Why does it hurt when I have sex?

dFor many women who have vaginal deliveries, it is not that much of a surprise when the vagina feels “different” after childbirth. We pretty much expect to feel “loose” after delivering a baby vaginally, because of the stretching that the vagina goes through. Many of us also assume that both we and our partner will experience less sexual pleasure than before (at least for a while). For those of us who give birth via cesarean-section, however, it’s especially surprising to find that even our vaginas feel different post-birth (despite there being no vaginal stretching involved). For both c-section and vaginal birth mamas alike, not only are the sensations and feelings going on in our vaginas different than they were pre-childbirth, but many of us experience painful intercourse as well. So what’s going on here? Why are our vagina’s acting up in all kinds of ways, and even to those of us who did not have vaginal births? Well, a lot of it has to do with the pelvic floor (the muscles that hold up the vagina, uterus, bladder, urethra, and rectum). Let me explain:

REASONS WHY IT HURTS TO HAVE SEX AFTER BABY

 

Possible Prolapse:

A woman’s pelvic organs (bladder, uterus, rectum, etc.) may not be supported as well as it was before childbirth) — which can make it feel like there is an obstruction blocking anything (like a penis, or a tampon) from trying to make an entry. This feeling may suggest some prolapse (i.e. a weakening of the muscles) of the internal organs.

Tight Pelvic Floor Muscles:

Another reason why sex might be painful, could be that our pelvic floor muscles are too tight.  The pelvic floor muscles make up the opening of the vagina. It is this group of muscles that have to stretch big time to let baby out. After such an event, the pelvic floor muscles are often sore, tired, and go into “protection mode”, making them tense up. There are other factors that can contribute to a tense pelvic floor after having a baby:

  • Posture for postpartum women often involves a bum tuck (you know, “mom butt”!!) The problem with mom butt, other than the obvious, is that it pulls the pelvic floor muscles into a tight position and doesn’t let them relax.
  • Another big contributor is stress! Postpartum is tough, and with that comes stress — and we all know what stress does to our body and muscles!
  • C-section moms are not immune to tight pelvic floor muscles! Even though your baby didn’t come via the pelvic floor, all of the tissue and muscle that were cut and moved to the side during your delivery are very much connected to your pelvic floor. Not only does the fascia from your tummy area travel down into your pelvis, but the deep muscles around your incision are close neighbors with, and work alongside your pelvic floor. It is all connected!

When we have a tight pelvic floor, and we attempt to have penetrative intercourse, the tension in the pelvic floor muscles does not allow comfortable passage.  The problem, in some cases, is that the tension doesn’t always just go away with time, but instead can get worse.

Vaginal Dryness:

Vaginal dryness is another not-so awesome postpartum symptom, is associated with breastfeeding, and can contribute to painful sex. While we breastfeed, our estrogen levels (which help to keep us lubricated down there) are low. You may find using a lubricant is enough to solve the problem, but if you are feeling like it’s a desert down there, talk to your care provider about supplemental estrogen.

So. What can I do?

  • Find a strategy that works for you help decrease your stress level. Yoga, meditation and enough sleep are all helpful.
  • Take a look at your posture. Do you tend to tuck your butt under when you stand, or sit slouched all the time? If you do, you are pulling tension on the pelvic floor. Bad posture is a hard habit to break, but can be a very effective one.
  • Stop working exclusively on kegels! This only makes the tension worse and instead . . .
  • Learn how to properly tighten (kegel) and relax your pelvic floor so that the muscles aren’t in a constant kegel all day.
  • Find a physical therapist who works in the areas of pelvic health and or women’s health near you. Pelvic health physical therapists treat many women experiencing decreased sexual pleasure, including painfulex.

 

What do pelvic floor therapists typically do?

We ask you questions that likely nobody has asked you before. Your answers to the kinds of questions listed below, give us a pretty good idea if your pelvic floor muscles are tense:

  • Do you leak?
  • Feel like you are always going pee?
  • Do you get strong urges to pee?
  • Are you constipated?
  • Do you struggle with hemorrhoids or anal fissures?
  • Difficulty tolerating pap tests, tampon or menstrual cup insertion?

We assess your posture, your diastasis recti, and the muscles that live on the outside of your pelvis.

As physical therapists will assess your pelvic floor muscles by either inserting a gloved finger in your vaginal or anal opening OR use an ultrasound machine to show us what the pelvic floor muscles are doing.

You might get  some crazy cues and exercises that help you feel how to properly kegel and relax your pelvic floor.

We will work with you to treat WHY the pelvic floor muscles are tense and how to make sex pleasurable again.

Women who experience painful sex are often given the advice to “chill out and have a glass of wine” and it ends up being something that they learn to live with. I do not agree with this advice, except the part that involves having a glass of wine (LOL. )

What you can take away from all of this:

Don’t be embarrassed to talk about your symptoms. You aren’t alone! Your symptoms are there for a reason, but that doesn’t mean you need to live with them. Find a pelvic health physical therapist near you, and if you tell your partner that you are seeing someone to help you enjoy sex more, they will more than likely be supportive!

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