Painful Sex (Dyspareunia)

Painful sex after childbirth is very common. In fact, 50-60% of women report painful sex (dyspareunia) 6-7 weeks after childbirth and up to 30% report it at 6 months postpartum. There’s actually no difference in the prevalence rates between vaginal births and cesarean births, so it can happen to anyone.

What is dyspareunia?

Dyspareunia is technically defined as painful penetration, pain during sexual intercourse, or pain on orgasm. However, there are a lot of related symptoms, including vaginal dryness, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire

What causes postpartum dyspareunia?

There are usually two main culprits for these symptoms. One is low estrogen as a result of fluctuating hormone levels, which may be exacerbated by breastfeeding, and can lead to dryness and low libido. The second cause is pelvic floor dysfunction, which means that your pelvic floor muscles are weak and/or tight as a result of pregnancy and/or birth injuries like tearing or episiotomies.

What are the risk factors for postpartum dyspareunia?

Risk factors include:

  • Breastfeeding
  • Fatigue
  • Stress
  • Delivery by emergency caesarean section, vacuum extraction and to a lesser degree birth by elective c-section and vaginal birth assisted with forceps
  • Perineal pain at 1 month pp
  • Pelvic organ prolapse

What are the symptoms of Painful Sex (Dyspareunia)?
  • Painful penetration (dyspareunia)
  • Pain during sexual intercourse (dyspareunia)
  • Pain on orgasm (dyspareunia)
  • Vaginal dryness
  • Vaginal tightness
  • Vaginal looseness
  • Bleeding/irritation after sex
  • Loss of sexual desire (low libido)

What is the treatment for Painful Sex (Dyspareunia)?

An exam by an OB-GYN or healthcare professional can help diagnose the underlying cause of the pain. Treatments may include:

  • Pelvic floor physical therapy
  • Medication (including estrogen creams)
  • Surgery, if persistent, severe, and unresponsive to physical therapy

What you can try at home:

  • Use a water-based or silicone-based lube for sex
  • Try sexual activities that don’t cause pain, like oral sex or mutual masturbation
  • Before sex, empty your bladder, take a warm bath, or take an over-the-counter pain medication
  • After sex, apply an ice pack

Who can help diagnose/treat Painful Sex (Dyspareunia)?
  • OB/Gyn
  • Primary Care Physician (PCP)
  • Physical Therapist (PT)

Additional Resource(s)