The six-week postpartum visit is a standard medical checkup designed to ensure a smooth recovery after childbirth. This appointment serves as a comprehensive review of physical and emotional healing. Concerns about pain during this visit are common, especially given the recent trauma and intensive healing process the body has undergone. Many people feel anxiety about the possibility of an internal examination. This article aims to provide clarity on what the checkup involves and how to prepare for a more comfortable experience.
What the Postpartum Checkup Includes
The initial portion of the appointment focuses on a general assessment of overall health. The healthcare provider will first check basic measurements, such as blood pressure and weight, to ensure they have returned to a healthy range. A significant part of the visit involves a mental health screening, often using a standardized questionnaire like the Edinburgh Postnatal Depression Scale, to assess for signs of postpartum depression or anxiety.
Physical examinations cover areas impacted by pregnancy and delivery, but are external to the pelvis. If a C-section was performed, the provider will inspect the abdominal incision to confirm proper closure and rule out infection or complications. The breasts are also examined, particularly for those who are breastfeeding, to check for issues like mastitis, clogged ducts, or skin breakdown. The provider will also ask about the cessation of lochia, sleep patterns, and any concerns regarding urinary or bowel function.
Assessing Pain During the Pelvic Examination
The part of the visit that causes the most apprehension is the pelvic examination, performed to assess the internal reproductive organs. During this exam, the provider first uses a gloved hand to inspect the external genitalia and the perineum, checking the integrity and healing of any stitches from an episiotomy or tear. The provider then performs a bimanual exam, placing two fingers inside the vagina while pressing on the abdomen, to check the uterus. This action confirms that the uterus has properly shrunk—a process called involution—to nearly its pre-pregnancy size.
The expected sensation during this internal check is typically pressure or mild discomfort, rather than sharp pain, as the tissues are largely healed by six weeks. However, a speculum may be used to visualize the vaginal walls and cervix, which can introduce higher discomfort for some. If a Pap smear is due, it may be collected, though many providers defer this until three months postpartum. True pain, rather than pressure, may indicate underlying issues such as granulation tissue, infection, or muscle hypertonicity, which the provider can then address.
Individual Factors Affecting Discomfort
The level of sensation experienced during the pelvic exam varies based on individual circumstances surrounding the birth. The status of your hormones plays a large role, especially if you are exclusively breastfeeding. Lactation naturally suppresses estrogen levels, which can lead to vaginal atrophy—a thinning and drying of the vaginal tissues—making internal examination more sensitive.
The type and extent of perineal trauma also influence the exam experience. Patients who had a severe tear, such as a third- or fourth-degree laceration, may have more scar tissue or tenderness requiring a delicate approach. While C-section patients avoid vaginal trauma, they still require a pelvic exam to check uterine involution. They may also experience discomfort due to generalized pelvic floor tension developed during pregnancy. Previous experiences of pain or trauma during medical procedures can increase psychological and physical discomfort during the exam.
Tips for a More Comfortable Appointment
Taking proactive steps can help minimize anxiety and physical discomfort during the examination. It is helpful to communicate any pre-existing anxiety, a history of painful pelvic exams, or specific concerns about tenderness to the provider before the physical assessment begins. You can request a smaller speculum be used for the internal portion of the exam, as different sizes are available. You can also ask the provider to talk you through each step of the process before they do it, which helps maintain a sense of control.
Practicing controlled, slow deep breathing can help relax the pelvic floor muscles, which often tense up in anticipation of pain. If you feel sharp pain, immediately inform your provider so they can pause, adjust their technique, or stop the examination entirely. If vaginal dryness is a concern, you can inquire about the use of extra lubricant or a prescription for a localized estrogen cream, which may be safe even while breastfeeding.