One thing that often catches my new moms by surprise is finding postpartum sex can be painful. Here are the reasons, along with a game plan for navigating painful sex postpartum and unlocking intimacy once again.

A common experience in postpartum is painful intercourse. Many of my patients are surprised that their sex life didn’t simply go back to normal once their six-week recovery period was up. There are several reasons for this. As a postpartum nurse, let’s look at unlocking intimacy and navigating painful sex postpartum.

The postpartum period is a delicate time of healing and recovery. Even after our six weeks is up, our body continues to heal, recover, and go through big changes for several months. Let’s take a look at some of the reasons we can experience different sexual intimacy after birth.

Unlocking Intimacy: Navigating Painful Sex Postpartum

Sexual health is important, but slow is your new sexy for a while. Here’s why:

Sex Drive

Estrogen levels can lead to temporary vaginal dryness after birth. Breastfeeding can also affect sexual desire. These hormonal changes can cause a decrease in libido, trouble staying lubricated, and even the milk reflex happening during sex. It can be quite messy! Milk production can also lead to dehydration which affects vaginal lubrication as well. 

I recommend Femallay Vaginal Melts (not a sponsor, just appreciate the ingredients) or a water-based lubricant to help with lubrication after the all-clear to have sex from your doctor or midwife.

Mom Brain

Because of brain plasticity after birth, our minds are forming new connections and eliminating old ones. All of this rearranging allows us to bond with our babies as well as change our priorities to protect our new baby at all costs. This vigilant brain kicks in every time our baby cries. If we are in the middle of sex or attempting to be intimate, and our baby cries, we can kiss that drive goodbye. Our entire being shifts to mom mode. This will level out over time, and you will find your sexual self again. 

Scar Tissue

Scar tissue from birth trauma or injuries like episiotomies or a vaginal tear can cause sexual dysfunction. This can feel rough or “not right” when trying to have sex. It can be uncomfortable or painful and can be at the vaginal opening, the vaginal canal, or the perineum. More on what you can do about this in a bit.

Pelvic Floor Dysfunction

Your pelvic floor muscles go through quite the ordeal during birth. Your baby’s head has to navigate through them before descending into the birth canal. Depending on the tightness of the pelvic floor, this could lead to strains or injuries that need time and physical therapy to heal properly. The pelvic floor plays a great deal in sexual activity even before birth, and possibly more so afterwards. Vaginismus (the involuntary tightening of the vagina muscles), can also cause postpartum dyspareunia (painful sex). Ask your healthcare provider for a referral so insurance will be more likely to cover the cost of a pelvic floor therapist. 

Unlocking Intimacy: Navigating Painful Sex Postpartum

This certainly doesn’t have to be your forever. There is hope! But there are also several adjustments you can make right now that take some of this burden off of your shoulders.

Solutions for Healthy Sexual Function

The good news is that just because you have sexual pain right now, doesn’t mean you always will. New mothers with a perineal tear of the first or second degree may heal for two to six months postpartum. This means that sexual intercourse may feel painful or sore until that time. (I had a second-degree and felt soreness until six months.) Women with third or fourth-degree tears or episiotomies after a vaginal delivery, may experience pelvic pain or sexual issues for up to a year after birth. 

Please do communicate with your spouse or significant other about what is going on. We can’t expect them to know or be empathetic if we don’t tell them. They may have falsely been told that you would be back to normal sexually by six weeks. This rarely is the case. Hormones cause sexual arousal to be lower, our changing postpartum body may cause us to feel insecure, a perineal scar may cause discomfort,  or our pelvic floor may be injured.

Forms of Intimacy

Slow is your new sexy for a bit. Avoid penetrative sex until you are ready. If you have been okayed for this form of sex, but it causes pain, use other kinds of intimacy for a time. Things like oral sex or keeping intimacy on the “outside” can still be intimacy-makers while allowing you more time to heal and recover. When you feel penetrative sex is right, ask him to go by your cues. Slow and easy will probably feel best for a while. I don’t ever recommend anal for women. Because of our anatomy, it leads to fecal incontinence and anal sphincter injury (here’s the research).

Pelvic Floor Physical Therapy

The healthcare professionals that are best with pelvic floor health will be a pelvic floor physical therapist. They will be able to assess vaginal tissue, physical changes, and scar tissue, and help get you to pelvic health. I hope to one day see postpartum healthcare automatically include pelvic floor physical therapy, but until then, ask your OBGYN or midwife for a referral to a pelvic floor physical therapist so your insurance is more likely to cover it. If you don’t have insurance, call recommended therapists and ask about available payment plans.

Dolphin Neurostem MPS Therapy

C-section patients will at times be sexually affected because of left-over pain in their c-section scars. Dolphin Neurostem MPS Therapy is a form of microcurrent therapy that can release muscle, fascia, and help reroute the nervous system. Research is promising that this can relieve pain in c-section scars. Ask your pelvic floor therapists about this. Some massage therapists or other body workers are trained in this technique as well.

Unlocking Intimacy: Navigating Painful Sex Postpartum

Last thing: I’m reminded of the scripture in 1 Corinthians 13:4 which says “Love is patient. Love is kind…” If sex is causing significant pain for you, I pray you would have the courage to share this with your partner, that they would be patient and kind as you heal, and that you would be able to get the help you deserve.

Sex doesn’t need to be rushed. Intimacy can be achieved in plenty of other ways. Heal well, and you will unlock the intimacy you both desire in due time!

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Rachel is a Postpartum Nurse of 15+ years. She is also a Spinning Babies® CPE, Childbirth Educator, Published Author, and Recipe Creator. Rachel's passion is to encourage and empower women in all things related to motherhood.

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