Painful sex after birth is a very common but often not talked about issue. Whethere you had a vaginal delivery, or a C-section birth, you are not alone in experiencing postpartum sex pain. Let’s take a look at why painful intercourse happens and the treatments that actually work to improve sexual health.
Why Does Postpartum Sex Pain Happen?
There are many different causes for painful sex after birth. This can make it an even more challenging experience since multiple factors are contributing. Some of these will get better over time, while others may take more time and patience. The major causes of post partum sex pain are breastfeeding, vaginal dryness due to hormonal changes, physical recovery from a vaginal birth, physical recovery from a C section, mood changes, and fatigue.
Breastfeeding Can Contribute To Painful Sex After Childbirth
Breastfeeding causes many hormonal and physical changes that can lead to painful sex postpartum. Many of these will start to improve as you get more accustomed to breastfeeding, or when you wean from breastfeeding.
During breastfeeding, the hormone prolactin is released, which stimulates milk production and can have a suppressive effect on sexual desire. Prolactin levels are generally higher during breastfeeding, and higher levels of prolactin can decrease libido in some individuals.
Fatigue And Physical Changes
Breastfeeding can be demanding physically and emotionally, particularly in the early months when there may be sleep deprivation and adjusting to the new role of being a parent. These factors can contribute to fatigue and decreased sexual desire.
Breasts are also very sensitive while breastfeeding. This can lead to pain or discomfort during physical intimacy if your partner engages in any foreplay involving the breasts. Be sure to communicate to your partner what areas are sensitive and which aren’t.
After childbirth, hormone levels, including estrogen, fluctuate significantly. Estrogen is essential for maintaining the health and lubrication of the vaginal tissues. Reduced estrogen levels can lead to a decrease in natural lubrication, resulting in vaginal dryness.
The hormone prolactin, which is responsible for milk production, is elevated during breastfeeding. Prolactin can suppress the production of estrogen, further contributing to vaginal dryness.
Birth Recovery Contributes To Painful Sex Postpartum
Giving birth is a big deal. Your body has undergone so many changes already and then it will again once you give birth.
Recovery From Vaginal Birth
Vaginal birth can be traumatic. If a patient has had any type of vaginal tearing (any degree) during childbirth, or if they have had an episiotomy, this can cause postpartum sex pain. Patients can have scar tissue that makes sex more painful. In addition to waiting at least 6 weeks, patients should also wait until the tears or stitches are fully healed before having penetrative sex. Make sure you are cleared from you Ob-Gyn to have sex.
Pelvic pain or pain with sex after c-section is common but not often discussed. On top of recovering from pregnancy, you’re also recovering from major abdominal surgery. Often, c-sections are unplanned and can take an emotional toll as well, so it’s important to give yourself time, patience and compassion when easing back into your sex life.
Mood Changes Can Contribute To Sex Pain Postpartum
Having a baby is not just physically demanding, it is emotionally demanding too. Hormonal changes and fatigue both can both contribute to an increased sensitivity to touch and pain. All of these can also contribute to low libido.
The demands of caring for a newborn, sleep deprivation, and the general stress associated with adjusting to parenthood can cause a lowered sex drive. A decrease in sexual desire and arousal can indirectly contribute to vaginal dryness.
Related: Postpartum Rib Pain
Postpartum Blues, Postpartum Anxiety, Postpartum Depression
Postpartum mood changes can reduce sex drive and contribute to painful sex, which is also called dyspareunia. Postpartum depression or postpartum anxiety, can lead to heightened anxiety and stress levels. These emotions can make it difficult for individuals to relax and become physically aroused, leading to vaginal dryness and discomfort during intercourse. Sleep disturbances are common during the postpartum period, which can result in extreme fatigue and reduced energy levels. Feeling exhausted can affect libido and arousal, making it challenging to engage in sexual activity comfortably.
Additionally, many individuals can experience body image concerns after childbirth due to physical changes, such as weight gain, stretch marks, or abdominal muscle separation. These concerns can lead to a decrease in confidence, making it difficult to feel relaxed and enjoy sexual activity. Not feeling relaxed and comfortable can also cause difficulty in vaginal lubrication and sexual arousal. In plain words, many women are just not in the mood, and that is not uncommon.
Treating Painful Sex After Birth
Luckily, there are some treatment options when it comes to dealing with postpartum sex pain.
Vaginal Lubrication To Manage Vaginal Dryness
Having a great vaginal lubricant is very helpful when it comes to managing vaginal dryness. A water-based, silicone or oil-based lubricant can also be helpful to lubricate the vaginal opening and vaginal canal and help you to feel more relaxed. Some patients may also find a warming gel useful. Find a personal lubricant that you and your partner enjoy using.
Physical Therapy For Both Vaginal Birth And C Sections
Physical therapy is very underrated in women’s health, especially after giving birth. With any other major bodily trauma, many people go through physical therapy. Pelvic health is also very important, and pelvic floor physical therapy is something many patients can benefit from.
A physical therapist, specifically a pelvic floor therapist, can guide you in performing targeted exercises to strengthen and restore the function of your pelvic floor muscles. These exercises, known as Kegel exercises, involve contracting and relaxing the muscles that support the bladder, uterus, and rectum.
Estrogen cream can be an effective treatment for vaginal dryness. Estrogen is a hormone that plays a crucial role in maintaining the health and lubrication of the vaginal tissues. When estrogen levels decrease, such as during menopause or after childbirth, it can lead to vaginal dryness, discomfort, and pain during sexual intercourse.
Estrogen cream, also known as vaginal estrogen or topical estrogen, is applied directly to the vaginal tissues. The cream is typically applied to the vagina using an applicator, allowing the estrogen to be absorbed locally. Estrogen cream helps to restore and maintain natural vaginal lubrication, reducing dryness and discomfort during sexual activity.
Estrogen also promotes the production of collagen and elastin, which are important for maintaining the elasticity and thickness of vaginal tissues. Using estrogen cream can help improve the elasticity of the vaginal walls.
Finally, estrogen cream can alleviate other symptoms associated with vaginal dryness, such as itching, burning, and urinary urgency or frequency. There are different forms of estrogen therapy available, including vaginal tablets, rings, or suppositories. Your healthcare provider can help determine the most appropriate form of treatment for your specific needs.
A vaginal dilator can potentially help with postpartum sex pain. A vaginal dilator is a medical device that is used to gently stretch and desensitize the vaginal muscles and tissues. It can be beneficial for individuals experiencing pain, discomfort, or tightness during sexual intercourse, including those who have recently given birth.
After childbirth, the vaginal muscles may be tense or tight, and there may be increased sensitivity in the area. Using a vaginal dilator under the guidance of a healthcare provider or a pelvic floor physical therapist can help gradually stretch the muscles and desensitize the tissues. This process can improve flexibility, reduce muscle tension, and decrease pain during sexual activity.
Painful Sex After Birth: Summary
Postpartum sex pain, also called postpartum dyspareunia, is very common. Once women are cleared to have sex again (usually around 6 weeks postpartum), they may find that it is not the way it was before. Hormonal, emotional, and physical factors can all contribute to painful sex after birth.
Prolactin is elevated in moms who are breastfeeding, and this can suppress estrogen which can cause vaginal dryness. Mood changes can also make any sex feel not as good as it once did. Breast sensitivity as well as recovering from a vaginal tear or cesarean section can also contribute.
Treatment involves vaginal lubrication, physical therapy, estrogen creams, as well as addressing any mood changes. Painful sex after birth can have multiple contributing factors so patients may need to address more than one to enjoy sex again.
It is also important to use contraception when you start having sex again. Remember, that it is still possible to get pregnant while breastfeeding. If you have pregnancies that are too close together (less than 12 months) this could be dangerous for both you and the future baby.
It is also important to give yourself time in the healing process. Painful postpartum sex can improve with time and keeping the lines of communication open between you and your partner is important.
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