There are a lot of insecurities that going through four pregnancies has created about my body.
I'm pretty sure most of the hair on my head has fallen out and been replaced by stray chin hairs, my chest rivals the pancakes I sometimes (rarely) make in the morning for my kids and, probably most embarrassing of all, I'm afraid to even assess the damage in my nether regions.
After this pregnancy in particular I feel like something is, well, amiss down there. I swear that my perineum — you know, that space of skin between your vagina and anus that gets stretched beyond recognition during birth? — is a whole lot shorter than it used to be. Which got me wondering: Am I normal? Am I in danger of developing a fistula? Am I freak of nature forever?
One study measured the perinea of 284 women heading in to give birth and concluded that the average perineum length was right around 3.90 centimeters, give or take .70 centimeters. Translated, that equals approximately 1-1/2 inches. Which, when you think about it, is pretty small. Good news for me, I guess, but bad news for any fellow women with shorter perinea, because apparently, the shorter it is going in to give birth, the more likely it is to tear or have other complications with labor and popping that baby out. Perineal length also differs among ethnicities, so there really is no one-size-fits-all when it comes to perinea.
"They all come in different lengths!" says Mary Rosser, M.D., Ph.D., Ob/Gyn at Montefiore Medical Center. But she explains that the perineum also encompasses deeper structures you don't see beneath the skin, which contain different muscles that may enlarge during pregnancy.
And then of course, there is the labor itself. "The perineum stretches and becomes more thin as the head descends the birth canal and crowns," explains Dr. Rosser. And apparently, I'm not crazy, as she says that the perineum can shorten following childbirth. "It depends on the type of laceration and the healing process," she explains.
The healing process for your poor perineum is no joke after childbirth either. "Soreness is normal," says Dr. Rosser. She advises to pile on those ice packs within the first 24 hours after birth to reduce swelling and pain and notes that any stitches will be completely dissolved by 6-8 weeks.
Bottom line? (No pun intended. Or maybe it is.) Childbirth stretches, tears, rips and forever changes our bodies, especially in the delicate area of our perineum — but most of the time, those changes are normal, and unless they are interfering with your daily activities, probably nothing to worry about.
Basically, unless you experience pain in your perineum after six months postpartum, or with sex or bowel movements, you're probably fine. And if you've had an episiotomy, if the site becomes more painful or tender or is not improving gradually, or is red, draining pus or bleeding, Dr. Rosser says it's time to get a checkup as well. As with anything though, don't be embarrassed to check with your healthcare provider if you have any doubts about what's going on with your perineum — concerns about what's normal "down there" are definitely common among us mothers, so don't be embarrassed.
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