July 30, 2020
In the Pelvic Health Care world, we hear a lot of bad information floating around. Much of which is not supported by evidence and can even be harmful. Unfortunately, most of these myths come about due to the underlying thought that a woman’s body is supposed to look and be a certain way. This has led women to overcompensate or choose potentially dangerous options to achieve what they believe is normal or acceptable. There is nothing wrong with wanting to look and feel healthy, but it’s important to do your research beforehand and make sure you aren’t doing more harm than good.
I wanted to take some time to debunk a few of these myths and provide information and options for people with related health concerns.
Any of the above-listed cleaning methods, when inserted vaginally, can destroy healthy bacteria and disrupt vaginal pH. This increases risk of infection such as bacterial vaginosis and susceptibility to HIV transmission. Vaginal steaming, the practice of sitting over steaming herbs or substances reported to "cleanse" or "restore" the vagina can also negatively impact vaginal tissue health by striping the tissue of its natural acidity and bacteria. More importantly, in some cases, this practice has caused severe intra-vaginal burns. There is no scientific evidence to support the efficacy of these products when used as mentioned.
Takeaway: Do not insert any kind of soap or cleansing product into the vagina via any method.
Staying hydrated, eating mostly healthy / whole foods and taking daily probiotics can positively impact the vaginal microbiome and pH, reduce infection (sometimes accompanied by unpleasant odor) and vaginal dryness.
When cleaning, it is best to stay outside of the labia minora, as the tissue within the labia minora and inner vagina are more sensitive and susceptible to damage. It is best to use your clean bare hand and water. For those who prefer some kind of cleansing product, stick with a pH-balanced "cleanser," not a "soap," and definitely not an anti-bacterial soap. A good pH to look for in your cleanser is 5.3 – 6.0.
Repeated use of external cleansing products including wipes and soaps can have the same negative impact to the vestibule (area within the labia minora). So, it’s best to avoid these products altogether unless you are someone who struggles with severe fecal and urinary incontinence.
Talk to your physical therapist about how tight or weak pelvic floor muscles and scar tissue are also associated with vaginal pH and healthy tissue.
Every woman is different and every delivery is different. Some women have vaginal tearing or c-sections. Women may heal differently depending on the level of trauma their body sustained, as well as other factors. What may be appropriate for one person, may not be appropriate for you.
Keep in mind, we’re NOT all returning to the same level of exercise intensity. Different forms of exercise require different levels of strength and preparation. Returning to yoga is not the same thing as returning to Crossfit or running. It’s important to keep this in mind when you’re cleared by your physician to "return to normal activity."
Additionally, many women experience pain with intercourse post-partum which may continue beyond the 6 – 8 week checkup. Even if you’re cleared to participate in intercourse, if it’s painful, you may need more time to heal.
We recommend checking in with your physical therapist before returning to normal activity. Your physical therapist can assess the strength and function of your pelvic floor and your core to determine a patient-specific program for return to previous activity.
These programs can be really beneficial to some individuals, but there are a few things you should know before you spend the money.
Again, every woman is different and their bodies heal differently. What may be appropriate for one person, may not be appropriate for you.
Not all of these programs are backed by evidenced-based research. Just because a website says its content is delivered by "experts" in the field doesn’t make it true. It’s important to do your research and check for credentials.
Over 80% of women do not Kegel (perform a pelvic-floor muscle contraction) properly, so it’s important to get checked out by your physical therapist to be sure you are doing these movements correctly before progressing exercise intensity.
You can also ask your physical therapist about the types of exercises you’re doing in the program to make sure they are appropriate for your personal stage of healing.
While abdominal binding can be used as additional support for the abdominal muscles in the early stages of healing, it is not a cure for abdominal separation or diastasis recti. Diastasis recti, for those who are unfamiliar, is the mid-line separation of the abdominal muscles that can happen during pregnancy, sports, etc.
You can think of abdominal binders like Band-Aids. A Band-Aid only covers the wound to protect it; it doesn’t heal the wound. An abdominal binder works similarly. It gives extra support when your body is still healing, but it will not re-train the muscles to function properly or make them any stronger.
Additionally, lack of movement over long periods of time from binding can contribute to scar tissue in women post c-section. Scar tissue can impede proper healing and contribute to other issues in the future.
Abdominal binding can provide comfort and support with the addition of appropriate core muscle re-training and strengthening exercises.
Talk to your physical therapist about how to use your abdominal binder in conjunction with core re-training and a progressive strengthening program.
Your physical therapist can also teach you scar tissue massage / mobilizations to reduce scarring and improve tissue healing.
Jennifer Gunter. (2019). The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine. Citadel Press.