We don't talk about it much, or only half-heartedly, between two pregnancy confidences. And yet, perineum re-education concerns the vast majority of women after giving birth. Much more than a medical formality or a series of exercises to be followed, this key post-partum stage is at the crossroads of physical care and reconnection with oneself. Whether manual or assisted by a probe, the right choice is the one that respects your body, your sensations and your rhythm. Because a well-supported perineum also means a more confident femininity.
CONTENTS:
- The perineum after childbirth: what you need to know
- The two main methods of perineal rehabilitation
- How do you know which method is right for you?
- Frequently asked questions about perineal rehabilitation
The perineum after childbirth: what you need to know
Invisible and often misunderstood, the perineum plays a central role. Its muscles support the pelvic organs and ensure continence, while accompanying sexual pleasure... So much so that women have every interest in learning more about it.
What is the purpose of the perineum? A brief anatomical reminder
The perineum, also known as the pelvic floor, is a group of muscles and tissues located between the pubis and the coccyx. It supports the organs of the lower abdomen (bladder, uterus, rectum) and plays a key role in urinary control, pelvic stability and the quality of sexual intercourse. In fact, when toned, the perineum intensifies sensations during intercourse by naturally tightening contact between the two partners. In other words, it's an essential part of everyday life... even if it's often discovered during childbirth.
What can weaken it
During pregnancy, the perineum is put to the test: it carries the weight of the baby, the amniotic fluid, the placenta... right through to childbirth, especially vaginal delivery, which can lead to significant stretching, even micro-tears or loosening. However, during the course of life, other, more discreet factors can contribute to its fragility:
- chronic constipation,
- certain high-impact sports (running, trampolining, etc.),
- regularly carrying heavy loads,
- or prolonged and repeated coughing.
When should you consider perineal rehabilitation?
In France, perineal re-education is systematically offered to new mothers, usually 6 to 8 weeks after childbirth, whether by vaginal delivery or Caesarean section. It is reimbursed at 100% by the French health insurance system, on prescription. However, certain signs or sensations should prompt you to seek medical advice:
- urinary leakage on exertion, when coughing or laughing,
- a feeling of heaviness in the lower abdomen,
- reduced sexual sensation,
- or an impression of muscle relaxation.
💡 Good to know: even without apparent symptoms, you can ask your midwife or a specialist physiotherapist for a check-up.
The two main methods of perineal rehabilitation
Do you recognize yourself in the symptoms listed, or are you expecting a baby and want to know what's next for you? Re-education of the perineum is a progressive process that focuses on both tone and body awareness. Depending on your needs, it is offered in two main forms that can also complement each other: manual or probe-assisted.
Manual rehabilitation
This is the method often proposed as the first line of treatment. Several sessions with a midwife or physiotherapist teach you which muscles to contract and release voluntarily.
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The aim? Get a better feel for your muscles, regain control and restore tone through voice-guided lying or sitting exercises, or through vaginal touch.
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Who's it for? This approach is ideal if you want to move forward gently and listen to your body. It also promotes breathing, posture and overall pelvic floor coordination.
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Plus: no equipment required, sensory learning and autonomous awareness of the body and its sensitivity.
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Limitations: requires more personal involvement, and progress is sometimes slower.
Probe rehabilitation
Here, a perineal probe is inserted into the vagina, connected to a biofeedback device (which captures and displays contractions on a screen) orelectrostimulation. At Perifit, they've even coupled re-education with an interactive video game, to make it fun and easier to stay motivated!
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The aim? See or receive a physical signal to strengthen your perineum, especially if voluntary contractions are difficult. With biofeedback, you visualize your efforts for added motivation. With electrostimulation, contractions are triggered automatically to "wake up" the muscles.
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Who is it for? This method is often proposed to women who have difficulty feeling or initiating a contraction, or who have a very relaxed perineum, for example after several pregnancies.
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Plus: useful in cases of serious muscle weakness and sometimes faster in toning up.
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Limitations: less focused on feeling, and requires equipment that some women may be reluctant to use.
🩷 In addition to the re-education practiced with your doctor, at home you can do series of perineal contractions when you're seated at the table or desk, stretching, hypopressive abdominals (work accentuated by the vacuum of air), enjoy the benefits of certain yoga postures (Supta Baddha Konasana, Balasana or even Setu Bandhasana) or discover Pilates. Don't hesitate to ask your doctor about these alternatives.
Choosing a midwife or physiotherapist: the importance of the right support
Both midwives and physiotherapists can help you recover your perineum, provided they are trained to do so. Do you feel the need for a more comprehensive or emotional follow-up, or are you postpartum? Midwives offer a more maternity-focused framework. If you're looking for technical support or support for other musculoskeletal disorders (low back pain, instability, etc.)? A specialized physiotherapist may be an excellent option.
In all cases, trust your feelings. Good rehabilitation always begins with a relationship of trust.
Getting to know your body to take care of it
Beyond the method chosen,perineal education plays a fundamental role upstream. Understanding how the body works, knowing when and how to contract the right muscles, learning to breathe consciously and to adopt the right postures... All these elements reinforce the effectiveness of re-education and prevent recurrences.
How do you know which method is right for you?
To make the right choice, the advice of a healthcare professional is your best guide, as he or she will be able to assess the health of your perineum as well as your needs, based on your personal history.
But beyond the protocol and the best medical approach for your body, your feelings have a key role to play. Whether you take charge of your rehabilitation or are 100% accompanied, the right method is one that is stress-free and respects your rhythm. Alternating or combining methods is also possible.
Last but not least, as with any medical treatment, the bond of trust between you and your practitioner is central; because this is an intimate area, and because you have already been solicited throughout your pregnancy. You need to feel free to ask questions, express doubts and object to the exercises if they make you feel uncomfortable.
Frequently asked questions about perineal rehabilitation
🩺 Does the probe hurt?
No, the probe is generally well tolerated. It's thin, flexible and gently guided. If discomfort occurs, it can be adjusted or replaced by another method.
🙈 Is rehab uncomfortable?
It's an intimate area, but professionals are trained to accompany you with respect. Also, discomfort often fades after the first few minutes, especially if you feel confident.
🍼 And if I don't breastfeed, does that change anything?
No. Rehabilitation is recommended for all women after childbirth, whether breastfeeding or not. It acts on the muscles, independently of the baby's diet.
👶 Does this only apply to vaginal deliveries?
No. Even after a Caesarean section, the perineum may have been overstressed during pregnancy, so it deserves to be assessed.
💧 Is it really useful if I don't have any leaks?
Yes, the absence of leakage doesn't mean that everything is perfect. Re-education can help prevent future problems and restore overall tone.
🧘 How does a perineum re-education session work?
It lasts around 30 minutes. Depending on the method chosen, it may include manual exercises, guided contractions or the use of a probe. Everything is explained and adapted to your comfort.
🚫 Are there any contraindications?
Perineal rehabilitation is generally gentle and well tolerated. However, in the event of infection, unexplained pelvic pain or a particular neurological condition, it is essential to seek medical advice before starting. The aim is always to provide personalized care, adapted to your overall health.
How about a fresh look at perineal rehabilitation?
Too often experienced as a medical formality or a chore, pelvic floor care can also be seen as a moment of reconnection with oneself. It's an opportunity to re-inhabit the body after pregnancy, with a deep, non-injunctive treatment.
Your body deserves time, attention and respect. So, whatever the method, the most important thing is to be accompanied with kindness.
What's next? Perineal rehabilitation in menopause
Although it is often mentioned after childbirth, perineal rehabilitation can also be suggested later, particularly during the menopause. With the drop in hormones, the perineum can become slack. Targeted sessions can help restore tone and comfort at any age.
