Aside from being exhausted from feedings, diaper changes and sleepless nights, having a baby can also affect your libido. If sex is painful, it can turn you off entirely.
Pain during sex after birth is common and can happen for both vaginal and cesarean women. The good news is that it can be helped.
1. Pelvic Floor Muscles
One of the main reasons for pain during sex after birth is that the pelvic floor muscles may have been stretched or injured during pregnancy and childbirth. This is especially true if vaginal tears or an episiotomy were required. Women with these injuries often experience a pain during penetration (dyspareunia) even after the tissue has healed. Gentle exercises or self-massage to desensitize these tissues can help. A physical therapist with advanced board certification in pelvic floor physical therapy can help teach these techniques to clients so they don’t have to suffer the pain.
In addition to preventing urinary incontinence and prolapse, the pelvic floor muscles are important for sexual function. They are used by men for erection and by women for pelvic organ support and sensation during sex. Those same muscles are also responsible for helping to prevent urinary incontinence after a Cesarian section.
To perform a Kegel, sit or lie down with your thighs and buttocks relaxed and squeeze the muscles in your anus (back passage) as if you were trying to stop passing gas. Repeat this exercise several times a day. As you improve, slowly increase the number of squeezes and your duration of each. Work these muscles into your daily routine such as when brushing teeth, doing laundry, checking social media, or driving to work.
2. Incisions or Tears
The area between your vagina and anus, known as the perineum, may tear during childbirth. This can range from a small first-degree tear that heals on its own to a more severe second-degree tear. A doctor may also need to repair a third-degree tear, but this is rare. If your tears or episiotomy become infected or have a pus-like discharge, you should tell your health care provider.
Many women undergo an episiotomy, which is an incision that a doctor makes to widen the opening of the pelvis during childbirth. This is done when a baby is in a c-section position or has trouble passing through the smaller part of the pelvis called the occiput posterior. It can also happen during labor when a baby is having trouble tucking in, as explained by Healthline.
Tears from an episiotomy and from the trauma of childbirth can affect how your body responds to sex, but this can be helped with proper lubrication and using a vaginal ring or prosthetic for lubrication. You can also do Kegel exercises to strengthen the muscles in the area. If you notice that your perineal injury hurts more during sex or that there’s any bleeding from the area, talk to your doctor. They can prescribe medication to help manage pain. They can also refer you to a mental health practitioner for support.
3. Scar Tissue
Scar tissue forms in the areas where the pelvic tissues were stretched, pulled and broken during the birth. When scar tissue is present, the area can be very sensitive, especially during sexual activity. This can occur for a number of reasons and is not normal.
The pain may be triggered by the movement of the sex organ (anus) and can also be a result of stretching of ligaments and muscles around the anus. This is because scar tissue can cause your internal organs to move in ways that they shouldn’t.
Another reason for painful sex may be due to scar tissue forming a tight band that restricts the vaginal opening. This is a common problem for women who have had an episiotomy or a cesarean section.
It is important to speak with your doctor if you are experiencing any of these symptoms. It is also a good idea to do pelvic floor exercises, such as Kegels, during and after pregnancy to help strengthen the pelvic floor muscles and avoid causing scar tissue problems. It is also a good idea to only have sex when you feel ready, and not to rush into it. Always listen to your body and only resume sexual intercourse after you have received medical clearance. Doing so helps reduce the risk of complications such as a blood clot or infection.
4. Pelvic Pain
After pregnancy and delivery, your body goes through a lot. Whether you had a vaginal birth or C-section, childbirth puts your pelvic floor through trauma that can lead to lasting pain and dysfunction.
Your uterus expands during pregnancy as the baby grows inside, pushing on muscles and bones that move and stretch to accommodate. This can lead to a weakened pelvic floor (PF) or create extra tension in your PF, both of which can cause different symptoms.
In addition to pain from scar tissue, many women are left with painful intercourse due to a medical procedure called perineal tearing or an episiotomy. This results in a tight, sticky and sensitive area that causes painful intercourse for weeks after delivery. It’s also common to experience a pubic diastasis, or separation of the pubic bone, during pregnancy. This is usually not a serious problem, but it can be painful to sit, exercise and walk.
Although some discomfort during sex after birth is normal, it’s important to get it checked out by a physiotherapist. This is because some pain can be a sign of underlying issues, such as bladder leakage, prolapse and pelvic girdle pain. It is always better to treat these early on, rather than ignore them. This will ensure that your GP, midwife or physiotherapist can help you to feel better sooner.