Every time I see a woman walking down the street with a newborn, all I can think is, “Does she have a traumatized vagina?”

My vagina tore when I had my first child. Doctors I’d never met before sewed me up and refused to tell me how many stitches they’d put in. I healed, and when I had another child five years later, I tore in the same place.



My midwives sewed me up and told me everything looked fine, but I noticed certain changes: it was next to impossible to hold in flatulence. Constipation became a painful and humiliating constant. I leaked urine when I sneezed no matter how many kegels I did. And it felt like the physical angle of everything having to do with evacuation and intercourse had somehow shifted after childbirth in new and uncomfortable ways. I felt like my vag was broken. That something was wrong.

Five years later, I started seeing a new gynecologist, who listened, examined me, and said, “Oh, yep, you’ve got a little rectocele in there.”

A what?

She told me that a rectocele occurs when the muscle between the rectum and vagina is so worn and thin that the rectum kind of pops out into the vagina.

I felt angry. Why hadn’t a single health professional, many of whom had examined me thoroughly, bothered to diagnose it? “Well, it’s within the range of normal, so we usually don’t mention it.”

I went home and searched for more information. The National Institutes of Health says, “Rectoceles are common and involve a herniation of the rectum into the posterior vaginal wall that results in a vaginal bulge. Women with rectoceles generally complain of perineal and vaginal pressure, obstructive defecation, constipation, or the need to splint or digitally reduce the vagina to effectuate a bowel movement.”

Splinting? Digital reduction? These are the medical terms for what I knew through anecdotal evidence was common practice: one friend must insert a finger into her vagina to release the stool from her rectum every time she defecates. Another said she always pressed into her perineum when relieving herself. Another friend, with a rectocele and a cystocele, splints and takes vast quantities of psyllium seed husk to stay regular.

Me? Once, I was doubled over in pain, so dehydrated and constipated that I took the plastic gloves out of a box of Nice’N’Easy haircolor because, well, it wasn’t. After I had dug out the feces that had become trapped in the small pocket of my rectum that protruded into my vagina, I was shocked, silent, humiliated.

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Even with my excellent health insurance, after giving birth the only medical attention I received was a quick six-week checkup. After learning about my rectocele, I went to see a pelvic floor specialist. She told me that because my rectocele was small and the risks were high, I was not a candidate for surgery.

She explained pelvic floor exercises, recommended I eat a lot of fiber and suggested “double evacuation” when urinating. Pee, then stand up and move from side to side, then urinate again so the bladder is completely emptied.

In France, where the republic wants to increase the population and the culture values sexuality, women may take vaginal rejuvenation classes or “rééducation périnéal”: 10 to 20 sessions of pelvic floor physiotherapy, paid for by the government. Here in the US, I learned about my condition 10 years after I first had symptoms.

A few weeks later, I was at my kids’ public school fundraiser, drinking and rage-telling the story of discovering the word rectocele. A woman I barely knew joined us, whisper-crying, “Stage four tearing. I’ll never be the same.” Women are suffering in silence, hurt and embarrassed. Shamed again.

The New York Times has devoted an admirable amount of editorial space to the women in Africa who suffer from fistulas, their dignity and daily routines compromised by bodies that leak urine or feces because of childbirth or assault.

What no one is talking about – not medical professionals, not educators, not mothers, not their partners – are the various states of post-partum prolapse that plague women after childbirth, causing a similar loss of control and dignity to that faced by fistula sufferers. The emotional and sexual ramifications of my situation included secrecy, shame and isolation.

We need to make the words rectocele and cystocele and urethrocele and enterocele, each a type of pelvic organ prolapse resulting most often from childbirth and ageing, part of the common vernacular of women’s health. The words are utterly absent, even to those of us who seek to learn more about these conditions and educate others.

According to the Mayo Clinic, prolapse means “to slip or fall out of place”. A rectocele is when the rectum bulges into the vagina. A cystocele is when the bladder bulges into the vagina. A urethrocele is when the urethra bulges into the vagina. An enterocele is when the small intestine bulges into the vagina. So basically, they are vag bulges.

The American Society for Colon and Rectal Surgeries estimates that 40% of women have a rectocele, yet most people don’t know the word. This needs to change. Harvard says that anywhere from 80% to 20% of women might have small rectoceles. Meanwhile, pharmaceutical companies spend and make millions of dollars to keep dicks in the air.

The medical industry is pushing vaginoplasty, labiaplasty, and Viagra for women, to keep women “young” and “tight” and looking like porn actors. I know our culture doesn’t make much room for older women, let alone our vaginas, but shouldn’t we be spending some of this time and money to care for the post-maternal vagina?

And I don’t mean surgery with the vaginal mesh that was recently banned in New Zealand. We need sexual education and respect for mother’s vaginas – vaginas that have been through a lot. We need to be talking about prolapse and non-surgical treatments like diet, hydration, biofeedback, electrical stimulation, and core strengthening exercises.

To be sure, some vaginas take a licking and keep on ticking. I have many friends who didn’t tear, who gave birth and kegeled their way to safe and healthy sexual lives.

My vagina has changed a lot in my 46 years. I loved exploring it for pleasure as a child. Then my vagina was injured when I was raped at 15 and didn’t tell. Later I had a lot of great sex and a lot of mediocre sex. I birthed two children through this space, a space that still holds potential for experience and love.

There is no equality without reproductive rights, there are no reproductive rights without knowledge of the female body, and there is no knowledge of the female body without acknowledgment of the post-maternal vagina. The lack of education and attention to my – and thousands of mothers’ – pelvic injuries is another sign of our country’s indifference to women’s rights and health.

We are, as a nation, in fits and starts, beginning to do better for women’s lives. I am thrilled, for example, to see longstanding silences broken. I am happy to see menstrual equity with states moving toward tax exemption for tampons and other feminine hygiene products.

So, how about we ask the medical and pharmaceutical communities to do better by mothers’ bodies – by acknowledging and treating the physical injuries caused by giving birth. By acknowledging our bodies as they are. By talking about maternal sexuality. By granting us language and autonomy. We can start conversations and healing.

And, how about we ask the mothers in our lives how their vaginas are doing? Hopefully, with the proper education, their answers won’t surprise us.