannot diagnose or treat you, so you really should go see your doctor and insist on an examination. If you do not have a warm, caring and sympathetic doctor, find somebody who is. Sometimes a nurse practitioner or a physician’s assistant is actually better educated about patients’ emotional needs than the doctor who supervises them.
It’s my suspicion that you did not get the best of care during this birth. If you had prenatal scans, your doctor would have known the baby was very large. There was no reason for him or her to allow your perineum to tear. There are still some cruel and stupid people in the field of obstetrics and gynecology who think it is just a woman’s lot to suffer. They believe there are no nerve endings in the vagina and extend that to believe women don’t need pain control during birth. A torn perineum is normal in that world-view. Since your “inferior” body deserves pain and does not merit pleasure to an incompetent and evil professional of that nature, you won’t get all the help Western medicine can give a woman during labor.
Stitching up a torn perineum is not a simple task. It requires a thorough knowledge of the soft tissue, nerves, blood vessels, and muscles in that area. Blood vessels that were compressed by the infant’s head may start to bleed and need special attention. Infection is a significant risk. You may be suffering from a poorly done repair job or an infection. This is why it’s important for a really good doctor to take a look at what was done.
The vaginal floor (the portion of the vagina away from the navel and toward the anus) is an important part of a woman’s sexual equipment. She needs that floor to be intact to keep fecal matter away from her vagina, and it is also sensitive to pressure and pleasure. Nothing is more stupid than the assertion that the vagina lacks nerve endings. There is a definite ability to feel pain as well as pleasure and pressure around the outside and within the vagina. Scar tissue can be problematic even if a wound has healed. It is stiffer than regular tissue so it does not stretch as well, and touching it can be painful.
I would recommend self-exploration with a water-based lubricant, to see where your vulva feels okay and where it hurts. Take a look in a mirror as you examine yourself so you can see where you still have erotic feeling and where you experience pain. Your doctor may be able to suggest creams that will help reduce the stiffness of the scar tissue. Rubbing it on can help to accustom the area to touch and gradually reduce sensitivity. If you can find the time to start masturbating again, this is an important way to make contact with your sexuality once more.
Few people acknowledge the sacrifice women make to have children. I hope this injury will gradually get better. The sleep deprivation and sexual demands of your husband don’t help, I’ll bet. He needs to take a look at that scar and imagine how he would react if his own crotch got torn from between his balls down to his asshole. I do understand that he feels frustrated. But a father’s responsibilities don’t end with fertilizing an egg; they have only begun when the baby is born. He needs to buck up and shoot for doing half of the work with the baby and around the house. If both of you are working, and you are still feeling like hell, that’s a reasonable goal.
I do understand you are living in the real world, though, and not a feminist utopia. If intercourse is painful, look for other ways to satisfy your husband. Using your hands or mouth can relieve some of his tension until you can “go all the way” again. In private, you might want to experiment with a very small object to see if you can enjoy penetration once more. But I’m going to ask you to make a bargain with yourself that you will not hurt yourself just so you can service another person’s pleasure. Your feelings come first. Touching, looking at, and affirming the beauty and courage of your body can help you to start to heal.
Having a child can be hard on a relationship on many levels. I hope you and your husband are able to adjust and maintain your partnership. Sometimes it can seem as if there is no more energy or strength to go on. But if you are allies, if you are backing each other up and being kind and loving to each other, you can get through the hard times and survive until things get better. And they will. Babies grow up. They get easier to take care of. Honest, they do.
Here’s hoping that between good medical care and pro-active self-care, you will heal and once more feel confident and strong. If your husband really wants sex with you, I hope he will read this answer and understand what a process it is going to take to restore your genitals so you can enjoy intercourse. It would help a lot if he was willing to gently explore your tender bits with his hands, go down on you, or masturbate with you so you can experience pleasure as a couple without any pain. I think you really need that reassurance now, the knowledge that no matter what, you are not going to be hurt again.
If our society did not take women’s pain for granted, especially when it came to birth, everyone would understand that you have PTSD and need the same care that anyone with a traumatic injury would get for full recovery. I am not saying that all births are traumatic, but some of them certainly are. If that paradigm doesn’t work for you, you should discard it. I mention it here because in the past I have had some luck with getting spouses and other members of the family support system to understand what a mother needs by comparing her birth injuries and subsequent pain and fear to other trauma.