Dyspareunia or pain with intercourse is common after having a baby. An estimated 50% of women report pain with intercourse 3 months after delivery and 17% still report discomfort at 6 months postpartum (Buhling et al, 2006). More severe perineal injuries correlate with more persistent pain, however women who undergo a C-section delivery may also experience pain with intercourse in the postpartum period. Muscle and tissue injury, hormonal changes, sleep deprivation, changes in body confidence, and sense of self, can all negatively impact one’s libido and contribute to painful intercourse.
Pelvic floor impact: A vaginal delivery can cause perineal injury and leave scar tissue that is sometimes painful if there is limited mobility along the scar, particularly if vaginal dryness is present. Some people have increased resting muscle tone in their pelvic floor muscles that also contributes to pain. Constipation, tailbone pain, and only contracting pelvic floor (kegels) while not practicing the relaxation, are just a few things that can contribute to increased pelvic floor tone. Pelvic nerve irritation or injury can also contribute to pelvic pain after delivery. Seeing a pelvic floor physical therapist after you deliver can help you determine if your pelvic floor muscles or nerves are contributing to your pain. A lack of estrogen in the postpartum period can also cause the vulvar tissue to be more sensitive. You may benefit from asking your OB/Gyn if they think topical medication could help.
C-section impact: During a C-section an incision is made through skin, fascia, and multiple lays of muscle including the uterus along with other connective tissue. As with any abdominal surgery nerves that innervate the groin, pubic area, inner thigh and labia could possibly get interrupted or compressed causing irritation, numbness, or pain in those areas.
Ways to reduce pain:
1. Scar tissue massage. Either at the perineum or abdomen, once the scar is healed (usually around 6 weeks) you can start to massage over any areas of scar tissue, working both on the surface and deeper layers of the scar to help improve scar tissue mobility and blood flow. Work with a pelvic floor physical therapist to learn how to perform scar tissue massage on yourself.
2. Pelvic floor relaxation. So often after vaginal delivery people are told to do kegels, “to build strength back up”, “to get tighter down there”, or “back to normal”. While pelvic floor strengthening may be appropriate for some people, it could make pain with intercourse worse. After a perineal tear, scar tissue or stitches, painful first poop, months of dealing with hemorrhoids, increased time sitting to feed a new baby, your pelvic floor has been through a lot. Injury and trauma in the area can create a protective contraction response where the muscles are being held short and tight. You might actually benefit from learning to relax or lengthen your pelvic floor to reduce pain and urinary urgency. Working with a pelvic floor PT at MEND can help you understand what is going on with your body.
3. Use lubrication. Due to hormonal changes, the vulvar tissue can feel drier than normal and using a lubricant can be beneficial. Not all lubrication is created equal. Pick a lubricant that has a pH close to normal vaginal pH (~4). Oil and silicone based lubricants tend to provide more moisture for a longer time, while water based lubricants can easily be used with condoms or silicone products. Oil based lubricants should not be used with condoms, and silicone lubricants should not be used with silicone products.
4. Build intimacy that doesn’t involve pain. Using a program such as Sensate Focus to build communication and discover new types of physical touch that feel good and are not painful. This could start as a foot rub or back massage without an agenda to do more. Connect with the sensation of touch and tuning in to what feels good and continue to build on that intimacy. It may be helpful to talk with a psychologist who specializes in sexual health or postpartum care.
5. Make time for you. With the responsibilities of caring for a tiny human, lack of sleep, changes in work and life habits, it’s normal to not prioritize time for yourself. Without time for you to relax, get creative, and re-energize yourself, your libido and drive will likely have little energy to grow from.
So often people and new mothers especially are told that pelvic pain or pain with intercourse is something they just have to put up with or push through. If you’re having pain with intercourse, please know that help is available and that although it is common, it is not something you should have to deal with all alone.