Top 3 reasons why sex might hurt postpartum
While sex might not be the first thing on your mind immediately postpartum while caring for a newborn, the return to intercourse can be a scary prospect for someone recovering from childbirth post vaginally or abdominally.
In a large study in Australia, women delivering both vaginally or abdominally via cesarean were asked to self-report their pain with sex at three postpartum time points. About 86% reported experiencing pain on first experience, about 45% at 3 months, and about 23% at 18 months postpartum. So even at 1.5yrs after birth, about a quarter of the women surveyed were still experiencing painful sex.
What is dyspareunia?
Genital pain experienced just before, during, or after sexual intercourse. This can have a significant impact on one’s mental and physical health, body image, relationships with partners and efforts to get pregnant.
Why does this happen?
There can be many factors but below are our top 3 reasons why sex might hurt postpartum.
Reason #1: Scar tissue from perineal tears
During a vaginal delivery, there may be some injury to the skin, fascia and muscles due to speed of delivery and increased stretch of the tissues. This can range from a superficial skin tear to an injury involving the perineal muscles and extending into the anal sphincters and rectum. Healing of these tears can lead to residual scar tissue that may be painful to touch, pressure and stretch with vaginal insertion.
Reason #2: Tight pelvic floor muscles
Pelvic floor muscles can be overactive or “tight” which can lead to reduced ability to relax or stretch to accommodate vaginal penetration for intercourse. This can happen because of increased tension from habits like clenching our butt/abs/teeth and/or the reduced ability to relax our pelvic floor muscles. If your pelvic floor muscles are shortened and tight they may be painful with attempts at intercourse leading to fear of vaginal penetration and contribute to trouble with conscious muscle relaxation to allow intercourse to occur.
Reason #3: Vaginal Wall Atrophy
While this is more commonly thought of happening during peri-menopause and menopause, postpartum women can experience vaginal dryness resulting from tissue thinning, reduced elasticity and have their vaginal tissue be more prone to injury. This can be the result of estrogen deficiency postpartum which contributes to blood flow, vaginal lubrication and tissue quality. Around 2-3 months postpartum, your hormones begin to reset to pre-pregnancy levels but this can be impacted by stress levels, lack of sleep, any previous hormonal issues, and breastfeeding. Hormones levels are suppressed longer in those who breastfeed and depending on if and how frequent, these levels might not return to normal until after 6 months postpartum.
If you are currently experiencing pain with intercourse or have concerns for postpartum wellness check out our team of specialist. We offer in person and virtual consults
Make sure to also check out our 12 week postpartum program which includes weekly workouts specific to core and pelvic floor and includes LIVE opportunities to meet with our team every quarter:
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Women In Motion Team