Women who have had a 2nd degree tear should wait until their stitches are healed before trying to have sex. This could be 6 weeks after delivery.
It’s important to remember that if sex is painful it will not be pleasurable. If you are having trouble, try doing pelvic floor exercises (such as kegels) or seeking the help of a pelvic floor physical therapist.
Talk to Your Health Care Provider
The best time to resume sex is when you and your partner feel physically and emotionally ready. This might take a while. Your libido may be low after having a baby, and it’s normal to feel uncomfortable during sexual activity as the scar tissue heals and organizes. In addition, having a baby lowers your body’s circulating estrogen levels. This can make your vaginal tissues less stretchy and lubricated. Serial attempts of sex can help your muscles work through this period, and communicating openly with your partner will promote comfort.
If you had a 2nd degree tear or anal sphincter injury, it’s important to talk to your health care provider about when it’s safe for you to have sex. They can advise you about how to prevent infections and what to expect with your recovery, including how long your stitches will last.
If you had a C-section delivery, your doctor will likely recommend that you abstain from sex until you have your six-week checkup after the birth to see how the incision has healed. This is a good idea because you’ll be more prone to infection if your uterus is still open. You might also want to talk to your doctor about pelvic floor physical therapy. This will strengthen the muscles that support your bladder and vulva, and may help with urinary or fecal incontinence.
Do Pelvic Floor Exercises
A vaginal birth places a lot of demand, or load, on the pelvic floor muscles. These muscles have to stretch, open and contract in order to push the baby through the birth canal. Sometimes they can tear or be strained during this process and may not work well afterwards. This can lead to pain in the perineal area, leaking urine or feces, and pelvic organ prolapse.
It is important to do pelvic floor exercises daily, called Kegels, to strengthen the muscles that support your bladder, womb and anus. These are best done in a sitting or standing position, with your back upright. It is also optimal to have a pelvic health physio or women’s health physio to help teach and guide you with these exercises and other core and postural strategies.
The generic advice after childbirth is to take it fairly easy for 6 weeks and then start incorporating more exercise as you feel comfortable. However, this advice is tuned for people with a first degree tear and not those with 2nd or 3rd degrees of injury to the pelvic floor muscles or levator avulsion (which extends into the anal sphincter). For these injuries, recovery may be much slower. Keeping your pelvic floor muscle strong will protect you from pelvic organ prolapse and incontinence down the road as well as making orgasms and sex more satisfying.
Take Care of Your Injuries
The skin part of the tear heals within weeks, and most tears close on their own without requiring stitches. You may notice bits of the stitching on your toilet paper or sanitary pads, but this is normal and nothing to worry about.
It is important to practice good hygiene after having a 2nd degree tear to prevent infections. Make sure to wash the area after you use the bathroom and after using a tampon or menstrual cup. You should also avoid sitting for long periods of time. It might help to sit in a bath that is deep enough to only cover your buttocks and hips (this is called a sitz bath). You can also try placing ice packs on the injury, or wearing special sanitary pads with a cold pack inside them.
You should always wear loose pants and underwear that fit well to minimize friction on your perineal wound. Avoid thong-style underwear if possible, as these can cause the skin to rub against itself, which could worsen the tear.
You will likely have a medical checkup about three to four weeks after you give birth and another six weeks later. During these appointments, a member of your health care team will look for any signs of infection or any other problems caused by the tear.
Consider Contraception
In addition to the pain and discomfort caused by perineal tears, some women have difficulty with sexual activity after having one. This can be very distressing and have lasting effects on a woman’s attitude towards a future pregnancy (6). Healthy sexual activity is seen as an indicator of a woman’s overall health (2) and women who are struggling with these problems might need psychological support in order to be able to deal with them (3).
A first-degree tear usually heals without stitches, but most second-, third-, and fourth-degree tears do require sutures. Your doctor or midwife will give you a local anesthetic (or a pudendal block) before repairing the tear to minimize pain and discomfort.
You may feel some pulling and tugging as the sutures are placed, but this should be tolerable if your epidural is still working. In the case of a third- or fourth-degree tear, you might not be able to feel anything.
Some women have reported persistent pain in the perineal area after delivery, and this can last for months or even years (5). This is known as dyspareunia and can lead to avoidance of sexual activity. A study conducted by Gommesen et al (6) found that women who had suffered these complications from labor tended to have negative attitudes towards a future pregnancy and might not be open to the idea of having more children.
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