The six-week postpartum check-up is failing women in many ways and the bedroom is a big one. The visit is often too little, too late, when it comes to breastfeeding, mental health and pelvic health. Most women leave their appointment with a green light to return to life as normal including exercise and sex.
And then, so many women say that sex is painful after childbirth. This goes for moms who had Cesarean births and women who have had vaginal births. No matter how you birth your baby, painful sex is not normal. It’s not normal before you have a baby and it is not normal after you have a baby.
It’s not normal, but it’s really common. Like problems with breastfeeding, maternal mental health and other pelvic health issues, we aren’t talking about it. Women who are brave enough to bring up the issue are often told to use more lube, drink a glass of wine, and chill out. But most new moms will suffer in silence and too often their caregivers are also under-informed about what can cause pain during sex (dyspareunia).
Some common issues that can lead to pain with intercourse (dyspareunia) after baby:
- Presence of scar tissue, either from a tear, or episiotomy in the pelvic floor, or from a Cesarean-birth incision. Scar tissue will bind muscle and fascia down and prevent normal expansion and contraction of that tissue. Tissue mobility is required for non-painful intercourse (and most certainly for being able to have an orgasm).
- Muscle spasms in pelvic floor or deep hip stabilizers. Spasms throughout the pelvic muscles are quite common and can be the result of imbalances that existed before becoming pregnant or birthing a baby. They can be made worse by a host of variables that come with childbirth – and especially with a very quick or very long pushing phase.
- Vaginal dryness. Hormonal fluctuations during the postpartum months and with breastfeeding contribute to dryness which contribute to irritable tissues when friction is introduced. That irritability will then lead to muscle spasms. (See #2) If lube is being use and pain persists, it is likely secondary to a spasm or scar tissue issue.
- Fear. Anticipation of pain turns the protective part of the nervous system up, which is likely to cause a bracing effect of muscles throughout the body. Super contracted PF muscles and intercourse don’t mix well.
So, What can you do?
- Get comfortable with your anatomy – get a mirror and look at it and then use your finger and feel it. Yes, I just told you to put your finger in your vagina. It’s a good test to see how things feel. If your finger is causing pain, you probably don’t want anything else going in there. If something doesn’t feel right, see your healthcare provider and get it checked out.
- Just because your doctor said that you can go for it, doesn’t mean that you should. Some women feel ready for sex at six weeks, some women feel ready at six months. Six weeks means that soft tissue should be healed (and for some women it may take longer). In my informal and unscientific polling, women without complications, who wait about 10 to 16 weeks, seem to feel positive about their first post-baby roll in the hay.
- If you have pain, get help from your midwife, OB or a Physical Therapist specializing in Women’s Health. If you get advice to “just use more lube and drink some wine,” and it doesn’t work, get other help. Keep advocating for yourself. You are worth it – sex after baby should be just as great as sex before.
The above is not intended to be or to replace medical advice from a licensed healthcare provider. The information above is general in nature and should not be used to diagnose or treat any problem or disease.
Information for this article was provided by women’s health expert, Anne Duch of Physical Therapy for Women.