Hardening at the vaginal entrance - is natural birth still possible?

Question from Jana B: Thank you so much for your quick, informative and encouraging response to my questions! Your answers have really strengthened my motivation to address the pain I feel at the entrance to my vagina. The description that this may not be a hardening but rather a muscular tension actually matches my own sense of it. When I explore the area with my finger, I can feel what seems like a ring of tissue or skin – it’s soft, but it gets “pulled along” when something is inserted or removed, and that causes pain, both during penetration and when I try to massage it.
I’m 31 years old and my partner and I are starting to feel a growing desire to have a child. I really hope that with consistent exercises over the next year or two, we’ll be able to make this dream come true – maybe even with a natural birth. From your perspective as a midwife, do you think that’s a realistic goal?
One more question: someone once suggested I use an oestrogen creamtogether with vaginal dilators to support the exercises – to help soften the tissue a bit and to stimulate my body’s natural vaginal lubrication. Would you recommend that too? I’ve been hesitant to try it, since I wanted to see how far I could get without adding any hormones – but I haven’t made much progress so far.

Answer: 

Becoming pregnant – and giving birth naturally, meaning vaginally – absolutely seems realistic to me! Especially because both your tissue and your body awareness will change significantly under the hormonal conditions of pregnancy.
As for the oestrogen cream: that’s a difficult one to answer. To be honest, you do seem a bit young for that kind of treatment. These creams are not highly dosed, but still, the hormonal system as a whole is an extremely delicate and sensitive structure – any kind of intervention needs to be considered carefully. Before doing anything, I would strongly recommend checking your hormone levels. For that, you’d most likely need to see a naturopath. Most gynaecologists either don’t do hormone testing at all, or they only use blood samples – but in my experience, saliva testing is much more meaningful.
There are also bioidentical hormone preparations and homeopathically potentised options. You can find more information here:
https://hormonselbsthilfe.de/ and https://www.marktapotheke-greiff.de/.
Similar options in the UK include:

• Marion Gluck Clinic (London): Specialises in bioidentical hormone therapy, including saliva testing and personalised treatment. https://www.mariongluckclinic.com/
  
• The Natural Hormone Clinic: Offers hormone balancing using bioidentical hormones and functional diagnostics. https://www.naturalhormoneclinic.com/home 
  
• Women’s Hormone Health UK (Ruth Hull): Focuses on holistic hormone support with nutrition, herbs and functional medicine. https://www.ruthhull.com/about/  
  

Believe in yourself and in your dream – and don’t only listen to conventional medicine. It tends to focus on a narrow segment and often promotes standardised, fast (and more profitable!) "solutions" like caesarean section. Don’t let that unsettle you.