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
Do you have a history of pregnancy and delivery? Whether or not you have had a live birth, or a cesarean or vaginal delivery, painful sex after pregnancy is common and treatable with pelvic floor physical therapy.
You may want to enjoy sexual intimacy for your mental health support because orgasms release endorphins!
You may desire to resume intimacy with your partner to nurture your relationship with them.
However, your body has been through a transformation to move through pregnancy, to deliver a baby (assisted, spontaneous, or cesarean), or to experience pregnancy loss. Therefore, penetrative sex after pregnancy can be stressful for many people.
If you have given birth, you may have heard that it will hurt initially, but after a while “it should get better.” This implies that the pain is normal.
Persistent sex pain after birth (dyspareunia), or pain with vaginal penetrative sex, is not normal and it can be treated with pelvic floor physical therapy.
How common is postpartum dyspareunia?
In a 2022 study in the Journal of Obstetrics and Gynecology, roughly 31% of first-time parents with a vulva experience pain with penetrative sex at three months postpartum. Of the people surveyed, 11% continued to have pain 24 months postpartum.
Despite how common this is, postpartum pain with sex is largely under-reported because most vulva bodies do not share their sexual health concerns with their provider.
You may have received sexual counseling at your six-week postpartum visit, but your pain or difficulty with sexual activity beyond this appointment can be easily overlooked.
What are some of the symptoms of pain during sex after birth?
Pain or discomfort during vaginal penetrative sex is any unwanted sensation that does not feel good and was not present before pregnancy or delivery.
It may include dryness or chafing.
It may feel like sharp, stabbing, or aching symptoms.
Post pregnancy and early postpartum is like a mini perimenopause. Your hormones may be contributing to dryness. Use lube!
If you are experiencing additional symptoms such as burning, shooting symptoms, numbness, tingling, itching, and stabbing sensations, pelvic floor therapy can help!
Are you experiencing symptoms during or after penetrative sex?
How is initial vaginal penetration?
How does it feel? Tight, stiff, dry?
Are your symptoms superficial or deep?
When do your symptoms start? Does it matter if sex is prolonged?
Does the angle or sexual position matter?
Does your vagina feel heavy?
Do you experience a change in bladder function after penetrative sex? Urinary urgency? Leaking urine?
If any of these questions are related to your experience, you likely have “pelvic floor dysfunction” and postpartum PT can help! Pelvic floor physical therapy will explore these questions with you. These symptoms are common and very treatable.
It may be common to think, “I do not pee my pants, so it’s fine.” But your pelvic floor muscles do so much more than that!
Your pelvic floor adapts during pregnancy, and the postural compensations may need to be addressed now that you are no longer pregnant.
You may benefit from pelvic floor physical therapy to address how your pelvic and core muscles coordinate with your breathing and how they support your posture, your core muscles strength, and your bowel, sexual, and bladder functions.
What can contribute to sex pain after birth?
Birth trauma - perineal tearing, muscle strain, nerve injury, Cesarean delivery, and vacuum or forceps-assisted delivery
Pushing for longer than 2 hours or less than 20 minutes increases the chances of incurring birth trauma.
Emotional trauma from stillbirth, serious concerns of the health of the birthing person or infant, unplanned medical interventions
Estrogen changes - decreased estrogen can cause changes to your vulvar tissue and may contribute to dryness or irritation during penetrative sex. Reduced estrogen may continue during lactation and linger for at least a few months after you stop lactation. Use lube!
If your symptoms during penetrative sex are largely due to decreased estrogen, you may also be experiencing hot flashes and night sweats.
What can contribute to “pelvic floor dysfunction”?
Changes to posture, core strength, joint mobility of the whole spine, ribs, pelvis, and hips
Returning to exercise too soon after delivery.
Progressing exercise too quickly after delivery.
Complications from perineal tearing or Cesarean delivery - painful scars or decreased cervical ligaments mobility
Pelvic pain during pregnancy that was not cared for or addressed during pregnancy and is now persistent.
Fatigue, stress, mood changes, or insufficient social or professional support to grieve or to care for your baby.
Increased muscle tension.
Delayed tissue healing.
What is postpartum PT for painful sex after pregnancy?
Your pelvic floor PT is part of your health care team to comprehensively care for whatever factors are driving pain during sex after birth. Your team may also include an OB-GYN or midwife, and a mental/behavioral health specialist who can help hold the stress, grief, or other postpartum mental health concerns.
Scar and visceral fascia mobilization techniques to improve how your scars and fascia move with your movements and to improve blood flow to decrease pain and improve function.
Your pelvic PT can determine the causes of your pain with sex, and can treat the issues specifically and help you improve your pelvic floor function.
For example, if your symptoms are caused by tense muscles, you will be able to identify the pelvic floor muscles and train them to rest sufficiently, or you may need other core muscles to support you more. If your symptoms are caused by inflammation or injury to your pelvic nerves, your pelvic PT can treat these tissues and prescribe tailored movements to improve the blood flow to the nerves and improve tissue healing.
Your treatment plan and education will be customized to your needs, your lifestyle, your body, and your values.
You will begin to train appropriate and long lasting core muscles conditioning and strengthen your pelvic health and spine support, improve how you do all daily activities, and to enjoy vaginal penetrative sex again!
If participating in vaginal penetrative sex after birth causes fear of pain and distress, your postpartum PT will offer gradual and individualized exposure resources, based on modern pain science, to gently ease your neurophysiology and reduce fear.
Relaxation techniques are important because your pelvic floor and your autonomic nervous system (fight, flight, freeze, rest, digest, etc.) are interconnected.
Education (online visits available) about what is best for you, especially if you have tried many things, have heard various tips from friends and the internet, and you need guidance to sift through the noise and to keep it simple but relevant to you. This education can include lifestyle adjustments to prevent pelvic floor issues in the future and to sustain long term recovery and comfort.
If you are in the state of California, book a visit to learn more about pelvic floor physical therapy for painful sex after pregnancy. We offer Telehealth and in-person visits. Our office is located in Oakland, CA.
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
