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September 24, 2020
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 overall prevalence rates between vaginal births and cesarean births, so it can happen to anyone. But only 15% of women reporting symptoms actually talked to their healthcare provider about it.
First, doctors aren’t bringing it up. While 69% of new moms are counseled about postpartum sexual health, those conversations are largely focused on birth control and when they can have sex again (largely based on how well you’ve healed from any incisions or tearing).
So if doctors aren’t even asking or warning about the potential for painful sex, no wonder it’s going untreated. You may not even know who to bring it up to, since you might not notice it until after your 6-week appointment. Also, it might be embarrassing to bring up, especially if you’re not sure if it’s normal or not. So we’re going to fill you in, so that you feel comfortable getting help if you need it. Because the good news is that it is treatable! In fact, it’s generally very quick to treat, so there’s no need to suffer any longer.
Dyspareunia is technically defined as painful penetration, pain during sexual intercourse, or pain on orgasm. However, there are a lot of related symptoms after childbirth, including vaginal dryness, vaginal tightness, vaginal looseness, bleeding/irritation after sex, and loss of sexual desire.
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 (sex drive).
The second cause is pelvic floor dysfunction, which means that your pelvic floor muscles are weak and/or tight. The extra pressure on your pelvic floor from pregnancy often makes your muscles weaker, which is why leaking (incontinence) and prolapse are common. Sometimes weak muscles overcompensate and become tight. Also, if you had tearing, an episiotomy, or a c-section, there may be some scar tissue that is pulling on your muscles, adding to the tightness.
Related: What is a pelvic floor?
Breastfeeding is a big risk factor, since it keeps your estrogen levels lower for longer. Lower estrogen leads to dryness and sometimes pain.
Fatigue and stress have also been shown to be correlated with dyspareunia, but the relationship is less clear here. While there may be some psychological factors that contribute to the pain, pain also may contribute to stress.
In addition to vacuum extraction and emergency c-section, another risk factor for later dyspareunia (at 6 months postpartum) is perineal pain at 1 month postpartum. This is actually really helpful to know, since many women have not tried having sex yet at 1 month postpartum, but since they’re at higher risk, they can talk to their doctor earlier and get treatment earlier.
As always, you can talk to your general practitioner (GP) about this (and all things health related). But, don’t be embarrassed to go to your OB/GYN, as this does fall under their specialty.
Depending on your insurance situation and symptoms, you may even want to go directly to a pelvic floor physical therapist. Many pelvic floor physical therapists are knowledgeable about pregnancy and postpartum issues, but it’s helpful to go to a therapist that specializes in these.
A weak pelvic floor can make sex unbearable for months. Learn how to strengthen and rehab your pelvic floor with a postpartum pelvic floor rehabilitation program.
An exam by an OB-GYN or healthcare professional can help diagnose the underlying cause of the pain. If your symptoms are more on the dryness side of things, an estrogen cream may be prescribed. If it’s on the muscular side of things, you can get a referral to a physical therapist. Physical therapy may include exercises and manual therapy.
In the meantime, there are things you can do at home. Use a water-based or silicone-based lube for sex and increase foreplay. You can 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 to relieve any burning pain.
Alligood-Percoco, N. R., Kjerulff, K. H., & Repke, J. T. (2016). Risk Factors for Dyspareunia After First Childbirth. Obstetrics and gynecology, 128(3), 512–518. doi:10.1097/AOG.0000000000001590
Barrett, G. , Pendry, E. , Peacock, J. , Victor, C. , Thakar, R. and Manyonda, I. (2000), Women's sexual health after childbirth. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 186-195. doi:10.1111/j.1471-0528.2000.tb11689.x
ACOG FAQ: When sex is painful
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