Ask a Pelvic PT: Pain with Sex, Postpartum Healing & That Queefing Question
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, email us at contact@ladybirdpt.com or sign up for our newsletter here!
This month we’re answering these three questions:
How do I know if vaginismus is the cause of my pain with sex?
What can I do to support healing in the first couple weeks after childbirth?
I feel like air bubbles get trapped in my vagina after childbirth - what gives?
1. How do I know if vaginismus is the cause of my pain with sex?
I loveeeee that shows like Sex Education are shining the light on common sexual pain conditions like vaginismus. I do a happy dance whenever common pelvic pain conditions pop up in the media. But keep in mind, vaginismus is just one relatively common condition associated with painful sex. I’ll share some definitions of common conditions below to help you determine whether vaginismus sounds like your experience.
Pain with sex: Yes, I am seriously going to define pain with sex. For starters, pain with sex is a symptom, not a medical diagnosis. People have pain with sex for a number of reasons. Pain with sex can include pain with clitoral or external stimulation, pain with penetration at the entrance or deeper, pain with orgasm. It can feel like sharp, stabby pain. It can feel itchy or burning pain and it can feel dull (as well as a number of other descriptors). Pain with sex can be caused by lack of lubrication, changes in hormones, and muscular overactivity, lack of foreplay and a number of conditions like endometriosis, menopause, yeast infections and STIs.
Vaginismus: Vaginismus is a condition where the pelvic floor muscles involuntarily contract with any attempted penetration. Vaginismus can onset at the first attempt to insert a tampon or have a gynecological exam, at the first attempt of penetrative activity or intercourse. It can also onset after childbirth or other pelvic floor injury or trauma. People with vaginismus will describe their experience of attempted penetration as feeling like the object attempting to penetrate the vagina is hitting a wall or like there’s no opening. It is typically associated with significant pain during attempted penetration.
Vulvodynia: Vulvodynia just means pain in the vulva, or external genitalia. Vulvodynia is typically diagnosed after three months or more of vulvar pain with no clear identifiable cause. This pain can feel like burning, stinging, rawness, sharp or dull and it can be categorized as provoked or localized.
Provoked pain is triggered by touch, pressure, or penetration
Unprovoked pain is present without any stimulus
Localized pain is concentrated in one area, most commonly the vestibule
Generalized pain affects the entire vulvar region
This is generally a diagnosis of exclusion, meaning other causes have been ruled out and the experience varies wildly, though it is not uncommon.
Vestibulodynia: Vestibulodynia is a subset of vulvodynia and it means having pain at the vestibule, or the vaginal opening. Vestibular pain can be also be provoked or unprovoked and causes often fall into one of three categories with overlap being common.
The three common causes of vestibulodynia include:
Muscular tension
Hormonal changes
Nerve proliferation
Identifying the correct cause is incredibly important in creating a treatment plan as each cause needs to be addressed independently.
If you read the definition of vaginismus and it doesn’t seem to describe your pain, then vaginismus is likely not the right classification for you. I highly recommend working with a pelvic floor physical therapist experienced in treating pelvic pain to help you determine the cause of your pain and an appropriate path forward!
2. What can I do to support healing in the first few weeks after childbirth?
Two of my closest friends gave birth in the past few months so this question has come up A LOT in my personal life lately. Here are 5 things you can do to support healing in the first few weeks postpartum, whether you had a vaginal or cesarean birth:
Stay hydrated & take stool softeners
Making sure you poop regularly in the first few weeks after childbirth is so important. The way you poop is also important. In fact, poop is so important after childbirth that tip 1 and 2 on our list are going to be poop related. Pooping after birth can be scary but making sure you stay hydrated and take the stool softeners likely provided to you by your obgyn or midwife can make a huge difference. Staying hydrated can be particularly difficult for those new to the lactation journey. Figuring out how much water you need to make up for milk production can take some time. The general recommendation for lactating people is to drink 100-130 oz of water per day, which is much more than most folks are used to drinking. Proper hydration will help to keep your stool soft, and stool softeners will help finish up the job while you figure out your hydration.
Use a squatty potty
The way you poop is just as important as pooping regularly. Avoiding pushing and straining in those early weeks is important to help limit stress on your healing pelvic floor. Using a squatty potty reduces the need for straining and makes it easier for your body to empty. If you don’t have a squatty potty, grab a shoebox, put your feet on it and get your knees over your hips while you’re sitting on the toilet. That will get the job done just as well. It’ll just be slightly less aesthetically pleasing.
And if you struggle with bowel movements, check out these bowel habits for managing constipation.
Use a peri bottle and dab when you toilet
A peri bottle helps to gently rinse your perineum after toileting. This is particularly important for anyone who experienced a perineal tear during vaginal childbirth, but can also be helpful for those who had a c-section after pushing for any period of time. After using the peri bottle to spray the perineal area after peeing or pooping, gently dab with some toilet paper to dry the area.
Rest
Rest is hard after baby because they don’t let you sleep and generally require all of you energy and attention - so remember that the goal is simply to rest as much as you can. Rely on your partner or support folks to do as much as they can for you and your newborn - relying on others is key to achieving any rest in the early postpartum period. The more you spend in bed the first week or two, the more opportunity your pelvic floor has a chance to heal without having to do the job of supporting your organs. The general rule of thumb is to spend your first week mostly horizontal with the exception of self and childcare task and to spend the second week mostly sitting. From there we want to slowly, progressively, start increasing activity based on your tolerance.
Practice diaphragmatic breathing
Practicing diaphragmatic breathing is a great way to reconnect with your breath, your abdominal muscles and your pelvic floor and it has the added benefit of nervous system regulation. To practice diaphragmatic breathing, take a slow, deep breath in, allowing your ribs to expand and your belly to fill with air. At the top of your breath you should feel your pelvic floor gently relax. Then slowly exhale and feel your abdomen and rib cage sink back to resting as your pelvic floor slowly rises. To get some added nervous system benefit, breathe in for 4 seconds and out for 6-8 seconds. This will help to activate your parasympathetic nervous system, or the rest and digest system of the body. While you may not be ready to participate in exercise as you knew it pre-baby, this is a great exercise to start promoting coordination of your core while healing.
When it comes to movement and exercise, there's no one-size-fits-all approach. The goal is a slow, progressive return to activity and a simple starting point is walking: 5 minutes in week 1, 10 in week 2, 15 in week 3, and so on.
That said, your timeline will look different based on your prior activity level, birth injuries, underlying health conditions, your baby's needs, and your support system. Wherever you're starting from, begin slower than you think you need to and only progress if you're feeling good. A pelvic floor PT can help you build a plan that's right for your body.
3. I feel like air bubbles get trapped in my vagina after childbirth - what gives?
This is SUCH a common complaint after childbirth. This feeling can be anything from weird to annoying but there’s a reason this happens. The primary reason people feel air getting trapped vaginally after childbirth is because of anatomical changes that occur following pregnancy and birth. Because the position your tissue sits in can shift after childbirth, this can create an opportunity for air to get trapped in the vagina when you move around, only to exit when you least expect it later in the day. This can happen during yoga or other workouts, or just when you’re shifting positions on the couch.
While this is not the primary complaint of most folks I work with, I’ve had patients report an improvement in this symptom as we worked on their underlying tissue impairments.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.