First, some clarification. Although this blog mostly talks about early postpartum changes that can affect sexual health, once postpartum ALWAYS postpartum. So a lot of these things can crop up again (for similar hormonal reasons!) in the perimenopausal area of our lives too.
For some, all may go well on initial attempts to returning to sex after the birth of a baby. For others (many, many others!), there may be unwanted physical symptoms with sex. The focus of this blog is to discuss a few of the possible symptoms. What is normal and what isn’t?
Pain with intercourse. There could be many reasons why there is unexpected pain or discomfort during penetration. All the below symptoms are common, but should not be considered your new normal.
One possible cause of pain is restriction from a perineal tear. Whether stitched or not, there is a build up of scar tissue which makes the tissue less resilient to stretch and pressure. A little self-scar release starting at 6 weeks can be really helpful to improve resiliency and thus improve the tissues tolerance to friction!
C-section scarring may also contribute to pain. This scar is deep and can affect a lot of structures in the pelvis and abdomen along the way. Scar massage here at 8-10 weeks will also be helpful for keeping the tissue mobile.
Pain/pressure into the pelvis due to pelvic organ prolapse. This is where the uterus/cervix, rectum or bladder shift their position and can impede vaginal space. Think about a person leaning on the outside of a tent where the person is a pelvic organ and the tent is the vaginal space. When something tries to enter the tent (read: vaginal penetration) there is less room because the tent space is compromised. Certain positions during sex may now be painful.
Believe it or not, many women experience pelvic muscles that are actually too tight in the postpartum period (hence why we don’t believe Kegels are silver-bullet exercise to all concerns in the pelvis). When tight, there is less space for penetration, which leads to pain.
Inability to attain orgasm. Common, not normal. You have deep pelvic muscles that support your core and pelvic organs but you ALSO have superficial pelvic muscles. The superficial muscles optimize sexual health. Both layers get stretched during labor and delivery and may need some neuromuscular re-education on doing their job again!
Vaginal tissue dryness. Common, not normal. Vaginal tissues rely a LOT on estrogen, which plummets in the postpartum (and perimenopausal) period. Estrogen brings blood flow and blood flow brings lubrication. Friction from penetration on the ‘drier’ vaginal tissue can be uncomfortable. Locally, people working at A Woman’s Touch are your Lovely Lubrication Experts. Otherwise, make sure you research good, quality lubes. High quality lubes can make all the difference to reduce penetration friction AND we don’t want the tissues absorbing any unnecessary chemicals!
Loss of urine during penetration. Yep, it happens. Common, not normal. The active pelvic muscles are responsible for supporting the bladder and keeping us continent. These muscles have to release fully during penetration and in the postpartum period (due to many factors!) this release may cause the bladder to leak urine.
Similar to my previous blog Returning to Exercise in the 4th Trimester...If I have symptoms, what should I do? There are many options!
Ignore the symptoms and hope they go away (not recommended)
Pretend Kegels can fix everything (also not recommended)
Give yourself ample time to heal and SLOWLY return to sexual activity (good advice)
See your Pelvic PT who will support your body specific to its unique needs (best advice)
Once you are cleared for sex (at 6 weeks-ish), it may not be easy to immediately return to full on, pre-baby sex! Last few tips/reminders:
This is the time to start working on the tissues, gradually get them used to pressure, stretch, friction etc. Get ahead of the Lubrication Game by being proactive-there are many options to make penetration more comfortable! IF SEX HURTS, STOP and see a PT who can help you figure out the WHY. And…as always, I will end with raining all over the darn Kegel parade. They may not be the best answer for you.
All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.
NEXT BLOG: Diastasis Recti vs. Umbilical Hernia