By Dr. Susie Gronski, DPT, PRPC, WCS
Sleepless nights. Countless diapers. Becoming a 24-hour baby buffet. Challenges you expect to face as a new mom. But painful sex? No one said anything about that.
Your first stab at post-baby sex can be mildly uncomfortable the first few seconds - perhaps a twinge or soreness, maybe sharpness or burning - but after that it should be smoooooth sailing.
Recurring pain during or after intercourse, otherwise known as dyspareunia, is not normal after childbirth - especially when healing periods have passed, typically at 6 weeks postpartum.
Here are just a few reasons why sex may hurt in the postpartum phase:
Hormonal changes associated with breastfeeding: Breastfeeding could be a major factor. Decreased estrogen levels can contribute to low libido and lack of lubrication, leaving women often complaining of penetration feeling dry and scratchy, “like sandpaper”. No fun!
Tenderness of an episiotomy scar or tear: Maybe delivery has something to do with it. One study showed that women with assisted deliveries (c-section, episiotomy, forceps or vacuum extraction) experienced a greater incidence of pain during intercourse at 6 and 18 months follow-up postpartum. Interesting to note, the mode of delivery (c-section versus vaginal delivery) cannot accurately predict whether or not a woman will experience painful sex. Painful intercourse is possible for both groups with no significant difference in actual sexual function after 12 months. In other words, choosing to have a c-section to avoid painful intercourse isn’t always a guarantee.
Lack of sleep: Let’s face it, for a new mom, sleep is a luxury. In the same study referenced above, women who reported fatigue also reported experiencing more pain at an 18-month follow-up. Another study showed a similar trend with fatigue, physical function and pain impacting a new mom’s quality of health.
The fact is sleep deprivation can sensitize the pain response and impact numerous other bodily functions, like tissue healing, immune function, hormone health and brain function.
Past history: Was sex painful pre-baby? Having a history of painful intercourse pre-baby or during pregnancy could result in having pain post-baby. This isn’t for everyone but can be a possibility.
Adjusting to a completely new lifestyle: It’s been weeks and you still can’t believe you’re a mom. Yup, you have another human you’re responsible for. You’re learning a new way of operating in your world. Family demands are different; relationship dynamics and roles are ruffled. In other words, you’re still figuring out motherhood. And that’s okay.
No one said it would be easy. If they did, they pulled the ultimate white lie. Navigating your way through parenthood is exciting, but can be exhausting, both physically and emotionally. It’s no wonder sex is the last thing on your mind.
Conditioned self-protective responses to pain: Sex should never hurt. The fact you’ve felt pain when you least expected it can create protective “guarding” of your pelvic floor muscles. Completely normal response. Something hurts… We tense up to protect ourselves.
The problem is when it continues to hurt without resolution. Before you know it, a continual conditioned response is born. Your body’s alarm bells get really good at protecting you. Just the thought of sex can make you wince and hurt down below. This cycle alone can perpetuate the pain response, creating guarding and tension in your pelvic floor muscles, making sex more painful and uncomfortable.
And protection doesn’t just stop there. You become more anxious around sex, the impacts on your relationship surface, and you may start to think that something’s wrong with you. There’s nothing wrong with you. Painful intercourse following childbirth is more common than you think. Although it’s difficult to estimate the true number of women who experience dyspareunia post-childbirth, there have been studies documenting a prevalence anywhere between 17% and 60%.
Although common, painful sex after childbirth doesn’t have to mean the end of your sex life. Know that you’re not alone. Most women who experience pain 6 weeks postpartum, report little to no pain at 3-, 6- and 12-month follow-ups. In other words, things do get better. Phew!
That said, don’t wait around for the pain to end.
Here are four things you can do right now to make sex feel good again:
1. Wetter is better: Use lubricant to minimize vaginal dryness and help alleviate pain. Read this blog post if you need help choosing a lubricant.
2. Use a dilator to help calm the pain response: The more good feelings you can associate with penetration the better. Using a dilator can help your pelvic floor muscles gradually get used to touch, stretch and pressure without protective guarding, because you’re in control of how much, how fast and how deep. Start small and work your way to match your partner’s size. Dosing the activity is important here so make sure that you start slowly. The goal is to feel good without any residual flares-ups.
3. Read Sex Without Pain - A Self-Treatment Guide to the Sex Life You Deserve: This is a 75-page self-help manual designed to help you locate your pain and treat it, including how to use a dilator.
4. Get rest and replenishment: Time is precious as a new mom. Rarely is there room for some me-time. But before you go rolling your eyes, just know that taking care of yourself is the most important piece of advice.
I know this can seem impossible, but gather your troops and ask for help so that you can incorporate meaningful rest into your day.
In order to give more of yourself, you’ll need to replenish your tank. Do something you love that brings you joy. When baby’s asleep, make sure your to-do list has something on it just for you.
And toss the guilt! Your health is even more important now post-baby. You just might have to be creative with your time and resources.
A happy mom is a healthy mom.
If sex is still painful after giving these a try, let’s chat. Schedule a free 20-minute consultation here. Or go here for a directory of therapists in your area.
Dr. Susie Gronski is a licensed doctor of physical therapy, a board certified pelvic rehabilitation practitioner, and a certified health coach.