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Painful Sex Following Delivery

Pain with intercourse is common after delivering a baby with reports ranging anywhere from 12-62% reporting pain at 3 months, 17-45% reporting pain at 6 months, and 8-32% reporting pain from 12-18 months. There are many potential causes and risk factors that may impact this. Let’s go over a few of them:

  • Mode of delivery: While this may seem surprising, the mode of delivery (cesarean vs vaginal) does not change the risk of developing pain with intercourse. That being said, most studies suggest the use of forceps can lead to a higher chance of developing pain with sex.
  • Tearing during delivery: The higher the grade of tearing, the more likely someone is to experience pain with intercourse.
    • Compared to women with an intact perineum, those who sustained a second-degree tear were 80% more likely to report pain with intercourse, and those with a third- or fourth-degree tear were 370% more likely to report painful intercourse 3 months following delivery. (Episiotomy has similar scores to spontaneous tears).
  • Breastfeeding: Breastfeeding can lead to an increased risk of painful sex. Breastfeeding changes our hormonal system and can lead to vaginal dryness and delayed healing from childbirth.
    • One study reported women who were breastfeeding were 4x more likely to report pain compared to those who did not.
  • Number of children: Women are most likely to experience pain with sex after their first delivery.
    • For women after their first delivery, one study had 41% of women reporting pain with intercourse at 3 months following delivery and 22% reporting pain after 6 months.
  • Psychosocial factors: Feeling fatigued, depressed, or stressed. I know, I know, who doesn’t feel stressed and tired after delivering a baby?! However, these feelings are strongly correlated with pain with sex.

What can you do about this:

  • Lubrication: Estrogen is the hormone that keeps the vaginal tissue plump, moist, and elastic. Without enough estrogen, the vagina tissue can seem dry and fragile. Following delivery, estrogen levels tank! This drop in estrogen can lead to increased dryness and irritation following delivery. Estrogen levels will also drop during breastfeeding, which can be part of the reason for an increased chance of pain with intercourse for breastfeeding moms compared to those who do not breastfeed. Using lubrication can help reduce discomfort significantly! Even if you are someone who never needed to use lube before, it can make things so much easier when getting back into having sex after having a baby.
    • Discount codes:
      • Intimate rose: 20% off with code “Brooke7”
      • Sliquid: 20% off with code “MP20”
      • Good Clean Love: 30% off with code “Samples30”
    • Some lubricants even have numbing agents or CBD to reduce pain.
      • GoLove (CBD lubricant) use code “comfort” to save $5
    • When looking into what lube to use, make sure to note the ingredients to avoid anything that can lead to further irritation or sensitivities (see https://imovedaily.com/how-lubricant-ingredients-influence-pelvic-health/ for more info on this)
  • Wearable buffers: Products such as the Ohnut are wearable buffers if you experience pain with the depth of penetration. They are worn on the shaft to prevent it from entering too deep and can be adjusted for depth depending on your needs.
    • You can try the discount code “Brooke7” to save $7
  • Change in positions: First and foremost, communicating with your partner about how you are feeling is really important.
    • Different positions can allow for more relaxation in the pelvic floor. Try positions where you feel the least amount of strain (lying down on your back, stomach, or side can sometimes be a bit easier).
    • You can also try using pillows or wedges to help you find more comfortable positions.
  • Understand the body’s trauma response:
    • The stress placed on the body during pregnancy, labor, and delivery can be very difficult for the body to adjust to. This stress can lead to hyper-reactive pelvic floor musculature. The body’s trauma response is to form a spasm when it feels threatened. Whether it be insertion during sex or even the use of a tampon, this can trigger a trauma response and lead to pelvic floor muscle spasms.
    • To address this, you can try pelvic floor massage (see my previous blog for more information and handouts of pelvic floor massage at https://imovedaily.com/internal-work-pelvic-floor-massage/ )
  • See a physical therapist: When all else fails, seek help from a trained medical professional. Pain with sex does not need to become your new norm, and pelvic floor physical therapy can help.

If you have any questions or are curious about how physical therapy can benefit you, feel free to contact us 616.847.1280 to schedule a complimentary consultation with one of our skilled pelvic health physical therapists.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993626/

https://pubmed.ncbi.nlm.nih.gov/11303195/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843395/#:~:text=Dyspareunia%E2%80%94pain%20during%20vaginal%20intercourse,at%2012%E2%80%9318%20months).

 

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