Sex should not hurt, unless you want it to. Though I believe that with all my heart and soul, there are so many people suffering from pain during sex. The goal of this post is to help you understand what contributes to painful sex, specifically after having babies, as well as what can be done to help.
A study by O'Malley et. al. found that "nearly half of (postpartum people), 46.3%, reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5%" reported pain with sex at 6 months postpartum. (1) This same study found that breastfeeding and pain with sex prior to pregnancy are risk factors for continued pain postpartum.
Some of the top reasons for pain with sex in the postpartum period include:
1. Tightness in the pelvic floor muscles
People often expect that following birth the muscles in their pelvic floor will be weak and lax. However, if you've ever been injured, you may remember that the muscles around that injury tightened up. They were trying to protect you. Think about a car accident and whiplash. If you've ever had whiplash, maybe you went to PT and maybe you didn't, but I bet you used heat or ice, stretched and spent some time gently getting the mobility in your neck and shoulders back.
So, while I think it needs to be noted that I am NOT comparing childbirth to a car accident, we can all agree that childbirth is a BIG event that happens in our pelvis, impacting our pelvic floor muscles. Because we don't know how to stretch or relax these muscles, we don't know how to use ice or heat on them, these muscles can tighten up and get stuck that way. This can contribute to pain with sex.
2️. Muscular guarding in response to fear or anxiety
This does NOT mean the pain is in your head. Too many people are told this crap and it is a massive injustice to them. Have you ever sat in a car during stop and go traffic? Have you ever realized, seemingly out of nowhere, that you're gripping the steering wheel with all your might? Clenching your teeth?
When your body perceives danger, it protects itself. It does this by engaging your muscles, preparing for flight or fight. When we perceive fear during intimacy, our pelvic floor does it's best to protect us by tightening up. This tightening can cause sex to hurt, furthering our body's belief that it should be fearful and anxious in regarding to sex. This cycle can continue, causing the pain to continue as well.
3️. Scar tissue restrictions often a result of tearing or episiotomy
Have you ever seen or had a scar? You can usually see the skin looks different. It doesn't move the same way as the rest of our skin. Scar tissue isn't as stretchy as the rest of our skin. That decreased stretchiness can cause pain during penetration. Some people will report pulling or a "tearing" sensation at the site of the scar.
4️. Hormonal changes
Postpartum folks have decreased estrogen during the early postpartum months. This period is extended by breast/chestfeeding. Vulvar and vaginal tissue is highly hormonally dependent. These decreased hormonal levels can contribute to dryness in the vulvar tissue, thinning of the tissue and pain.
Postpartum pain with intercourse is often a combination of a few factors from the category above. The pelvic floor, vulvar and vaginal tissue are all impacted by pregnancy & birth, and pain can be stemming from any of these areas. Vaginal birth to planned c-section, your pelvic floor has been impacted.
Fortunately, so much can be done to help - pelvic floor muscle training, scar massage, topical hormones, dilators programs, lubrications, and more. You deserve to have a healthy sex life. Sexual health is an important part of our overall health. Did you know that sex can even be good for your heart!?
You never have to accept pain as your new normal. You can enjoy sex again. You deserve to.
1. O'Malley et. al. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study. BMC Pregnancy Childbirth. 2018; 18: 196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984394/