Sex, and especially painful sex after baby, is a topic that most women don’t feel comfortable talking about, but today we are going there in order to help women return to sex after baby without pain! And no, we are NOT going to tell you to just give it time, have another glass of wine, take a hot bath to relax, or any of the other bad advice that is floating around out there. Nothing makes us feel worse at Revitalize Physical Therapy than to hear a woman tell us that she hasn’t been able to have sex for months and has just been told to “loosen up and relax more.” To be blunt, this is ridiculous and this bad advice needs to stop because it only makes the problem worse by making women feel inadequate.
Why is sex after baby so painful?
Painful sex is a common problem in postpartum women with statistics of 60% of women suffering from this after baby. If you are one of these women, you should know that you are not alone, and it CAN get better. Being pregnant and having a baby puts a lot of stress on your pelvic floor muscles, and painful intercourse can even start to occur during pregnancy. When this happens, often times the pelvic floor muscles are overactive and become tight and tender. As a result, these tight muscles become painful during intercourse. Here are some other potential causes of painful sex:
If you had any vaginal tearing or an episiotomy during delivery, this will result in scar tissue as the area heals. Scar tissue is a normal response of the body to heal an injury, but it can also be problematic. It often is painful or tender to the touch so a woman can feel pain more externally or upon penetration from scar tissue within the superficial muscles. The more severe the tearing, the deeper the scar tissue goes. So, pain can be felt deeper as well, as the scar tissue extends into the deeper layers. If you had a Cesarean section, you can also be affected by scar tissue at your incision. This can lead to pain on the perineum or pelvic floor.
I want you to think back to a time when you slept weird and woke up with a sore neck. Can you picture how painful the neck felt and how it would radiate pain all the way up to your head or down to your shoulder blade? That is a trigger point - essentially a knot within the muscle that can send pain elsewhere. Most people don’t realize that you can also get trigger points within the pelvic floor muscles that can lead to pain. Many times, the pain is felt during intercourse when pressure is being applied to the trigger point. They can also send pain to other locations including the groin, hip or low back region. We often work with women who have trigger points and tight, tender pelvic floor muscles, causing pain during intercourse. Manually releasing these with gentle pressure alleviates the pain that most feel during intercourse.
Vaginismus and Vulvodynia
These pelvic pain conditions are less common than scar tissue and trigger points but can be extremely limiting for those suffering from them. Both of these conditions are considered chronic pelvic pain and the cause of them is often complex. Vaginismus is a condition where the superficial pelvic floor muscles spasm, making the vaginal opening very constricted. This often causes severe pain upon penetration, and the woman is likely unable to tolerate any intercourse or penetration. Vulvodynia is a condition where the woman feels pain near the entrance of the vagina that can be pinpointed to a specific location or sometimes more diffuse. This is not to be confused with scar tissue because with vulvodynia, the cause tends to be due to entrapment of a nerve. Both of these conditions can be complex to get rid of, but there are treatment options available if you are suffering from these.
Because there are several different potential causes for pain with intercourse, it is best to have an evaluation by a pelvic floor physical therapist to determine the exact cause for you. It is also difficult to treat these issues on your own since there aren’t any specific exercises that will eliminate the pain. However, I want to stress that most women find relief within a few sessions of physical therapy and do improve to a point where they can have sex without pain. It is not something that you just have to deal with and tolerate. It is not something that you just need to give more time in hopes that the pain magically goes away. It is not something that is all in your head, and you don’t just need to relax more. Your pain is real and there are treatment options available to help you get rid of it. If you are ready to take the next step towards a pain-free sex life, fill out this form in order to talk to one of our physical therapists and learn more about what we can do for you.