As a pelvic floor physical therapist, I often hear from my new mommas that they don’t feel normal even after their six week follow up with their ob-gyn. Many times, new mothers are given clearance to resume “normal” activities, even when they don’t feel normal. One complaint that I often hear about from many new moms is pain with sexual intercourse. If the doctor says that everything is normal, shouldn’t this be normal too? These women want to be intimate with their partners but the fear of pain has limited or even stopped their desire to have intercourse. This fear is not only with the women who is suffering with pelvic pain, but many times it creates a fear in their partner as they don’t want to be the cause of pain. This in itself can create a disconnect between the two, and create more problems down the road. There are several reasons that sexual intercourse may be painful after having a baby, and the good news is there are ways to resolve this problem. There is hope.
- Perineal tearing or episiotomy
Over 85% of women who have a vaginal birth can experience some type of perineal trauma and can lead to long-term physical and psychological problems.1 Tears can also occur inside the vagina or other parts of the vulva including the labia. Many women heal from these tears and don’t have problems but for some women the scars from these tears can be a source of pain. Perineal scars can lack tissue mobility and be very sensitive, especially during intercourse. The good news is that this can be treated by a pelvic floor physical therapist.
- Breast feeding
After giving birth there is a drop in estrogen and progesterone levels to allow production of prolactin, the hormone for milk production. Because of this, the normal levels of estrogen are decreased which can have side effects of vaginal dryness and make sexual intercourse uncomfortable. This can easily be treated by using water-based lubricants or oil-based (coconut oil) lubricants which typically last longer. However, using oil-based options is not a good idea when using condoms as a form of birth control. Oil-based lubricants breakdown the latex and can cause breaking of the condom and possibly another baby. If a lubricant is not working for you and you are still having pain with intercourse your provider may prescribe vaginal estrogen cream to help with dryness.
- Pelvic floor dysfunction
The pelvic floor muscles and their function, or lack thereof, can be a source of pain with intercourse. Muscles of the pelvic floor (PFM) can have an increase in muscle tone which doesn’t allow the PFM to relax during sexual intercourse. Pain can be on initial penetration, with deep penetration, or both. PFM dysfunction can be a result of pelvic trauma during birth but could have been a problem prior to pregnancy. In addition to pain with intercourse, there might be complaints of urinary incontinence. One might think that this happens only with a vaginal delivery, but it can also be a source of pain with mommas that have had a c-section. This is an area that a pelvic floor physical therapist can help to improve PFM function and return to pain free intercourse.
- Hormonal changes and postpartum depression
Many women understand the changes that their physical body goes through during pregnancy and postpartum but may not fully understand the hormonal changes and how it affects the mental and psychological wellbeing of a new momma. Postpartum depression is more common than one might think and can be a little tricky to treat due to the hormonal changes that occur postpartum. Approximately 70%-80% of postpartum women will experience mild depression and 10%-20% will experience a more severe type of clinical postpartum depression.2 Some symptoms that you might experience with postpartum hormone imbalance are anxiety & depression, chronic fatigue, and LOW LIBIDO (decreased sexual desire).
So, what do you do now?
First, consult with your obstetrician or midwife to make sure there is no underlying causes of your pelvic pain. Rule out any infections and make sure that the tissue is healing well.
Second, realize that this is common (not normal) and can be treated by seeing a pelvic floor physical therapist.
Third, give yourself some grace. You are a new momma and all of this is new also. Give yourself time to adjust and don’t be so hard on yourself. Don’t be afraid or too proud to ask for help.