For some, getting cleared for sex after birth is exciting. For others, it’s daunting. No matter how you feel, you can still experience pain with sex postpartum. Here’s what you need to know.
You get the green light to have sex at your six-week postpartum well-check. Do you feel nervous? Excited? Complete and utter dread?
All those reactions are expected, and to be clear, there is no set number of weeks when you are “ready” for penetration. Yes, you want to wait until you are fully healed so you don’t introduce infection or open the wound.
Other than that, you want to wait until you feel ready.
It’s important to note that if you are not mentally prepared to have sex, your body will respond by tensing and increasing the chance of having pain.
What are some other reasons sex can be painful after birth?
- Your pelvic floor is too tight
- Vaginal tearing and scar tissue
- Hormonal shifts and changes
- Sleep deprivation
Your pelvic floor is too tight
Pregnancy itself can lead to pain with sex in postpartum. As the uterus expands, abdominal muscles lengthen to give the baby room. This affects how your entire core, including your pelvic floor, can support you.
These muscles need to work harder to stabilize your pelvis as the baby grows and the pelvis expands. So no matter how you give birth, your pelvic floor has been working hard for months. If these muscles remain tight and overactivated, this can make sex painful.
If you had a vaginal birth, your baby passed through your pelvic floor. These muscles stretched up to 3x their average length for that to happen. Aren’t our bodies amazing? This incredible event may lead to tightness and muscle spasms, which can last into postpartum and make penetration difficult.
Vaginal tearing and scar tissue
Up to 90% of first-time moms will have perineal tearing with a vaginal birth. Scar tissue will develop with healing and can lead to tightness of the perineal tissues. Everyone heals differently and will end up with varying degrees of scar tissue.
Once you’ve fully healed, you can do a self-assessment to test for sensitivity and tissue mobility of the scar. If you have any tenderness here, doing some essential scar massage can help reduce the likelihood of pain with sex.
Hormonal shifts and changes
In postpartum, hormone levels shift, and you enter a “mini-menopause” state, which causes vaginal dryness and atrophy of your vaginal tissues. These shifts will continue as long as you are breastfeeding.
These changes can lead to general pain, especially with insertion, because the tissues lack lubrication and flexibility. Lube will be your best friend during these months, so find one that works with your body and keep it on your nightstand. Use a good amount directly on your tissues and your partner. Reapply as necessary.
Some moms also do well with topical vaginal estrogen to help support their tissues, so ask your medical provider if this is a good option.
You may not think sleep can directly affect your sex life, but it can! If you are sleep deprived (what new mom isn’t?!), this will affect your body’s ability to physically heal and increase your stress level, directly impacting your pelvic floor.
Sleep is one of our most critical self-care tools, so please focus on getting some restful sleep before a tumble in the sheets.
Final thoughts on pain with sex
Pain with sex is not normal, so if you have pain, please get in touch with a pelvic floor physical therapist. No matter the reason for your pain, there is something that can be done to help. Don’t live with pain. You deserve more.
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Katie Bayer, PT, DPT is a pelvic floor physical therapist with a special interest in women's pelvic floor dysfunction and treating pregnant and postpartum women. After experiencing a C-section with twins, and several years later a VBAC, (vaginal birth after C-section), she experienced the need for help both during pregnancy and with the recovery process after birth. This set her on a path to help others going through the same.