Postpartum Pain with Sex

After having a baby, there are many new sensations and some are uncomfortable, but important to discuss. This already stressful time can be made more difficult if you experience pain. Despite being cleared for sex as early as 6 weeks after giving birth, it is common for women to still experience pain.

However, it isn’t normal and there are treatment options available. After 8-12 weeks postpartum, the pain that lingers may be due to scar tissue, pelvic floor dysfunction, stress, and hormonal changes. These symptoms can occur in women who have given birth vaginally or via c-section.

Scar Tissue

Scar tissue can form in and around the vagina, perineum, and/or abdominal wall after giving birth due to tearing and surgical incisions. The formation of scar tissue can cause inflexibility and narrowing of the vagina, which can lead to painful intercourse. New and old scars can see improvement to their flexibility with scar tissue mobilization and the use of dilator therapy (see below for more).

Hormonal Changes

After giving birth hormonal shifts bring a decline in estrogen that can cause vaginal dryness. Hormonal imbalances can continue for up to 6 months or longer if breastfeeding and can contribute to decreased libido and pain experienced with sex. During this time increasing the use of vaginal lubricants inside and around the vaginal opening with sex and with use of dilators can decrease friction and improve comfort.

Pelvic Floor Tension

Pelvic floor muscles help support the uterus when pregnant and even if a baby does not pass through the vagina, the muscles can be strained from the excess weight. This may cause tenderness and pain in addition to other trauma that can occur with birth.

Abdominal muscles that are stretched and may be torn, separated, or affected via c-section. Work closely with the pelvic floor for stabilization, breathing, using the bathroom, and to offer support for virtually all movement.

If pain or other symptoms persist longer than 8-12 weeks discuss this with your physician. You may benefit from seeing a pelvic physical therapist to address pain, muscle weakness, and more.

Dilator Therapy

For persistent pain with intercourse, your physician or physical therapist may recommend dilator therapy. Dilators are cylindrical tools that come in a variety of sizes to slowly lengthen and stretch the vagina. They are used daily or several times per week, beginning with a smaller size and working up to larger sizes, for 10-15 minutes. Dilator therapy can help alleviate pain, improve vaginal tissue, and decrease tenderness to touch. This will help with any of the above issues.

The VWELL dilators (Also on Amazon) set comes with five medical grade silicone dilators with a tapered body to improve comfort and allow you to take back control of your recovery.

Dilators can be intimidating, but it should be a comfortable process that you can complete at home and at your pace. If you have not been directed to use dilators by a medical provider you can talk to your physician or pelvic physical therapist to work on an individualized program for you. Learn how to use dilators here!

Post written by Dr. Cassandra Sharp PT, DPT

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