Vaginal Issues During Pregnancy
You try to take the physical changes of pregnancy in stride – but even the most intrepid moms-to-be get anxious about what's happening south of the border. Most likely, though, these intimate adjustments are absolutely normal. "Pregnancy is meant to be a healthy time for your body," says Elizabeth G. Stewart, MD, coauthor of The V Book (Bantam). "You can expect a lot of little changes that are sometimes annoying, like skin tags, increased secretions, and itchiness. But they're not something to worry about." Calmer now? Here's the lowdown on what to expect down low.
First Trimester Vaginal Issues
Early in your pregnancy, everything from your body's blood volume to concentrations of hormones like estrogen is on the upswing, leading to some of the first subtle effects on your vaginal health.
Increased Vaginal Discharge
Soon after you get pregnant, your body begins pumping out extra estrogen and progesterone, which trigger a heavier flow of vaginal secretions. Celeste Brophy, of Ottawa, Ontario, a mother of two, says that her pregnancy discharge was so abundant, "I actually had to change my underpants a couple of times on some days." Don't want to tote around extra undies? Wear a mini-pad to catch the flow.
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During pregnancy, your body's blood volume rises by about 50 percent, with much of that fluid routed to your uterus to nurture your growing fetus. As a result, vaginal tissue becomes engorged with blood, leaving some women feeling a bit swollen and tender.
In happier news, the engorgement of your vagina and labia during pregnancy mimics what happens when you get aroused during sex, so you could end up feeling a tad turned on all the time. It's not a bad situation for your partner, either, says Robin Elise Weiss, author of The Joy of Pregnant Sex (Fair Winds Press). As the tissue in your vaginal walls fills with blood, your husband will get more stimulation during intercourse.
Though estrogen may thicken the mane on your head, different hormones dictate the growth of your pubic hair – so it won't grow thicker. And you may not get the same results from waxing, shaving, or using depilatory creams. One reason is that you're more susceptible to ingrown hairs, which occur when sebaceous glands get clogged with sweat and dead skin cells, two things you're producing more of thanks to progesterone and your body's accelerated metabolism. Increased blood flow could also make your Brazilian wax more screamingly painful than normal, making pregnancy a nice time to go au naturel.
With more blood flowing around your cervix, your vulva may turn a darker, bluish hue. This hyperpigmentation, sometimes called Chadwick's Sign, is an early sign of pregnancy and has also been attributed to the same whirl of hormones – estrogen, progesterone, and a hormone that stimulates pigment-producing cells – that give some moms-to-be a linea nigra (a dark line down the abdomen). Either way, it's harmless, and your regular coloring should return to normal after pregnancy.
Doctors aren't quite sure why up to 30 percent of women experience harmless vaginal bleeding during the first trimester, but increased blood supply to the cervix is one culprit. For some women, a Pap smear or intercourse can trigger some spotting. "We use a small brush and swab to take vaginal cultures at the first prenatal visit, and I see blood about 25 percent of the time," says Terry Hoffman, MD, the head of an all-female Ob-Gyn group at Mercy Hospital, in Baltimore. First-trimester bleeding is often innocuous; still, call your Ob-Gyn ASAP, if only to be reassured that everything's okay.
Second Trimester Vaginal Issues
In the second trimester, pregnancy hormones, along with pressure from your growing bump, can cause south-of-the-border irritations. Meanwhile, libido levels are all over the map (but you could get lucky with one that's high).
More Intense Orgasms
After the morning sickness and pure exhaustion taper off, lovemaking sometimes regains its appeal. "Sex during pregnancy is very enjoyable for me, even more than normal," says Jennifer Rifkin, the mother of a 4-month-old, from Van Wert, Ohio. "The added lubrication and blood flow to the area make everything feel a bit more intense." Because you have more discharge, you can keep foreplay short and sweet. Some women even orgasm for the first time or suddenly become multiorgasmic. (Talk about a pregnancy benefit.)
Then again, not everyone wants to fool around. "In terms of libido, it's a mixed bag," says Carol Livoti, MD, a New York City-based gynecologist and coauthor of Vaginas: An Owner's Manual (Thunder's Mouth). "Some women are never as turned on as they are when they're pregnant. And some women are just the opposite." When you have complications like placenta previa, an incompetent cervix, or a history of premature labor, your doctor may put you on pelvic rest, eliminating any choice you have in the matter. If lovemaking isn't in your future (for whatever reason), consider other ways to connect with your partner, such as offering a back rub or leaving a love note.
Just 17 weeks pregnant with her second child, Kate Sanchez, of Everett, Washington, has already logged two yeast infections, which she treated with an over-the-counter clotrimazole cream. Her other yeast-fighting tricks: "After I shower, I don't put on panties right away so I can let things air out." Though it's not quite clear why moms-to-be rack up more yeast infections in this trimester, some doctors blame pregnancy hormones for altering vaginal pH and allowing yeast to grow. Luckily, you can treat yourself with a topical medication like Monistat. Just talk with your gynecologist first.
Even without an infection, you may itch more, since increased secretions and weight gain leave you wet, uncomfortable, and more likely to chafe. To soothe the problem, stick to loose cotton panties, and opt for a treatment that's less messy than a cream.
Brophy noticed that a skin tag cropped up on her labia during her first pregnancy had vanished by the second. The disappearing act is actually common for most genital skin tags, which develop in response to hormones that accelerate skin cell growth during pregnancy but are often easily sloughed off afterward. Skin tags aren't dangerous at all, but if you are bothered by some of yours, ask your OB to snip them off with surgical scissors after your delivery, while you're still numb from your epidural.
As your baby grows, pressure from your uterus slows blood flow in your lower body, with the potential to distend veins anywhere below the waist, including your groin. Like varicose veins on your legs, varicosities in your vulva can cause pressure and throbbing. But you're not likely to experience them until you're on your fourth pregnancy, and they go away after birth.
Third Trimester Vaginal Issues
Toward the end of your pregnancy, your body begins to prepare itself for labor and delivery. However, you still have a few last-minute irritations before the big day.
Ever get that not-so-fresh feeling? If hormonal changes give your discharge a less-than-great odor, clean yourself a few times a day with soap and water – just don't douche. "You're washing away healthy bacteria – the protective lubricating layer on the surface of the vaginal wall, which can throw your vagina into an imbalance," Dr. Livoti says. If that happens, you may develop bacterial vaginosis, a vaginal inflammation linked to premature labor.
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A swollen, damp vulva is the perfect setup for a breakout of vaginal acne. Treat vaginal acne the way you would treat pimples anywhere else: by washing with plain soap and water and using witch hazel or a salicylic acid-based topical acne cream to clear things up. If zits don't budge, consult your doctor.
Group B Strep
Don't expect any outward signs of group B strep, a bacteria that lives in the intestines and vagina of 30 to 40 percent of American women. It's not an STD, and it's harmless while you're pregnant, Dr. Stewart says. But it can cause serious illness in your baby – including pneumonia or meningitis – if you deliver vaginally. When you're between 35 and 37 weeks along, your Ob-Gyn will take rectal and vaginal cultures to check you for the bacteria. If you test positive, you'll likely be given antibiotics during labor, which prevent group B strep-related diseases in babies 99.9 percent of the time.
Most Ob-Gyns agree that sex isn't a reliable way to kick-start labor, but if your body's ready, it might help push you over the edge. That's what happened for Michelle Henry, of Overland Park, Kansas. "We had sex hours before I lost my mucous plug [a mass that blocks the cervix during pregnancy], and contractions started shortly after," she says.
At the end of your pregnancy, having an orgasm can also set off a wave of mini-contractions. They're not harmful to the baby and don't necessarily signify that you're in labor, but if you're uncomfortable, have your partner wear a condom; his semen contains prostaglandins, spasm-causing compounds that intensify contractions when they come in contact with your stretched-out uterine muscles.
"Prostaglandins cause stronger cramps later because there are more receptors in your uterine muscle cells for them to bind to," Dr. Hoffman explains. So the closer you are to your due date, the more painful the cramping will be.
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When Your Water Breaks
If your water breaks, forgo sex. The penis can introduce bacteria to the cervix and up your chance of infection. "I encourage my pregnant patients, as long as they don't have ruptured membranes, to have a lot of sex," says Lee Shulman, MD, a professor of obstetrics and gynecology at Northwestern Memorial Hospital, in Chicago. "I don't know if it works, but everyone's always very happy."
Vaginal Exams During Pregnancy
You see your doctor for regular prenatal visits, but even if everything is going well, you'll still have to submit to a limited number of vaginal exams and cultures. What to expect:
At 6 to 8 weeks: A complete gynecological exam and Pap smear to make sure all is normal. Your Ob-Gyn will also take a vaginal culture to find out if you're STD-free.
At 35 to 37 weeks: A group B strep culture.
At 36 weeks: A vaginal exam to see how your cervix is softening and dilating.
At 40 weeks: A vaginal exam to strip your membranes. That's a cervical exam where your doctor will insert her finger into the cervix and try to slightly separate the membranes from the uterine lining; if it works, it'll release the prostaglandins that bring on labor.
When to Go to the Doctor
Most of what happens when you're expecting is totally normal. But these five signs signify that it's time to get checked out ASAP:
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