Women usually get the “all clear” for sexual activity at the 6-week postpartum visit. They are told that the area is healed, and they can return to pre-pregnancy levels of activity. Working with new moms every day in my clinic, I can tell you that this advice can set women (and their partners) up for a bit of a surprise in the bedroom!
Not only does sex feel different after having a baby, but sex might be painful sometimes. Research suggests that more than 40% of women report painful intercourse until 6 months after childbirth, with about 20% reporting pain well into a year post-partum. So don’t fret if you’re in that club!
Let’s look at some reasons why sex may not feel great after having a baby. And what you can do about it?
Childbirth can leave scars! Not just emotional ones but also actual physical ones. Two types of scars are most common after childbirth.
One is at the perineum (lower end of vagina), where tissue often tears or is cut to allow the baby’s exit. These cuts heal with time but often leave a thick scar tissue underneath, which doesn’t have the same suppleness or flexibility as the original tissue. Depending on the extent/depth of the tear, episiotomy scars can cause varying degrees of pain. Despite the 6-week guideline commonly given to moms, research shows that these scars can take many months to heal. More severe (or deeper) scars take longer to heal.
How to manage Perineal scars: Most hospitals in the US provide a “sitz bath” to help the initial swelling from perineal scars. This is a little plastic tub filled with warm water and put on top of the toilet bowl to dip your lady parts into. This is very helpful and should be done 1-2 times per day during the initial 3-4 weeks after childbirth. Using a “witch hazel” panty liner after bleeding has stopped can keep the scar from drying out and hurting. But the major work for scar tissue is usually done after the 6-week clearance. The newly formed scar tissue needs to stretch and move in all directions and tolerate pressure. This is where a pelvic floor physical therapist comes in.
A pelvic floor physical therapist can work on these scars and the muscles inside the pelvis to improve the flexibility and blood circulation of these tissues. When appropriately treated, these scars improve fairly quickly, and pain decreases significantly within a few weeks. Pelvic Floor physical therapists can also help you strengthen these muscles, which can help in improving arousal and orgasm.
You might think that not having a vaginal birth will save you from painful sex. But the cesarean scars can cause “reflexive tightness” (muscles tightening in response to the incision) in muscles of the pelvis, which may affect the ability of these tissues to expand. Cesarean scars look deceptively small from the surface, but they are pretty deep as they extend more than halfway into the depth of your abdomen. Cesarean scars can also make positioning for intercourse pretty difficult.
How to manage cesarean scars: These scars are deep and can cause restricted mobility in the pelvis, lower back, and abdomen. They can make it difficult for you to tolerate many positions of intercourse. Two major nerves pass near this scar that can get “entangled ” in the scar and cause pain.
Women often go through years with symptoms of burning, numbness, and pain at cesarean scars. And contrary to popular belief, it isn’t normal, and there are ways to improve the flexibility and function of these scars.
Working on these scars with a physical therapist can improve the flexibility and help the appearance of cesarean scars. And make all the difference in your romantic endeavors!
2. Breastfeeding-Related Estrogen Deficiency
Breastfeeding has many benefits for the baby, but it can be pretty hard on the mom’s body, both physically and hormonally. The lactation hormone called Prolactin, which enables us to produce milk, also inhibits estrogen production in the body. This decreased estrogen often leads to thinning of the vaginal tissue and decreased production of natural lubrication. Decreased lubrication can mean increased friction and more pain.
How to manage: Using plenty of extra lubrication during sex usually solves this problem, but sometimes using vaginal lubrication throughout the day is needed. Talk to your obstetrician about your options. While lubrication will help, you should also make sure that there is lots of foreplay on the menu to get things moving
Research has proven that mothers who are well-rested and happy can enjoy sex more. Although it may not feel like sex can physically hurt just because you’re mentally exhausted, but our pelvis and its muscles are very much in-tune with our emotions.
Feeling run down, exhausted, and anxious can definitely make those muscles tighten up and close the vaginal canal, making sex painful. Painful sex can also be a sign of hormonal imbalance and often correlates with post-partum depression.
How to manage: Ask for help from family, from friends, from your healthcare team. Know that your mental health challenges are not your fault. Give yourself grace in this very hard journey of motherhood. Take time out for self-care, even if it means blocking out the outside world for some time. Sunlight and a good night’s sleep go a long way. And if you’re struggling, consider medication, psychotherapy, or sex therapy. All are highly successful in resolving these issues.
In the end, know that going back to intimacy when you don’t feel ready isn’t going to help. Give your mind and body as much rest as it needs, and don’t feel pressured into getting back to it before your heart desires it.