Ok so you’ve successfully got through the pregnancy, delivery, and now you are trying to feel a little normal in the intimacy department again... Here are a few things to have a think about.
Firstly, congrats on getting to this point of thinking about it! Thats a huge step in the right direction. You have probably been ‘cleared’ for intercourse at your 6 week check if all was recovering well but now what… You just jump straight in and pretend you didn’t just deliver a baby??
I often get people ask me what is a normal timeframe for returning to intercourse. The answer is there is absolutely no normal! Everyone has a different birth experience, a different libido, different routines, and different baby needs so there is absolutely no ‘norm’.
I’m writing this post to give some tips and raise awareness that there should become a time when intercourse becomes pleasant again! I’m seeing far too many patients coming to me for other issues (say urinary incontinence, pelvic floor check or even a return to sport check) but when I run through routine questions I find out they are experiencing pain with intercourse.
First things first, lets talk about the hormonal side of things. If you are breastfeeding your oestrogen levels are lower than normal. This causes vaginal dryness and therefore lubrication becomes more essential than it may have in the past. Don't feel this dryness is because you are not aroused.
If we now talk about those of you that had vaginal births, I want you to consider if you had a perineal tear (ie. a first, second, third, fourth degree tear or episiotomy). When scars heal they pull the tissue from the surrounding area into it, which can lead to tightness. Scars can also be quite sensitive. Now if we translate this to the tissue around our vagina.
Your perineal scar or episiotomy scar can become tight and sensitive- not so fun for intercourse.
This is where scar massage or de-sensitising the area comes into play. It all just about getting that tissue used to being touched again to prepare for the real deal. I often advise people to start scar massage from about 6 weeks post delivery and do it for a few minutes after the shower (however whatever works for you). A lubricant or natural body oil to reduce friction works well.
Another fear people often have is that intercourse can cause damage to the stitches. Be assured the material for these stitches is nice and strong and the stitches dissolve on their own. It is very very unlikely that intercourse will cause any re-tearing to this area.
I want to move on to those people that are having ongoing pain issues with intercourse that is not improving with the above tips (ie. the initial pain/comfort you were having is not improving or even getting worse). Pain with intercourse in medical lingo is given the umbrella term dyspareunia and it is something physiotherapists trained in women’s health can assess and treat.
There are many factors which could be contributing to an ongoing pain with intercourse. I’ll list some to get you thinking however often it is a combination of these-
(And probably the largest factor) - Birth is traumatic!
Perineal tissue tightness/sensitivity
Vaginal dryness
Increased pelvic floor muscle tone/tension
Anatomical changes with your pelvic organs
Sensation changes
I want to expand a little on #4 in terms of our pelvic floor muscles role in allowing pleasant intercourse. y\Your pelvic floor is the sling of muscles from our pubic bone to our tailbone and it surrounds all three of our openings (ie. urethra, vagina, anus). Our pelvic floor pelvic floor has the ability to both contract and relax. You may have been doing some strengthening pelvic floor exercises to rehab your strength post baby. However, in terms of intercourse being pain free, we actually want our pelvic floor muscles to relax! Think about it, if we relax the muscles around our vagina it should loosen and therefore allow more room.
Teaching people how to relax their pelvic floor is always one of the first things I teach in someone who has pain issues with intercourse.
It’s something that very few people have considered as there is always so much focus on strengthening our pelvic floor, especially post baby! Yes our pelvic floor does need to have strength but it also needs to be able to relax. Both functions are equally important. Can you feel your pelvic floor relax?
Ok I'll wrap this up; as a summary I just want to reiterate that ongoing pain with intercourse post baby (or at any time through your life) is not normal and treatment is available to help with this.
This is still quite a taboo area but thats why I felt the need to write this post. I see far too many people that have been putting up with the pain or have just ceased their sexual intimacy without getting an assessment and treatment. This is absolutely a treatable issue.
Like always feel free to reach out to me via the contact page!
Claire xx
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