Postpartum Sex: Overcoming the Barriers

Did you know that up to 80% of women experience pain during sex after giving birth? Shockingly, despite these challenges, around 15% of women do not discuss these symptoms with their doctor. This silence often stems from misconceptions about what’s “normal” postpartum, leaving many women to suffer in silence.

Typically, a woman follows up with her OB around six weeks after delivery and often hears, “You can return to life and sex!” But after hearing this, many women are left wondering:

Am I physically ready for sex?

Am I emotionally ready?

I’m so exhausted; I have no desire!

What if sex hurts?

My body feels different—what if something is wrong?

 

These concerns are common. There are various reasons why returning to sexual activity after childbirth can be challenging. Fatigue, body image changes, relationship shifts, breastfeeding, hormonal changes, and physical discomforts like perineal pain, vaginal dryness, and pelvic pain all play a role.

Understanding Your Body After Childbirth

It’s crucial to understand the changes your body has gone through and the healing process that follows. Many women try to cope by pushing through the pain or avoiding intimacy, but there are healthier, more effective ways to reclaim your sexual well-being after delivery.

One of the most important steps you can take is to see a pelvic floor physical therapist. Whether you’ve had a C-section or vaginal delivery, your pelvic floor muscles have likely been affected. These muscles may become either overactive or underactive, and scar tissue can cause restrictions or adhesions. Manual therapy techniques to mobilize and desensitize these areas can help make sex more comfortable and enjoyable.

Why Wait Before Returning to Sex?

It’s important to wait until you’re cleared by your doctor to resume sexual activity. Your body needs time to heal, and there’s a risk of infection if anything enters the vagina too soon.

Why Does Postpartum Sex Hurt?

Pain can stem from several factors, including surgical incisions from a C-section, episiotomies, or perineal tears. These can lead to scar tissue, which may cause restrictions, adhesions, hypersensitivity, or muscle tension. Addressing these issues with a pelvic physical therapist can make a significant difference.

The Impact of Hormones

After giving birth, your body undergoes hormonal changes that can affect your sex life. Sometimes the postpartum period can be referred to as a “temporary menopause” due to the drop in estrogen. This can lead to symptoms like vaginal dryness, pain during sex (dyspareunia), decreased arousal, and delayed recovery of sexual function. On the other hand, some women may experience increased erotic feelings postpartum.

If you’re experiencing vaginal dryness, there may be solutions you have not considered:

• Vaginal lubricants: These can decrease pain and friction resulting from vaginal atrophy and dryness. Not all lubricants are the same. Look for one with a vagina-friendly pH of 4.5, low osmolality, and glycerin-free. Lubricants can be made from water, silicone, oil, or aloe vera
• Vaginal moisturizers: These over-the-counter options are like a “lipstick for the labia”! Adding moisture to the vulvar and vaginal tissues can provide some relief
• Vaginal estrogen cream: Available by prescription, this cream can help regenerate thinning vaginal tissues. The estrogen level is low enough that it does not raise blood levels of estrogen, making it safe to use while breastfeeding

Pelvic Floor Physical Therapy

Another helpful way to address the changes you may be experiencing postpartum is to see a pelvic floor physical therapist. It’s important to address pelvic floor dysfunction, which can impact bladder, bowel, or sexual function. Coordinating your pelvic floor muscles with specific exercises and stretches will help you live with more freedom from pain, embarrassment, and inconvenience.

Yes, you may be experiencing changes, but please don’t ignore these or just put up with the symptoms. There are solutions available to make your sexual intimacy more enjoyable.

Building Trust and Comfort

The postpartum period is a time to reconnect with your new body and communicate openly with your partner. If you’re dealing with postpartum depression or anxiety, it’s essential to seek help from your doctor. Thyroid issues can also contribute to these feelings and should be checked.

You don’t have to put intimacy on hold while your body heals. Sensate Focus, a structured series of activities you can do with your partner, can help you build intimacy without pressure.

Remember, you’re not alone in this journey. Many women face these challenges, but with the right support and care, you can overcome the barriers to postpartum sex and enjoy a fulfilling, pain-free intimate life.

Heather Marra, PT, MPT, PRPC, PCES, is a pelvic floor physical therapist and founder of One Simple Step. For 25 years, she has empowered women to go from pain, fear, and confusion to freedom, confidence, and living. For more information on your pregnancy and postpartum journey, check out Heather’s book: Connecting With Your Body Throughout Pregnancy.

References:

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Perelmuter S, Burns R, Shearer K, Grant R, Soogoor A, Jun S, Meurer JA, Krapf J, Rubin R. Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms. Sex Med Rev. 2024 Jun 26;12(3):279-287. doi: 10.1093/sxmrev/qeae034. PMID: 38757214.

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Rosen NO, Dawson SJ, Binik YM, Pierce M, Brooks M, Pukall C, Chorney J, Snelgrove-Clarke E, George R. Trajectories of Dyspareunia From Pregnancy to 24 Months Postpartum. Obstet Gynecol. 2022 Mar 1;139(3):391-399. doi: 10.1097/AOG.0000000000004662. PMID: 35115480; PMCID: PMC8843395.