Six weeks after the birth of her second child, Sarah,* an American writer who had recently relocated to Paris, went to her obstetrician for a standard postpartum checkup, just as she'd done after the birth of her first child in the United States. This time, however, the vaginal exam included an assessment of her pelvic-floor muscles, which, her French doctor announced, hadn't recovered the necessary fortitude. Sarah left with a prescription for 10 visits to a physical therapist for rééducation périnéale, a program available to all postpartum women in France that's designed to help them retrain their pelvic-floor muscles (primarily the one known as the levator ani, which is located between the legs, near the vagina). "I was relieved," Sarah says, "because after an alarming week when I couldn't control my bladder—there was the moment I stood shaking hands with the hospital president as urine dribbled down—I still had the laugh-cough leaking."

At Sarah's first session, the physical therapist inserted something that looked like a metal dildo and instructed her to squeeze as hard as she could. Initially, she could barely budge the needle on the attached gauge, but after a month of weekly visits and intermittent "workouts" at home, Sarah had it hovering at the far end of the dial—and she no longer had to cross her legs every time someone cracked a joke. The better she felt, though, the madder she got. Why, she wondered, are American women essentially left to deal with this dilemma on their own, aside from the perfunctory reminder to "do your Kegels"?

In the future, they probably won't be, predicts John DeLancey, an ob-gyn who directs pelvic-floor research at the University of Michigan. "At some point, prenatal instruction will include simple Kegel training," he says. "Because there's no question that women get back to normal faster if they exercise [those muscles]. That's just the straight, honest truth."

But that's the foreseeable future. Right now, women with pelvic disorders still confront a social stigma. "Pelvic disorder just isn't the type of thing anyone brings up in polite conversation," says DeLancey. "Attitudes toward both urinary incontinence and erectile dysfunction have really been influenced by advertising from pharmaceutical companies, but those toward other pelvic-floor disorders haven't. So I think a woman would feel more comfortable joking about a little incontinence than about the fact that her uterus has fallen out."

For a problem fraught with such issues, pelvic disorders sure are common: A 10-year study of 229 mothers who delivered vaginally, conducted by Stockholm's Karolinska Institutet, found that about one in two experienced incontinence. A more potentially debilitating disorder is pelvic organ prolapse, in which the bladder, uterus, rectum, or bowel sags into the vagina, sometimes even herniating between the legs. According to DeLancey, there are 300,000 operations a year in the U.S. for prolapse. "That's about one in 10 women," he says. "There are actually 2.5 times more operations done for prolapse than for incontinence, yet people don't talk about it as much."

While pregnancy and childbirth top the list of risk factors for pelvic-floor disorder, American mothers are generally neither prepared for it nor offered viable treatment options for symptoms. And for new moms especially, even mild cases that clear up on their own can produce lingering anxieties about incontinence or being "too loose," making a process that's already difficult—getting one's sex life back on track—that much harder.

Fairly typical are experiences like Cindy's: At the six-week checkup after the birth of her first child, she complained of leaking urine and an uncontrollable urge to go, but her ob-gyn dismissed her concerns. When symptoms persisted, Cindy sought the help of a urogynecologist, who outlined her choices: She could take duloxetine, an antidepressant often prescribed off-label for incontinence (it helps control the muscles at the bladder's opening). But given that she'd finally managed to control her lifelong depression with a low dose of meds, she was unwilling to introduce another drug into the mix. She could have a small sling surgically inserted under her urethra. But that would mean a hospital visit, local anesthesia, and an injunction against lifting anything heavy, including her baby, for possibly two months. The third option was to do nothing. So Cindy wears pads every day, and she can count on one hand the times she's had sex since her daughter's birth more than a year ago. Her husband is sympathetic—they make a lot of jokes about buying diapers for the baby and for Cindy—but it's a humiliating condition.

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