When women with PVD become pregnant, they are understandably worried about the impact the new condition will have on their genital pain. Their worst fears are that they will not be able to give birth naturally, and that anatomical changes brought about by labor will worsen their symptoms forever. Based on the clinical experience of Ob-Gyn professionals who have an interest in the management of genital pain, there are no changes in the intensity or occurrence of PVD-related pain during pregnancy, nor changes in the characteristics of pain afterwards. Clinical data on this matter is sparse, however one author reports that 30% of women report improvement against 40% who report no change during and after pregnancy. Certainly, genital pain does not interfere with or prevent natural childbirth. It is also worth remembering that most medications used to treat PVD are not considered risky during pregnancy, and there is no need to interrupt a treatment that’s already working.

On the other hand, women with PVD who become pregnant, like every other pregnant woman, have to deal with changes in their bodies that can trigger genital pain. For instance, as the baby grows, the weight forces the lower spine into an unnatural position to compensate. The growing fetus will also put additional pressure on the muscles of the pelvic floor.

In both cases, back pain and pelvic pressure may not necessarily trigger PVD, but may have a negative effect by adding overall discomfort and pain. It is important for patients to learn about safe painkillers or other forms of relief such as physical therapy or yoga, which can be of great help.  

During pregnancy, it is common to develop varicose veins on the legs, and by the third trimester these may appear on the external genitalia. They are not harmful and usually resolve spontaneously after childbirth, but they do provoke swelling, a sense of heaviness and fatigue while walking. To ease the discomfort of varicose veins, patients should wear support stockings, underwear, or belts that are specially designed to help pregnant mothers, and should also learn techniques such as resting with the legs elevated, taking long, easy walks and remaining within weight-gain limits. 

Labor and delivery must be handled according to the advice of the attending obstetrician. About one month after giving birth, which is the time genitals need to go back to their pre-pregnancy state, women with painful sexual intercourse should resume the Kegel exercises to strengthen the muscles, provide adequate support to the uterus and avoid spasms.

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