Fix Pain with Sex Postpartum - Dyspareunia Solutions

Great sex doesn’t have to stop after having a baby, but having pelvic pain with intimacy can definitely kill the mood and feel really discouraging. Research shows 43% of women are still experiencing pain with sex at 6 months postpartum. And it’s probably higher when we consider how many women aren’t sharing this with their doctors, or are unfortunately dismissed when they are brave enough to do so. Because pain with sex is so common postpartum, many begin to assume that this must be the “new normal” after having a baby. I’m here to tell you it doesn’t have to be this way and there are solutions! I’m going to break down the four most common reasons why pain with sex develops postpartum and give you solutions to fix it.

The 4 Most Common Reasons For Painful Sex Postpartum

Reason #1 - Scar tissue from a pelvic floor tear or C-section

Scar tissue is necessary to help with wound closure. It provides reinforcement around an injury, decreasing stretching and loading to the area until the wound is fully closed. It is also highly sensitive to touch and stretch early on which is another protection mechanism. However, if these tissues don’t regain their flexibility after wound closure then pain and discomfort persist. In the case of a pelvic floor tear, this can mean pain with initial insertion or deeper penetration into the vaginal canal. In the case of a C-section, scar tissue within the abdominal wall can decrease mobility of the uterus which is connected to the vaginal canal, making movement and stretching within the vaginal canal feel uncomfortable. 

Solution - Scar tissue massage is beneficial and often needed to restore flexibility and movement to tissues that were affected by a scar once wound closure has been completed. Pelvic floor physical therapists use this technique in treatment sessions and even educate patients on how to do this at home.

Reason #2 - Vaginal dryness caused by hormone changes

Estrogen serves many roles in the body, one of which is to provide lubrication and circulatory support to the vulva, urethral and vaginal tissues. In the early postpartum period and throughout the time of breastfeeding, the body goes into a low estrogen state, increasing the likelihood of vaginal dryness, which for some can increase the prevalence of pelvic pain and urinary urgency symptoms. Vaginal dryness can also develop with certain types of hormonal birth control and is a common side effect of medications like antidepressants. Low thyroid levels and age-related factors can also play a role.

Solution - Have a discussion with your OB to see if a prescription for topical estrogen cream or an intra-vagainal estrogen suppository would be right for you. Many of my postpartum patients find these to be really helpful. I also recommend my patients get blood work done with their doctor to assess how their body is doing overall, especially to check on thyroid and adrenal function, vitamin D, and iron levels.

Reason #3 - Pelvic floor muscle tightness

Tight pelvic floor muscles at the vaginal opening or deeper around the vaginal canal can create pain with intimacy. When these muscles are too tight, it limits their flexibility, resulting in pain or discomfort with penetration. As mentioned previously, scar tissue from a pelvic floor tear or C-section incision can also contribute to this tightness. Generally speaking a tight pelvic floor means more strength and coordination is needed among the muscles of your core team (spinal muscles, abdominal muscles, pelvic floor, and the diaphragm) and your hip muscles. All of these work together as a coordinated system and that system underwent significant adaptations for 9 months growing and carrying a baby. Once postpartum, these changes don’t just automatically return to a pre-pregnancy state.

Solution - Know that kegels alone is NOT a solution, and often makes pelvic floor muscles tighter and more painful. Connecting with a pelvic floor physical therapist is the best way to determine the specific cause of tightness in your pelvic floor and guide you towards a solution.

Reason #4 - Postpartum care ends too soon

Most women who give birth in the US get only ONE follow-up visit at 6-8 weeks postpartum. This is usually just enough time for wound closure, but not enough time for full healing. Full healing involves restoring tissue strength and flexibility, which takes at least 12 weeks. So being told you’re “all clear” at 6 weeks postpartum when you don’t feel “all clear” places a huge burden on you to figure out next steps.

Solution - Ask your birthing provider for a referral to pelvic floor physical therapy! We specialize in postpartum recovery and getting you back safely to the activities you enjoy most, including sex with your partner. 

So when your OB says “Goodbye” at 6 weeks, I encourage you to say “Hello” to a pelvic floor physical therapist in your area. And know that whether you gave birth 6 weeks ago or 6 years ago, it’s never too late, we can always help.