Early Days
Painful Sex Following Childbirth
Lulu Becker, a specialist Women’s Health and Paediatric Physiotherapist, discusses the five most common causes that she sees in her Women’s Health Physio clinic. Lulu is the owner of LuluJay Physiotherapy. www.lulujayphysiotherapy.com
Research indicates that up to 75% of women are experiencing pain or discomfort with intercourse in the first year after childbirth, and sadly for many women, this continues well after the first year. Having a caesarean section doesn’t guarantee that you will escape being a part of this statistic either; in my clinic this year, I have treated more ladies who have had caesareans and who are struggling with pain during sex, than those who have had vaginal deliveries. But while dyspareunia after childbirth is common, it is important to know that it is not normal.
There are a number of reasons why a woman may be experiencing pain during sex after having a baby, but the below are the five most common causes that I see in my Women’s Health Physio clinic.
1. Vaginal dryness due to reduced oestrogen in the post-natal period and when breastfeeding
Our oestrogen and progesterone hormone levels drop immediately after childbirth and our prolactin levels increase to help with the production of breast milk. Prolactin also inhibits ovulation, and ovulation helps to increase oestrogen levels (which help with keeping the walls of the vagina moist and make sex more comfortable) which is why many women experience vaginal wall dryness while breastfeeding. My patients report varying amounts of dryness while breastfeeding, with some aware of it constantly and others hardly noticing it at all. I send all my new mothers home with a sachet of lubricant to use the first time that they have sex or if they are finding intercourse uncomfortable, and many report that it makes all the difference to them. Make sure that you have some lubricant gel to use when you resume intimacy after childbirth!
2. Painful perineal scar tissue from a tear or episiotomy after a vaginal delivery
It goes without saying that scar tissue in the perineum following a vaginal delivery can cause great discomfort during intercourse. The effect from these on sex can be two fold; the scar tissue (especially if the skin is all puckered up or keloided) can be sensitive to touch, and it may also contribute to tightness in the pelvic floor muscles as discussed in the point below. A GP may prescribe oestrogen cream or a local anaesthetic cream to use prior to sex, to help to reduce this discomfort. Seeing a women’s health physio is also very beneficial. I use scar tissue massage release techniques to help to mobilise the skin of the scar from where it has often adhered to the underlying connective tissue and teach my clients how to do this at home too. I also find that low level light laser therapy can promote the scar healing and reduces the pain locally. Therapeutic ultrasound can be helpful for this too.