Sex after baby is tricky enough – you’re exhausted, sleep deprived and probably distracted by your new bundle of joy. Add to that the fact that pelvic floor muscles are tight and overactive after childbirth, and you have a recipe for pain during sex.
It can feel like pressure, throbbing pain or soreness, and even dryness. The good news is that sex pain after birth is very common and treatable.
Pelvic Floor Issues
The pelvic floor muscles (or pubococcygeus muscles) support many organs including the uterus, bladder, anus and urethra. They can be big sources of pain during sex when they are tender, shortened or irritated from childbirth, perineal trauma, hormonal changes and other health conditions like interstitial cystitis and irritable bowel syndrome.
It’s normal to have some pelvic floor dysfunction after birth – it just depends on the level of damage and how quickly your body recovers. For most women, this goes away with time and diligent practice of Kegel exercises.
Weak pelvic floor muscles can also lead to a feeling of heaviness in the vagina and poor bladder control. In more serious cases, the internal organs can slip down into the vagina (prolapse) causing symptoms like painful urination and a protrusion that is noticeable when wearing tight pants or underwear.
If you have pelvic floor dysfunction, your physical therapist will spend time talking with you about your delivery and the specific issues you are having, then perform a full exam of your head to toe. They will check your muscles for spasms, knots and weakness and will give you an intrarectal (inside the rectum) or vaginal exam to check the integrity of your pelvic floor muscles. Then they will teach you how to coordinate breathing and pelvic floor muscles to gain control over them and improve your sexual experience!
Some women may experience events during pregnancy, childbirth or immediately after birth that can cause them to feel traumatised. This is not always because of sensational or dramatic events but rather feelings such as feeling powerless, helpless, stripped of dignity, fear for the health and safety of themselves or their baby, not being heard, a sense of hostility from those around them or the absence of informed consent to medical procedures.
While most people do not end up with post-traumatic stress disorder (PTSD), it is very common for some to have lingering feelings and experiences from birth that can make sex less enjoyable. If you have a negative reaction to your sex life, it may be worth seeking out the support of a pelvic health physiotherapist who specialises in treating birth injuries and trauma.
They can conduct a full internal vaginal examination and then use techniques such as manual therapy to release tension in the area, soft tissue work and breathing strategies, manual sensory input and biofeedback to facilitate healing of scarring, distortion and numbness in the vulval and perineal areas. This can then lead to a more enjoyable and relaxed sexual experience. It is also a good idea to talk about the trauma you have experienced with a therapist trained in perinatal mental health and trauma treatment as it has been found that talking through these types of experiences can help heal them.
Whether you had an emergency C-section or one that was planned, you may still experience pain during sex after your doctor gives the go-ahead to resume sexual activity. A study out of Australia found that women who had a C-section were twice as likely to report pain during penetrative sex 18 months after birth compared with those who had a vaginal delivery.
This is due to many different factors, including changes in pubic symphysis muscles and increased pain caused by the need for a surgical wound to heal. Some women also experience problems due to breastfeeding-induced hormone changes, which can cause a drier vagina and make painful intercourse more common.
The good news is that most women who have a C-section are able to get back to having normal vaginal sex eventually, but it could take more time for some. If you’re having trouble, it might help to try a lubricant or talk with your OB about sexual positions that feel better.
Taking it slow and only having sex when your body is ready will help you navigate these sexual challenges. Don’t feel pressured to have sex before you’re ready and use the pain as an opportunity to explore other forms of sexual pleasure such as oral sex or mutual masturbation until you’re ready for more. For now, focus on getting aroused and letting your sexual energy and physical intimacy grow with your baby.
Hormones are chemical messengers that regulate all sorts of organ function, including reproduction and sexual arousal. Hormonal changes can be caused by events like puberty and pregnancy, as well as underlying health conditions.
During the time after birth, hormones can cause pelvic tissue to become thinner and more sensitive, which can lead to pain during sex. In addition, if you’re breastfeeding, it can lower your libido. And then there’s the fact that new moms are often sleep deprived, stressed and emotionally drained from taking care of a newborn.
If your doctor has given you the go-ahead to have sex, take it slowly and use lots of lube. Also, try to find other ways to bond with your partner, such as touching and foreplay.
It’s common for women to expect that once their bodies have physically recovered from childbirth, their sex life will return to normal. However, it’s important to remember that every woman heals at a different pace. And the good news is that these issues usually don’t have a long-term impact on sex, whether vaginal or C-section. So don’t worry if your sex life doesn’t return to what it was before baby, or if you experience pain during sex. You can always make it better with a little planning and plenty of lube. And don’t forget to talk about your feelings with your partner, and keep communicating throughout the process.