Loose Vagina: Causes, symptoms and how to fix it

The number one cause of a wide vagina is a vaginal birth. This is when the baby travels through the cervix and out through the vagina, which must stretch in order to allow the baby through.

Many women manage to tone their vaginal muscles by doing regular pelvic floor exercises, but this part of the body often doesn’t return to its pre-birth state by doing Kegel exercises alone. A loose vagina caused by childbirth can also lead to urinary incontinence. This may or may not be temporary.

If you have more than one child, this means that your vaginal muscles may have lost even more elasticity than if you had given birth just once.

Age is another major factor in whether a woman has a loose vagina. As we age, our muscle tone and skin elasticity naturally weaken in all parts of the body, including the vagina.

This age-related change in vaginal elasticity begins when a woman hits her 40s. This coincides with when oestrogen levels begin to drop in perimenopause. A loose vagina is a classic symptom of vaginal atrophy, a condition which often occurs later in life. In vaginal atrophy, the lining of the vagina gets drier, thinner and less stretchy, causing itching, burning, pain during sex, urinary tract infections and frequent urination. Lower oestrogen levels also lowers the amount of normal vaginal fluids and changes the acid balance of the vagina. Vaginal atrophy is more common among women who have been through menopause.

This problem of a loose vagina can be made worse if you have previously given birth and are experiencing falling oestrogen levels associated with menopause.

As women age, oestrogen levels decrease, which naturally has an effect on a woman’s vagina. Low oestrogen levels cause the vaginal tissue to become drier and thinner, eventually causing it to lose its elasticity, making it feel looser. It is very common, with around 50 percent of women reporting noticeable laxity of the vagina after menopause, due to falling oestrogen levels. Although menopause is a common cause of low oestrogen levels, other health issues or certain medications may also be to blame. Medications that contain anti-oestrogen properties include tamoxifen, which is used to treat and prevent breast cancer,  medroxyprogesterone, which is used to treat abnormal uterine bleeding and unusual stopping of menstrual periods, and nafarelin which treats the symptoms of endometriosis.

Women also experience a drop in oestrogen levels after giving birth. This is because the placenta produces oestrogen during pregnancy and this is lost once the baby is born. This is compounded by the presence of milk-producing hormone prolactin, which temporarily blocks oestrogen production while the new mother is breastfeeding her baby.

And if you needed another reason to quit smoking, nicotine reduces oestrogen levels and has been shown to cause the early onset of menopause.

Certain gynaecological cancers, pelvic surgery, injury and other medical conditions may be responsible for a loose vagina. Chemotherapy or radiation therapy for cancer can cause decreased ovarian functioning, which may impact on vaginal laxity. Oophorectomy (surgery to remove the ovaries) can also make the vagina more lax.

Genetic disorders that involve collagen metabolism can also contribute to a loose vagina. These include osteogenesis imperfecta, Ehlers-Danlos syndrome, and Marfan syndrome, which are all disorders of the connective tissues.

Ligament laxity, which can cause a loose vagina, can occur after a sudden injury to the lower back, injury to the pelvic floor or after childbirth.

The vagina is largely protected from trauma due to the protective function of the mons pubis and labia majora, but it can still be subject to trauma, including sex abuse.

A common complaint following childbirth is reduced sensation in the vagina during sex. This can lead to reduced sexual pleasure and feelings of frustration and anxiety. This problem can be made worse if a woman has sustained injuries in the area during childbirth, particularly if they have not healed well. This may also lead to painful sexual intercourse. 

When pelvic floor muscles are stretched during childbirth or due to aging, this can cause urinary incontinence, as well as making some women feel a constant urge to go to the toilet. This can vary in severity and can prove debilitating. Although mild cases of incontinence may resolve with pelvic floor exercises, severe cases are likely to need surgical intervention.

One real risk of loose vagina muscles is the possibility of pelvic organ prolapse occurring. Pelvic organ prolapse happens when one or more of the organs in the pelvis, namely the uterus, bowel, bladder or the top of the vagina, slip downwards and out of their normal position leaving them bulging into the vagina. Pelvic organ prolapse is scaled from 1 to 4, depending on its severity. A grade 4 prolapse is considered to be the most severe. The more severe the prolapse, the more likely surgery will be required. 

Pelvic organ prolapse can cause discomfort, pain and seriously impact a woman’s quality of life. However, it is not life-threatening.

A good place to start when it comes to tightening up a loose or wide vagina is pelvic floor exercises. If there is only a small amount of muscle laxity, then a few exercises may prove effective. To exercise your pelvic floor, you should squeeze and draw in your anus at the same time while simultaneously closing and drawing your vagina upwards. You should do this quickly several times before slowing down and holding the contractions for as long as you can, up to 10 seconds, before relaxing. For the best results, you should repeat each exercise 10 times, between four and six times a day. These exercises can be done standing up or sitting down. It can take time for pelvic floor exercises to work.

You may also wish to try pelvic tilts. These exercises are very easy, all you have to do is stand with your shoulders and bottom against a wall, making sure that you keep your knees soft. You’ll then proceed to pull your belly button inwards so that your back is flat against the wall. Tighten the stomach for four seconds before releasing the hold.

Sometimes pelvic floor exercises are not enough to restore the vagina to its previous state, particularly if a woman has sustained a severe pelvic organ prolapse. This is when vaginal tightening surgery, also known as vaginoplasty, comes highly recommended. This treatment tightens the vaginal muscles, perineum and surrounding tissue providing more tone, strength and control to the vaginal muscles, enhancing your sensitivity and sexual experience.

The surgeon will use dissolvable stitches to join together the stretched muscle at the back of the vagina, shortening the muscle. The excess vaginal lining will then be removed, tightening the surrounding soft tissue. 

If your vaginal muscles and perineum were damaged in childbirth, particularly if you had an episiotomy, you may wish to consider perineum and pelvic floor repair surgery.  This treatment acts to restore both the cosmetic appearance of the perineum as well as the muscle tone deep in the pelvic floor and vaginal muscles.

Alternatively, you may wish to consider vaginal rejuvenation, a bespoke combination of surgeries designed to repair and enhance the intimate area. This can include vaginoplasty, perineum and pelvic floor repair surgery and labiaplasty, a largely cosmetic surgery that is concerned with reducing the size of the labia. This combination of treatments can be tailored to meet the needs of each individual patient.

Here at the Cadogan Clinic we also offer our highly-popular Mummy Makeover surgery, which aims to restore a woman’s body to its pre-childbirth state, including the vagina. A Mummy Makeover is a bespoke combination of surgeries involving the breast, abdomen, waist, hips and thighs designed to restore the body to its original contours and appearance prior to childbearing.

The procedures typically involved are breast augmentation and breast lift, a tummy tuck and liposuction, which can be combined into a single procedure. However, it is common for women to undergo surgery on their vagina and labia as part of this particular treatment. 

You may have heard of the term designer vagina. This is just a catch-all term for cosmetic surgery carried out on the vagina and vulva and is not a procedure in its own right.