Vaginal birth, eh? RCOG figures show 85% of women experience some form of perineal trauma, one in three suffers postnatal incontinence after first child, 50% of all mothers eventually experience prolapse, long-term bladder and bowel symptoms “horrifyingly common” with assisted birth.

Posted by: on Sep 18, 2011 | No Comments

This is the full and unedited account of this weeks Times column response

Q I cannot get over the damage done to my body from giving birth seven months ago. I’m not referring to a flabby tummy or having put on a bit of weight, but to the result of having an assisted ventouse delivery and the huge impact on my sex life and self-esteem. I used to be very confident sexually; now the only word I can come up with to describe myself is “disgusting”. My husband is being supportive but I do not feel like a real woman and I cry about it every day. I still feel sexual desire but dare not make love or even fantasise because of the way I feel I have been disfigured.

A Giving birth is an enormous physical challenge and although midwives, and the Sheila Kitzinger brigade, bang on about the benefits of natural birth, very few women escape the process physically unscathed. The Royal College of Obstetricians and Gynaecologists (RCOG) estimates that about 85 per cent of women experience some form of perineal trauma during a vaginal birth. One woman in three suffers from postnatal incontinence after her first child. At some point, half of all women who become mothers will experience prolapse. And according to an NCT evidence-based briefing, long-term bladder and bowel symptoms are “horrifyingly common” in women who have had an assisted birth.

You can be damn sure that if men had babies the process would be a lot more sci-fi and a lot less camel-through-the-eye-of-a-needle, but as things stand, UK maternity services are hugely overstretched and there is increasing dissatisfaction with the standard of care provided. During the birth, the main focus is on delivering the baby safely, but the way in which this is achieved can leave physical, mental and, indeed, sexual scars. A British study of 131 couples carried out by Dixon (2000) found that half of the men and women questioned eight months after childbirth described their sex life as “poor” or “not very good”. And in women who have had difficult births — involving tears, cuts, forceps and ventouse — painful sex, delayed resumption and sexual dysfunction are far more common. Yet Women’s sexual health after childbirth, a study carried out in 2000, found that only 15 per cent of London women who had a postnatal sexual problem reported discussing it with a health professional.

You are lucky to have a supportive husband, but it can’t have been easy for him to watch you go through the pain of childbirth and then to see you so distressed by the long-term effects of having the baby. Men often feel marginalised by the arrival of a new baby and sex is an important way for new parents to reconnect. Though I know you don’t want to have penetrative sex, plenty of non-sexual touching such as hand holding, kissing and cuddling will be good for your relationship. Although you feel traumatised by your appearance, your husband does not share your feelings of “disgust” and he probably has a more intimate knowledge of what you looked like before the birth than you did.

There is no point in my advising you to do pelvic floor exercises or invest in a good lubricant because you need to be examined by a gynacologist (gynaecologists.co.uk) as soon as possible, and you may require psychosexual help (cosrt.org.uk/find_therapist.asp). Obviously, no clinician worth his salt would try and diagnose without seeing a patient, but when I explained the specifics of your condition, Gurminder Matharu, a gynaecologist and spokesperson for the Royal College of Obstetricians and Gynacologists suggested that you might be suffering from something known as ‘buttonholing’, where a tear in the tissue at the opening of the vagina creates a second hole above it. He also said that one problem specific to ventouse deliveries is ‘trapping’, where the vaginal tissue gets caught between the baby’s head and the cup and the force of the suction traumatises the tissue. Matharu says that “obstetricians should always check for this before performing a ventouse” but it does happen.

Because you mentioned your urethra I also spoke to The British Association of Urological Surgeons, however they believe the issue is gynaecological not urological. And finally I spoke to sexual dysfunction expert, Dr David Goldmeier at Imperial College. He was curious about your case because a few years ago, he treated a woman who was referred by her gynacologist who thought she was suffering from vaginissimus, When Dr Goldmeier examined her he felt a large mass of scar tissue inside her vagina and he concluded that the force of the ventouse procedure had left her vulva so inflamed and raw that as her vaginal passage had healed it had literally sealed together in the middle creating two large holes, rather like the condition you describe.

You are cleary traumatised by the whole experience so you should definitely get in touch with the Birth Trauma Association (birthtraumaassociation.org.uk). It offers e-mail support, although Maureen Treadwell, a spokeswoman, reiterates that seeing a specialist is the most important first step. She says “a lot of the women find that just taking the first step and visiting a urogynaecologist or accessing counselling makes a huge difference to their levels of confidence”.

Reassuringly, Gurminder Matharu says that the fact that your problems are external and visible makes them much easier to treat and repair. However, until a doctor can look at you, it is impossible to offer more specific advice; but now that you have been brave enough to write to me, I hope you will pick up the phone and make the appointment.

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