Pain is very common following pregnancy and delivery, but again is not normal! Your body is trying to tell you that something isn't right. If you’ve ever seen a vaginal birth, then it will come as no surprise that the trauma a woman’s body experiences during childbirth can affect her sexual pleasure and cause sexual pain. Nearly 50% of women who have babies each year report pain with sex three months after delivery, and many continue to experience painful sex even a year later. More than half of women who say they had little or no trauma during delivery still report pain the first time they have sexual intercourse. Childbirth can lead to painful sex regardless of the type of delivery-uncomplicated vaginal delivery with or without tearing or episiotomy, complicated vaginal delivery or caesarean section. Your postpartum sex life can even be affected by breast-feeding.
Painful sex, on top of the upheaval of a new-born baby and the emotional mood swings tied to the fluctuating hormones of post partum life, can be devastating. After all, the last thing you need at this point is more stress and insecurity about your body. Not only this, painful sex can also interfere with your relationship with your partner, who many not understand why you’re not eager to resume lovemaking immediately once the doctor gives the green light. He may already be feeling ignored and discarded, given your focus on the baby. He thought he’d at least get you back through lovemaking. Ha! Not quite.
The good news is that painful sex following childbirth is rarely permanent. It tends to improve with appropriate advice and treatment.
You might think that women who have caesarean sections won’t have to worry about pain during sex. In fact, some women choose caesarean section to avoid the possibility of any damage in their vulvovaginal area. However, studies show little difference between rates of postpartum pain with sex in women who had a caesarean section and those who delivered with no tears or episiotomy. The reason? Hormones! Simply put it, a woman’s oestrogen level plunges drastically after giving birth. Add breast-feeding to the mix, this further reduces oestrogen levels adding to dryness and pain even months later down the track after delivery. Commonly, I hear women describe the pain being extremely painful within the vagina and during entry. Even afterwards, it tends to feel like a burning sensation for several hours. This cycle can continue up to a year.
Generally, postpartum sexual pain is usually temporary. In the meantime, you can do the following to ease the pain today:
· Have an assessment with your pelvic health physiotherapist. The six week check up is to check you out, physically and emotionally. Even though most women experience pain during sex after giving birth, only 15 percent mention it to their health care provider. You have to speak up when it comes to your sexual health. If you don’t tell them there’s a problem, then they can’t help you. It’s also never too late to have a check, this could be several years after your delivery.
· Apply topical oestrogen (prescribed from GP or specialist). Oestrogen can help plump up the tissues around your perineum and also to replace the low levels contributing to your pain with sex. If you do use this, remember to treat both the vestibule (opening to the vagina) and the vagina itself. We recommend oestrogen cream in the vagina two or three times a week and rubbing a pea-sized amount of estrogen cream on the vestibule daily until the tenderness improves.
· Use personal lubricants. Low oestrogen means low lubrication. That in turn means vaginal dryness which translates to pain or at the very least discomfort during sex. So, we recommend slathering on the lubricant before intercourse. We recommend lubricant that does not contain propylene glycol, which can irritate the area. You can even use olive oil.
· Numb the pain. Topical anesthetics like lidocaine can numb frazzled nerve endings still smarting from an episiotomy or tearing. Try soaking a cotton ball in lidocaine ointment, applying to to the vestibule, and keeping it there overnight.
· Perineal massage can work wonders, a pelvic health physiotherapist who has had specialised training can give you advice on how to do this.
Take home message
If it hurts when you have sex – even if bubba has started crawling and eating solids – don’t worry! This is quite common and will improve. The tips above are only the tip of the iceberg. Hopefully, some of the tips mentioned above can help relieve your pain until your body returns to its normal hormonal and physical state – a process that actually takes about a year, sometimes two, not the six weeks many women are led to believe! Just remember that Physiotherapy is an important component for anyone who experiences pain with sex, no matter what the cause. Its not a quick-fix solution, however, it will take time to work, and you have to do your homework. But together with a multidisciplinary and holistic approach, Physiotherapy will improve your pain and your sex life.