05 Apr Painful sex after delivery: is it normal?

Your body undergoes many changes during the pregnancy and postpartum period. These changes are common, like having painful sex after delivery, but should not be considered your new normal. Many of these changes can be successfully treated conservatively—without surgery or medication, through pelvic floor physical therapy visits and a home program. In this True or False Article, we demystify sex after the baby.

Demystifying sex after delivery

1) True or False?  Your body changes during pregnancy and should be back to normal six to eight weeks after delivery. You can resume all normal activities, including exercise and sexual intercourse.

FALSE. While, a majority of the medical community would have you believe at your six week check-up you are “all clear” to resume normal activities, the truth is, the changes that have occurred are far from returning to “normal” at the six week mark. For starters, your body has undergone significant changes in hormone levels throughout pregnancy and after delivery. Estrogen and Progesterone, while generally ever-increasing as the pregnancy progresses, plummet in the early postpartum period. Breastfeeding will keep these hormones low during this time. This has a significant impact on your tissues, creating vaginal dryness and thinning of the tissues, similar to what happens to women during menopause. These hormonal changes occur regardless of whether you’ve had a vaginal delivery or a cesarean and can contribute to experiencing painful sex.

2) True or False?  Painful sex is an extremely rare condition, and even if experienced prior to conceiving, is likely to resolve itself after delivery.

FALSE. Painful intercourse is very common, with the American Congress of Obstetricians and Gynecologists citing 3 out of 4 women will experience this at some point in their lives. It is even more common in the postpartum period and beyond. This can be devastating to a relationship already tested with lack of sleep, diaper changes and adjusting to a new family schedule. A recent study in the International Journal of Obstetrics and Gynecology (BJOG) with over 1,200 patients cited the frequency at nearly 9 out 10 on their first attempt after delivery. This prevalence is regardless of whether the women delivered vaginally or via cesarean. Women that were most likely to experience painful sex were after elective cesarean, emergency cesarean, or vacuum-assisted vaginal delivery. The good news is these numbers do reduce over time, to about 45% at 3 months postpartum, and to about 23% at 18 months postpartum. Of note, women that delivered via cesarean were more likely to report more intense painful intercourse at the 6 month mark. Sadly, 10% of the women that reported painful intercourse in this study described it as “distressing”, “horrible” or “excruciating”, which will undoubtedly have equally damaging effects on their intimate relationship. Also remarkable, at the 18 month mark, 2 out of 10 women were continuing to have painful sex. So, painful sex is common, but there are ways to work on it and ease into recovery faster through targeted pelvic floor exercises.

3) True or False?  Any symptom you are likely to have as a result of delivery will be noticed within the first couple of months after delivery.

FALSE. Patients in a recent study with injuries occurring at the time of delivery, do not develop many of their symptoms until several years later. How can this be? This is likely due to an injury of the nerves (likely the inferior hypogastric plexus) in the area and they are initially asymptomatic, but as the nerves reinnervate (or, heal), they may do so incompletely or inaccurately, leading to symptoms down the line, sometimes several years later. These include prolapse, incontinence and painful sex.

4) True or False?  Time heals all wounds. If I just wait it out, it will resolve on it’s own.

FALSE. While some bony abnormalities that may occur during childbirth tend to resolve, injury to the levator ani muscles tend not to, according to a recent study. This leads to weakness of this muscle and prolapse of pelvic organs if left untreated.

5) True or False?  Because my symptoms, like painful sex are common, I should consider them a normal part of having had a baby and just live with them.

FALSE. Women are routinely told they are “normal” after six weeks. I am told when I meet with many of these doctors that they don’t send patients to a pelvic floor physical therapist because I am treating such a “rare” condition. I think at least 20% of their patients (and perhaps you) would disagree. Do not normalize your symptoms, just because they are common. Conservative options offered by a pelvic floor physical therapist include manual therapies, specific exercises, instructing in a home program, modifying postures and behaviors and more. These help in treating the common ailments after baby, including incontinence, urgency, prolapse, painful sex and chronic pelvic pain, you now have the power to rewrite your future and start leading your life to its fullest, including having pleasant and pain-free sex as soon as possible.

About Heather Jeffcoat

Heather Jeffcoat, DPT is a pelvic floor physical therapist in Los Angeles, CA. She is the owner of Fusion Wellness & Physical Therapy with two offices in the Los Angeles area and the author of Sex Without Pain: A Self Treatment Guide to the Sex Life You Deserve.

Sources

• EA McDonald et al. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015; DOI: 10.1111/1471-0528.13263 
• M Quinn. Injuries to the levator ani in unexplained, chronic pelvic pain. Journal of Obstetrics & Gynaecology. Nov. 2007, Vol. 27 Issue 8, p828-831.
• JM Miller et al. Evaluating maternal recovery from labor and delivery: bone and levator ani injuries. [Am J Obstet Gynecol] 2015 Aug; Vol. 213 (2), pp. 188.e1-188.e11