gettin’ through it

The medical term given to pain during or after intercourse is Dyspareunia. Pain can be felt in the genitals, pelvis, hips, or lower back. The mechanical trauma of birth contributes largely to Postpartum [after having a baby] Dyspareunia. Episiotomy, vaginal tearing, instrumentation [vacuum or forceps], and assisted birth [being induced or scheduled Cesarean] all contribute to muscle dysfunction, tissue adhesions, perineal scarring, or nerve irritation within the vagina and pelvic floor. Additionally, decreased estrogen production can cause poor lubrication or thinning of the vaginal wall, causing increased friction. Some more severe cases may also include pain with sitting and/or pain with bowel or bladder functioning. Length of lactation can make a difference in symptoms, but, surprisingly, there is very little difference between vaginal or Cesarean deliveries when comparing the incidences of Postpartum Dyspareunia.

The Facts

As many as 50-60% of women experience Postpartum Dyspareunia for at least six to seven weeks, and 17-33% still experience painful intercourse three to six months after having a baby. The physical changes that occur after having a baby can cause the vaginal tissue to thin, decreasing blood flow, which results in the vagina being less flexible during intercourse. Less ability to stretch during penetration can account for most of the initial pain during intercourse, often described as a “burning ring of fire.” Scarring from an episiotomy or tearing can make the inability to stretch even worse and may allow trigger points [aka muscle knots] to form, thus worsening the pain. Pain that occurs deeper or after initial penetration is often described as more achy, but can also be sharp. Common causes of deep pain can be pelvic adhesions, or scarring from the uterine positioning and amount of stretch experienced during pregnancy, or from uterine prolapse. Often, Postpartum Dyspareunia has a component of both deep and superficial stretch pain. On occasion, the pain may be from something more severe and you may need to see your doctor if your symptoms do not resolve within a year.

not tonight, honey

There are definite physical reasons that make returning to a healthy, happy sex life difficult after having a baby, but there is also simply a lack of desire. With all the different stresses placed on a woman during the postpartum period, it’s easy to see why! Taking some time to relax and keep mentally and physically strong is essential to walking the tightrope of demands that motherhood entails. Communication with your partner is essential to restoring a healthy sex life. The sexual experience after having a baby is different initially and having an understanding partner can make the transition to a satisfying sex life easier. Sexual healing involves relaxation techniques or meditation, physical stretching and strengthening of the perineum, and optimal timing and positioning during intercourse.

Talking to a Women’s Health Physical Therapist is a great way to safely supervise yourself during the postpartum recovery. During the postpartum period, your body has been spending its energy healing itself, so preparing for intercourse is the key to satisfaction. Most women return to satisfying intercourse by 12 weeks postpartum. Pre-pregnancy levels of desire, enjoyment, and frequency should resume within a year. It’s important to remember that having a satisfying sex life can build a healthy relationship! Here are a couple ways you can help yourself and your relationship get back on track faster:

Physical And Mental Health

• Get adequate rest whenever possible

• Get light physical activity 3-5 times/week - this can include family-centered workouts like going for walks with your child, yoga or baby-centered exercises, or walking the stairs of your home extra times.