The following is a guest post by Annemarie Everett Lepe, PT, DPT, Clinic Director at Miracle Physical Therapy. 

Should you have painful sex postpartum?

“Sex after having a baby is supposed to be painful, right?”

As a pelvic floor physical therapist specializing in the treatment of postpartum issues, I hear that question several times per day. But the answer is a resounding “No!”

My first objective in treatment is to try to understand what kind of discomfort my client is feeling, which helps me determine the right course of action. Feelings of “rawness,” “friction,” or “dragging,” or seeing spotting of blood after intercourse indicate to me that lack of vaginal lubrication is a major contributor to my patient’s discomfort.

If a new mom is breastfeeding or pumping, it means that she has lower estrogen levels. This creates thinning of the vaginal lining and greater sensitivity to repeated contact during vaginal intercourse. Even if someone isn’t lactating, it’s possible that the life of a new parent isn’t helping with producing vaginal lubrication as before pregnancy. There can also be an elevated degree of discomfort from vaginal dryness.

Why does painful sex after pregnancy happen?

If a patient tells me that she is feeling muscle tension at the vaginal opening, like the “doors are closed,” that usually indicates involvement of the superficial layer of pelvic floor muscles. This can occur because of muscles reacting to discomfort from vaginal dryness, and often as the result of any perineal tearing and stitches from a vaginal birth. I have often seen it occur following cesarean delivery as well, because of the tension generated on the pelvic soft tissue at the lower abdominal surgery site.

Pushing through painful postpartum intercourse is never my recommendation. Most of the time, repeated painful experiences teach your body to anticipate and “guard” against that experience the next time – which in turn creates more discomfort!

How To Beat Painful Sex Postpartum

One or both of these sets of symptoms may be present, but regardless my first recommendation is to use a good quality lubricant. That means pH balanced with no special scents or “tingly” properties. Even if someone did not need it before pregnancy, most new moms and especially a client who is lactating may see a huge change in their symptoms if they begin using lubricant.

If changing to a good lubricant does not resolve the issue, physical therapy from a pelvic floor specialist is the next step for treatment of any muscular dysfunction.

Learn more about managing pain during sex by speaking with one of our GYN providers. Learn more about Telemedicine here.