Your body did something extraordinary delivering a baby. Still, it is common to feel unfamiliar in your own skin after childbirth. Pelvic heaviness, pain with intimacy, urinary leaks, or a sense of looseness can be unsettling. You are not alone, and you do not have to “wait it out.” At Boston Urogyn, we take a function-focused, medically supervised approach to postpartum intimate wellness so you can feel comfortable, confident, and connected to your body again. New moms often feel guilty prioritizing themselves but your care is important to recovering function to enjoying motherhoodMany symptoms improve naturally over time, but persistent discomfort or disruption to daily life deserves attention. The sooner you get a clear diagnosis and a tailored plan, the sooner you can move forward. Our team, led by urogynecologists Neeraj Kohli, MD, MBA, and Monica L. Richardson, MD, MPH, guides you step by step with compassionate care.
Common postpartum changes, explained in plain language
- Vaginal laxity: A feeling of looseness or loss of friction during sex, often from stretching of the vaginal tissues and pelvic floor muscles in pregnancy and birth. Laxity can coexist with mild urinary leaks or reduced sensation.
- Pelvic organ prolapse: When pelvic organs like the bladder, uterus, or rectum descend and bulge into the vagina. Prolapse may cause pressure, a vaginal bulge, difficulty emptying the bladder or bowels, or discomfort after standing. Unlike laxity alone, prolapse involves organ support changes rather than just tissue tone.
- Pelvic pain: It is common to experience discomfort in the pelvic region or “dyspareunia” (pain during intimacy) following delivery. This often stems from a combination of healing scar tissue from a tear or episiotomy, vaginal dryness related to breastfeeding hormones, or pelvic floor muscles that have become overly tight or “hypertonic” in response to the stress of labor. Rather than just waiting for it to go away, addressing these changes early through specialized care can prevent long-term discomfort and help you return to your normal quality of life.
Pelvic floor dysfunction can also show up as overactive bladder (urgent, frequent urination), stress incontinence (leaks with cough or exercise), constipation, or fecal incontinence. These are medical issues with solutions, not personal failings.
Your Boston Urogyn care pathway
We built a clear, private, and supportive pathway so you know what to expect and when to expect change.
1) Presentation and screening
Your first visit is a confidential, judgment-free conversation. We review your birth history, current symptoms, sexual function and comfort, bladder and bowel patterns, medications, and goals. You can share as much or as little as you are ready to discuss, including concerns like scar tenderness or fear of intimacy.
2) Diagnostic evaluation
You receive a targeted pelvic exam focused on comfort and clarity. We assess pelvic floor muscle tone, tenderness, and coordination and screen for prolapse. When helpful, we include a brief vaginal health evaluation, such as pH or signs of atrophy. Imaging or advanced testing is ordered only when indicated.
3) Conservative management
We start with the most effective, least invasive options:
- Specialized pelvic floor physical therapy with a postpartum focus, plus home exercises and biofeedback when appropriate. BostonUrogyn has a network of pelvic floor physical therapists specializing in postpartum care throughout New England.
- Lubricants and vaginal moisturizers; vaginal estrogen when clinically appropriate
- Behavioral strategies for bladder and bowel health, including hydration guidance, bladder retraining, and irritant identification Many women begin noticing steady improvement within weeks to months. Timelines vary by condition and healing pace.
4) Energy-based, regenerative, and device options when needed
If symptoms persist, we may layer in targeted therapies:
- EnFemme 360 for tissue support and collagen remodeling to address laxity and mild leaks
- MonaLisa Touch for dryness and vaginal atrophy, including postpartum and lactation-related changes when appropriate
- SoLá Pelvic Therapy for pelvic pain and muscle tenderness, described to promote healing and relaxation with brief, in-office sessions
- EMSELLA chair for high-intensity pelvic floor strengthening to reduce urinary incontinence These are office-based, walk-in/walk-out options with no incisions and minimal to no downtime. Candidacy and timing are individualized, particularly in the immediate postpartum and breastfeeding period.
Boston Urogyn offers these and additional treatments; learn more about our procedure options and scheduling at https://bostonurogyn.com/procedures/.
5) Surgical options when indicated
Surgery is reserved for situations like significant prolapse or stress urinary incontinence not responsive to conservative care. When surgery is appropriate, we discuss minimally invasive options, expected recovery, and realistic outcomes without pressure.
What improvement can you expect and when?
- Many patients experience meaningful progress over weeks to months with conservative care.
- Energy-based therapies and EMSELLA often fit into busy schedules and may accelerate gains.
- Every recovery is unique. We tailor timelines and follow-up to you, with privacy, quick access, and virtual visits available when appropriate.
Safety, candidacy, and privacy
We take safety seriously. All recommendations are medically supervised. It is important to address the unique needs of postpartum moms. We consider breastfeeding status, perineal healing, scar sensitivity, and your comfort level. Conversations about sexual function and intimacy stay confidential. If insurance coverage influences your choices, our team can help you understand benefits and out-of-pocket estimates.
When to seek care sooner
If you have severe pelvic pain, fever, heavy bleeding, inability to pass urine or stool, a new vaginal bulge that worsens quickly, or pain that limits daily activity, contact a clinician promptly. Many of these symptoms worsen over time and can be addressed with less treatment and better results with earlier intervention. Urgent symptoms can be evaluated quickly at our offices in Hudson and Wellesley.
How Boston Urogyn supports you
- Locations in Hudson and Wellesley with discreet scheduling and options for virtual follow-up when suitable
- Access to a comprehensive team skilled in postpartum pelvic floor care, minimally invasive surgery, and advanced technologies
- Connected Care remote support for eligible Medicare patients living with chronic pelvic conditions, offering regular check-ins and care coordination
If you are seeking a female pelvic health specialist in Hudson or would like to schedule a urogynecology consultation in Wellesley, our team is ready to help. Explore our programs and request an appointment on our website.
Quick answers to common questions
- 1. I mentioned my leaking/pain to my OB, and they said it’s “normal” after birth. Should I get a second opinion? A: While these issues are common, they should not be considered your “new normal.” Most obstetricians focus on the health of the pregnancy and delivery but may not have specialized training in the long-term restorative care of the pelvic floor. A urogynecologist specializes specifically in this area and can offer targeted solutions that go beyond the standard “wait and see” approach.
- 2. Why should I see a specialist now instead of just waiting for my body to heal on its own? A: Early intervention is key. Many postpartum symptoms, such as pelvic heaviness or stress incontinence, can worsen over time if the underlying structural issues aren’t addressed. By seeking care now, we can often utilize less invasive treatments—like pelvic floor therapy or energy-based technologies—to achieve better, faster results than if we wait years for the condition to progress.
- 3. What exactly is a Urogynecologist, and how are they different from my regular GYN? A: Think of a urogynecologist as a specialist who bridges the gap between urology and gynecology, with a specific focus on the “architecture” of the pelvic floor. While a regular GYN handles general reproductive health, we specialize in restoring the function of your bladder, bowel, and vaginal support systems that may have been stretched or injured during childbirth.
- 4. Is it too late to seek help if my “baby” is already a toddler? A: It is never too late. Whether you are six weeks or six years postpartum, your pelvic health matters. Many women find that symptoms they ignored for years can be significantly improved or even resolved once they receive a specialized evaluation and a custom treatment plan.
- 5. I’m doing my Kegels every day but I’m still leaking. What am I doing wrong? A: You likely aren’t doing anything “wrong,” but Kegels aren’t a one-size-fits-all solution. For some women, the pelvic floor is actually too tight (hypertonic) rather than too weak, and more Kegels can actually make the pain or leaking worse. We use specialized diagnostics to determine exactly what your muscles need—whether it’s strengthening, relaxation, or medical coordination.
- 6. Will I definitely need surgery to fix my pelvic floor issues? A: Not necessarily. Many postpartum issues can be successfully managed with conservative, non-surgical options such as pelvic floor physical therapy, pessaries, or in-office treatments like Votiva. Our goal is always the most effective, least invasive path to getting you back to your active lifestyle.
- 7. Can I still have more children if I receive treatment for pelvic floor dysfunction now? A: Absolutely. In fact, addressing these issues now can often help you have a more comfortable subsequent pregnancy. We tailor our treatment plans based on your family planning goals, ensuring that the care you receive now supports your body’s future needs.
- 8. Is “heaviness” or “bulging” down there just a sign that I’m tired, or is it something more? A: That “heaviness” is often a sign of pelvic organ prolapse—where the pelvic organs aren’t being supported correctly by the vaginal walls. While it’s common to feel this more at the end of a long day, it is a medical condition that can be treated. Ignoring it often leads to increased discomfort as the support continues to weaken.
- 9. I’m afraid to start exercising again because of “accidents.” When is it safe to return to high-impact workouts? A: There is no universal “safe” date. Returning to running or HIIT depends entirely on your internal pelvic support. We provide functional assessments to see how your body handles pressure, helping you return to the gym with confidence instead of worrying about leaks or injury.
- 10. Do I need a referral from my primary doctor or OB to see you? A: In many cases, no. Most women can book directly with a urogynecologist. If you are experiencing symptoms like leaking, persistent pelvic pain, or a feeling of “falling out,” you are a candidate for a specialized evaluation. We often work alongside your existing doctors to ensure your recovery is comprehensive.
Take the next step
If pelvic pain, laxity, dryness, or leaks are limiting your comfort or intimacy, we can help you chart a calm, evidence-based path forward. Request an appointment in Hudson or Wellesley, and we would be happy to see you in a timely fashion. Preventing delays with proper diagnosis and treatment is the key to a healthier and happier postpartum mom
We respect your privacy, your time, and your goals. Let’s rebuild comfort and confidence, one thoughtful step at a time.