Ask A WHT Doctor: Why is Sex Painful Postpartum?
Giving birth is one of life’s most rewarding miracles. Once the baby has arrived, it takes time for your body to heal and adjust to a “new normal” post-partum. With the focus on the little one, you may be too tired, overwhelmed and sore to even think about being intimate with your partner. Once your doctor says that it’s okay, and you are ready to have sex again for that first time, women are sometimes surprised that it is different, uncomfortable and even painful. It is important to know that many women experience these issues and should not be suffering silently or hoping that it goes away on its own. Discomfort and pain should be talked about with your ObGyn because there’s a range of treatment options available to help. We sat down with Dr. Jessica MacLeod of Renaissance Women’s Group, a Women’s Health Texas care center to review what happens to your body post-partum, how the healing process can impact intimacy and the ways that your ObGyn can help if you are experiencing any of these issues.
Is it common to experience discomfort during sex post-partum?
It is fairly common. I will see patients that tell me they are experiencing painful intercourse after delivery on a semi-regular basis. There’s a lot of different causes for this, but the most common is often seen with breastfeeding moms who will have an altered hormone status. Breastfeeding causes lower estrogen in a way that is similar to what postmenopausal women experience even though they’re not menopausal. It also causes vaginal tissue to become thinner and can also cause discomfort.
Is sex painful for women that have vaginal and c-section births?
It can be, based on multiple factors that women deal with post-partum. On a physical level, there is a strong correlation between breastfeeding and estrogen levels that can affect intercourse. Low estrogen can result in vaginal dryness and decreased sex drive. In addition, whether breastfeeding or not, new moms deal with sleep deprivation and a significant change in their relationship. Those changes can cause difficulty with lubrication and sexual arousal. Also, depending on the type of delivery, there could be scar tissue and tearing and damage to the pelvic floor muscle or nerve damage if it was a long, difficult delivery.
When does this topic come up with post-partum patients?
After delivery, there are typically two visits that take place. The first one is often after the first two to three weeks and then another visit at six weeks. At the six-week visit is when most women have a vaginal exam. The purpose is to assess the healing process and if there was a more complicated or intensive delivery, we want to be sure that the stitches and internal organs are healed. At that point, women shouldn’t typically be having sex, but at this visit, we make sure everything has healed enough to resume everyday activities including sex. It is at the following visit that women will raise an issue or concern.
How does the pelvic floor affect intercourse?
The pelvic floor is a group of muscles that begins at the pubic bone and connects to the coccyx. It’s like a bowl inside of the pelvis that holds all of the organs up and is right where the baby sits during pregnancy. So, the vagina goes through this group of muscles, the pelvic floor. Pregnancy and delivery cause stress on that pelvic floor. So even women who have a c-section can have some damage to the pelvic floor, but more often women that have a vaginal delivery experience nerve damage or physical tearing causing weakness in the pelvic floor which can sometimes lead to urinary incontinence. With healing, the muscle can overcompensate on the other muscles and lead to muscle spasms. And in that case, women often have a difficult time relaxing these muscles or experience a spasm during intimacy, leading to painful intercourse.
What is the most common treatment plan and what is the timeframe for recuperation?
Treatment depends primarily on what the issue and cause are for the pain and discomfort you may be experiencing. An example is an issue like the pain that is caused by vaginal dryness and vaginal atrophy. It is often treated with vaginal estrogen we would expect a result within a month or so, but we will continue to re-evaluate until the issue is resolved. An issue like a pelvic floor muscle spasm may require longer and a variety of treatment based on the symptoms and needs of the patient. Some women require physical therapy for several months and we would continue to evaluate over three to six months.
It is very reliant on what the problem is, and the treatment is personalized based on all the details of the birth experience, issues, symptoms, and pain of the mom. In some cases, a woman may not address her pain right away or wait to see if the issue resolves on its own. In the case of breastfeeding and estrogen levels, it may not be until after six months, or longer than the baby has been weaned that their hormone level may not naturally go back to normal until a year mark. Because of that they may not even be thinking about it or thought to talk to their doctor about it or in past experience, their hormones have returned to normal in previous pregnancies and it was not a concern.
What are the common symptoms women experience that define painful postpartum sex?
The first place we would start once an issue is mentioned is with an evaluation to make sure that we’re ruling out things like infection because an infection can certainly cause similar symptoms and then an exam to discuss specific pain and symptoms.
Most women that are experiencing low estrogen will typically describe their sexual experience as dry, or that the friction of intercourse feels like sandpaper. Others have described a burning sensation during, or after sex, and sometimes mention bleeding. In some cases, women are not used to using lubricant during intercourse so they may not have known that it will assist with that dryness. We also typically utilize vaginal estrogen cream to help with these types of issues.
There are times that women will have pain that is very localized and they’ll mention that they had vaginal tearing during delivery and in the area that the stitches had been is highly sensitive and they may feel that very specifically during sex. It may also feel like things don’t stretch like they normally would, or there might even feel like there’s a lump there that they can actually feel an area where they had them, and we talk through those kinds of experiences during the exam. With poor healing issues, there might be surgical intervention required depending on the scar tissue and how severe the problem is.
Women who are experiencing pain inside of the vagina, not necessarily right at the opening but deeper inside the vaginal canal or describe a cramping sensation or cramping into their pelvis during sex, that might more indicative of a pelvic floor spasm. During the exam, we can check the pelvic floor muscles to see if there is any evidence of spasm. That would lead us in the direction of physical therapy, or at-home exercises. That might be something that requires anywhere from six weeks to upwards of three months of treatment before we expect significant results in terms of improving pain with intercourse.
What about Kegel exercises?
With Kegel exercises, we often give patients a brochure that explains what to do and we review which ones would be best for their specific issue. We have an excellent nursing staff that can also review the pamphlet and helps with any questions with patients that call for help. Often times, when dealing with a muscle spasm it is not a concern for strengthening the pelvic floor, it’s about learning how to control the pelvic floor so that it can relax and release the tension that is causing pain. So, in physical therapy what they’re doing is they’re using electrical stimulation to try and fatigue the muscle and other sophisticated techniques to help. Kegels are a good place to start, but more help may be needed.
Is it common to deal with these issues repetitively with a second or third child?
For most moms, recognition is a little bit quicker with subsequent births and I’ve had patients who became more proactive about mentioning an issue after a second pregnancy. Once they’ve had the experience with their body and knowing what has happened, we can work quickly to get ahead of the issue because they have that knowledge.
It is common to just hope an issue will get better or think that it is a normal part of the childbirth process, but that’s why it’s important to tell us how your body is feeling because we can help. It can be difficult to bring up the issue because it deals with sexuality, but it is important to not ignore it because your ObGyn cares about your sexual health and overall wellbeing.
Is there harm in not seeking help?
It’s imperative to talk to your physician when you are experiencing pain or discomfort. Having an evaluation and exam will incorporate testing for infection, poor healing and other issues that will not go away on its own. It is also important to document your experience with your provider so that there is an understanding of how your healing has progressed and to build a medical history for future treatment.
Using lubricant does not require a prescription and is a helpful tool to use. If you do have questions or haven’t used a lubricant on a regular basis either before having kids or after having kids, you can always talk to your doctor.