Why Sex Is Painful After Pregnancy — and How to Heal with Pelvic Floor Therapy
Authored by Dr. Maryssa Steffen, PT, DPT, Board-Certified Women’s/Pelvic Health Clinical Specialist
Pain With Sex After Pregnancy: Understanding the Cause & Treatment Options
Do you have a history of pregnancy and delivery?
Whether or not you’ve had a live birth—and whether your delivery was vaginal, cesarean, assisted, or you experienced pregnancy loss—pain with sex after pregnancy is common and treatable with pelvic floor physical therapy.
You may want to enjoy sexual intimacy for your mental health—orgasms release endorphins and support nervous system resourcing.
You may also desire to reconnect with your partner and nurture your relationship.
And yet, your body has been through a profound transformation. Pregnancy, birth, surgery, or loss all place demands on your tissues, hormones, nervous system, and your energy. Because of this, penetrative sex after pregnancy can feel stressful, uncomfortable, or painful for many people.
If you’ve been told, “It hurts at first, but it should get better,” this can imply that pain is normal.
But persistent pain with sex after birth (dyspareunia) is not something you have to live with.
There are effective, evidence-based pain with sex treatment options, including pelvic floor physical therapy.
How Common Is Pain With Sex After Birth?
Postpartum dyspareunia is more common than most people realize.
A 2022 study published in the Journal of Obstetrics and Gynecology found that:
31% of first-time parents with a vulva reported pain with penetrative sex at 3 months postpartum
11% continued to experience pain 24 months postpartum
Despite how common pain with sex is after pregnancy, it is often under-reported. Many vulva-bodied people do not share sexual health concerns with their provider, or symptoms may be overlooked after the standard six-week postpartum visit.
If pain persists—or begins during pregnancy—it deserves care and attention.
What Does Pain With Sex After Pregnancy Feel Like?
Pain with sex refers to any unwanted sensation during or after vaginal penetration that:
does not feel good, and
was not present before pregnancy or delivery
Symptoms may include:
dryness or chafing
sharp, stabbing, aching, or burning pain
tightness or stiffness with initial penetration
deep pelvic pain during or after sex
Post-pregnancy and early postpartum can feel like a mini-perimenopause hormonally. Decreased estrogen may contribute to dryness or tissue sensitivity. Lubrication can help—but it’s not the whole picture.
If you also experience:
burning or shooting sensations
numbness, tingling, itching, or lingering pain
Pelvic floor therapy can help address these symptoms.
Questions That Can Help Identify the Cause of Pain With Sex
You may recognize some of these experiences:
How does initial penetration feel—tight, dry, stiff?
Are your symptoms superficial, deep, or both?
Does pain increase with duration of sex?
Do certain angles or positions matter?
Does your vagina feel heavy or pressured?
Do bladder symptoms change after sex (urgency or leaking)?
If any of these resonate, pelvic floor dysfunction may be contributing, and postpartum pelvic floor PT can help.
Why Pelvic Floor Dysfunction Can Cause Pain With Sex
It’s common to think pelvic floor problems only matter if you leak urine—but the pelvic floor does far more than that.
During pregnancy, your pelvic floor adapts to:
changes in posture and center of gravity
increased intra-abdominal pressure and load transfers
hormonal shifts
After pregnancy, these adaptations don’t always resolve on their own. Postural compensations, muscle tension, and altered coordination can persist—and contribute to pain with sex.
Pelvic floor physical therapy helps restore how your pelvic floor, core, breathing, and posture work together to support:
sexual comfort
bladder and bowel function
spinal and pelvic stability
What Can Contribute to Pain With Sex After Birth?
Physical contributors may include:
perineal tearing or scar tissue
cesarean delivery scars
prolonged or rapid pushing
assisted deliveries (forceps or vacuum)
unresolved pelvic pain during pregnancy
Hormonal contributors:
decreased estrogen during pregnancy, postpartum, and lactation
vulvar dryness or tissue irritation
lingering symptoms like night sweats or hot flashes
decreased libido
Nervous system & emotional contributors:
birth trauma or pregnancy loss
fear of pain or re-injury
fatigue, stress, or insufficient support
delayed tissue healing
increased muscle tension
All of these are valid—and all are treatable.
Pain With Sex Treatment: What Postpartum Pelvic Floor PT Involves
Your pelvic floor physical therapist is part of your care team and works collaboratively with providers such as:
OB-GYNs or midwives
mental or behavioral health professionals when needed
Treatment for pain with sex after pregnancy may include:
scar and visceral fascial mobilization to improve tissue movement and blood flow
pelvic floor muscle coordination and relaxation training
pelvic floor/abdominal and hip muscles strength and endurance progressive exercises
core and postural support retraining and rehabilitation
nerve-informed approaches to reduce sensitivity and irritation
education so you understand what’s happening in your body and why
If pain with sex has created fear or distress, your PT may offer gradual, individualized exposure strategies, grounded in modern pain science, to help your nervous system feel safe again and to progressively load your tissues appropriately.
A Whole-Person Approach to Healing Pain With Sex
Your treatment plan is always individualized and reflects:
your body and medical history
your lifestyle and values
your goals for intimacy and movement
Education—whether in person or through online pelvic floor PT visits—can help you filter through conflicting advice and move forward with clarity and confidence.
Work With a Pelvic Floor PT for Pain With Sex in California
If you’re experiencing pain with sex after pregnancy, you are not broken—and you are not alone.
If you’re in California, you can book a visit to learn more about pain with sex treatment through pelvic floor physical therapy.
We offer Telehealth and in-person visits at our Oakland, CA office.
Your body deserves care that is thoughtful, specific, and supportive of healing—so intimacy can feel safe, comfortable, and enjoyable again.
References
Rosen NO, Dawson SJ, Binik YM, Pierce M, Brooks M, Pukall C, Chorney J, Snelgrove-Clarke E, George R. Trajectories of Dyspareunia From Pregnancy to 24 Months Postpartum. Obstet Gynecol. 2022 Mar 1;139(3):391-399. doi: 10.1097/AOG.0000000000004662. PMID: 35115480; PMCID: PMC8843395.
Barrett, G., Pendry, E., Peacock, J., Victor, C., Thakar, R. and Manyonda, I. (2000), Women's sexual health after childbirth. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 186-195. https://doi.org/10.1111/j.1471-0528.2000.tb11689.x
Alligood-Percoco NR, Kjerulff KH, Repke JT. Risk Factors for Dyspareunia After First Childbirth. Obstet Gynecol. 2016 Sep;128(3):512-518. doi: 10.1097/AOG.0000000000001590. PMID: 27500349; PMCID: PMC4993626.
O’Malley, D., Higgins, A., Begley, C. et al. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth 18, 196 (2018). https://doi.org/10.1186/s12884-018-1838-6
