Having a new baby is amazing, but it can also bring challenges, like experiencing pain during sex after childbirth. If you're experiencing discomfort or painful intercourse after cesarean or vaginal delivery, you're not alone. Many new mothers face this issue. About 50% of women have reported painful sex (dyspareunia) after giving birth.

As pelvic floor physical therapists in NYC, we've helped many new mothers overcome painful sex after c-section or vaginal delivery.

How long does sex hurt after birth?

At your 6 week visit with your OB or midwife, you will most likely be given permission to resume sexual intercourse. 

Painful intercourse thus often happens around 6 weeks postpartum, and can persist for up to 6 months or even longer. In a 2018 study, almost 40% of women experienced painful sex 6 months after birth.

Why painful intercourse after delivery occurs

Painful sex after birth can happen to any new mother, regardless if you had a vaginal birth or via c-section. Painful sex after pregnancy can occur either upon entering or with penetration. Some women describe the pain as burning, stinging, dry, and sharp.

There are several reasons why you may experience post pregnancy painful intercourse, including:

• Healing from Childbirth: Your body needs time to recover from the physical injuries that can happen during childbirth. This includes tearing of the perineum or needing an episiotomy. Trauma to these tissues will often lead to pain. Just like any tear or incision to your other muscles in your body, these tissues have to heal. In addition, scar tissue may develop as a result of these injuries and may also contribute to discomfort.

• Pelvic Floor Dysfunction: Pelvic floor dysfunction is one of the most common reasons for painful sex after childbirth. The pelvic floor muscles endure significant stress during pregnancy due sustained pressure on your pelvic floor muscles. This sustained tension can strain your pelvic floor muscles, which you may feel the first time you are intimate. 

  Delivery may also result in pelvic floor dysfunction. This may manifest as excessive pelvic floor tightness or weakness, contributing to pain during intercourse.

• Vaginal Dryness: After childbirth, you may also experience vaginal dryness, which can further contribute to painful intercourse. Within 24 hours of giving birth, your estrogen levels drop dramatically, which causes vaginal dryness. Furthermore, breastfeeding results in the release relaxin. This release in relaxin further decreases your estrogen levels and leads to more pronounced vaginal dryness.

• Psychological Factors: Anxiety, fear of pain, and body image issues can also play a role in painful sex after childbirth. These psychological factors can lead to muscle tension and exacerbate physical discomfort. A mental health practitioner can help you manage these feelings and provide you tools and resources. 

How to Make Sex Less Painful After Birth?

There are a few things you can do to prevent or minimize pain during sex in the postpartum period.

Pelvic Floor Physical Therapy

Seeing a pelvic floor physical therapist for a postpartum assessment can be very beneficial for improving dyspareunia after c-section and vaginal birth. All of the physical therapists at FemFirstHealth are well versed in performing a postpartum assessment and helping you achieve pain-free sex.

After getting to know you and your concerns, our therapists will perform a thorough evaluation of your pelvic floor muscles, to assess their strength, tension, and coordination. They will also take a look at your overall strength, posture, flexibility, and mobility.

After determining the cause(s) of your dyspareunia, our pelvic floor physical therapist will help you address these issues and treat any underlying pelvic floor dysfunction. They will tailor their treatment plan according to your needs, concerns, and goals.

How we can treat painful intercourse:

• Pain Reduction: We use a variety of techniques aimed at improving your pain. These may include a combination of manual therapy techniques, targeted exercises, and pelvic floor exercises to provide both immediate and long-term pain relief.

• Manual Therapy: Our therapists also use hands-on techniques to release tension in your pelvic floor muscles. They will also help you improve your tissue mobility and address any scar tissue from an episiotomy or tear of your perineum.

• Strengthening and Coordination: After childbirth your pelvic floor muscles can become weakened or uncoordinated. By providing you with specific exercises to improve your pelvic floor muscle strength and coordination, we can enhance your pelvic function and reduce your pain.

• Graded Exposure Therapy: For those experiencing fear or anxiety about intercourse, our therapists may introduce dilators to help reduce anticipatory pelvic floor muscle tension.

• Relaxation Techniques: For those experiencing pelvic floor tightness, our therapists will teach you relaxation techniques and individualized stretches to help release tension in your pelvic floor. This can be crucial for reducing pain during intercourse and improving overall pelvic health.

• Education: Our therapists will also provide you with education on pelvic health and self-management strategies. They can provide guidance on exercises and lifestyle modifications that can prevent future pelvic floor issues, contributing to long-term recovery and comfort.

Be sure to use ample lubricant: Additionally, using ample lubrication during intercourse can help alleviate discomfort. We highly recommend Slippery Stuff.

Sexual activities: You can also engage in a lot of foreplay or try different sexual positions.

Open Communication: What is most important is to be honest and open with your partner and communicate your feelings. It is important that you feel ready to engage in intercourse again after childbirth. Just like goals in parenthood, you need to express your goals as a couple now that you’re parents. Make physical intimacy and emotional intimacy goals for your relationship.

Reference: O’Malley, D., Higgins, A., Begley, C. et al. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth 18, 196 (2018). https://doi.org/10.1186/s12884-018-1838-6