Pain with intercourse is common after delivering a baby, with studies reporting rates ranging from 12–62% at 3 months, 17–45% at 6 months, and 8–32% at 12–18 months postpartum. These ranges reflect differences between studies and populations, but they show just how common this experience can be. There are many potential causes and risk factors that may contribute to pain with intercourse. Let's go over a few of them!
What Can Contribute to Pain with Intercourse After Delivery?
Mode of delivery: While this may seem surprising, having a cesarean delivery does not necessarily eliminate the risk of developing pain with intercourse. Research has found that pain can occur following both cesarean and vaginal deliveries. Instrument-assisted vaginal deliveries, such as those involving forceps or vacuum extraction, have also been associated with an increased risk of pain in some studies.
Tearing during delivery: The severity of perineal trauma can influence the likelihood of experiencing pain with intercourse.
Compared to women with an intact perineum, one study found that women who sustained a second-degree tear were 80% more likely to report pain with intercourse, while those with a third- or fourth-degree tear were 270% more likely to report painful intercourse 3 months after delivery. Episiotomies can also contribute to pain, although the relationship between the type of perineal trauma and symptoms varies across studies.
Breastfeeding: Breastfeeding can increase the likelihood of experiencing painful sex. Breastfeeding changes our hormonal system, including lowering estrogen levels, which can contribute to vaginal dryness, tissue sensitivity, and discomfort.
One study found that women who were breastfeeding were more than four times as likely to report pain with intercourse at 6 months postpartum compared to those who were not breastfeeding. Other studies have found a smaller, but still significant, association. Breastfeeding is not the only factor involved, and not everyone who breastfeeds will experience pain.
Psychosocial factors: Fatigue, stress, depression, and emotional well-being can all play a role. I know, I know, who doesn't feel stressed and tired after delivering a baby?! However, research has found associations between fatigue and stress in the early postpartum period and pain with intercourse at 6 months. These factors can be part of the bigger picture when trying to understand why sex may be uncomfortable.
What Can You Do About It?
1. Lubrication
Estrogen helps maintain vaginal tissue moisture, elasticity, and overall tissue health. When estrogen levels are low, vaginal tissue can become drier and more sensitive. Following delivery, estrogen levels drop significantly. They can remain lower during breastfeeding, which may contribute to dryness and discomfort during intercourse.
Using lubrication can make a significant difference! Even if you are someone who has never needed to use lube before, it can make things much more comfortable when returning to sexual activity after having a baby.
When choosing a lubricant, pay attention to the ingredients and look for products that are less likely to cause irritation or sensitivity. Some products contain additional ingredients intended to help with discomfort, but these are not right for everyone and may cause irritation in sensitive tissues.
2. Try wearable buffers
Products such as the Ohnut can be helpful if you experience pain with deeper penetration. These wearable buffers fit around the shaft of the penis or a penetrative device to limit depth and can be adjusted to suit your comfort level.
They may be worth considering if deep penetration is a trigger for your symptoms. However, they will not address every cause of pain, so it is important to understand what may be contributing to your discomfort.
3. Experiment with different positions
First and foremost, communicating with your partner about how you are feeling is really important. You should never feel like you need to push through pain.
Different positions can change the amount of pressure placed on the pelvic floor and surrounding tissues. Try positions where you feel the least amount of strain. Lying on your back, stomach, or side may be more comfortable for some people, while others may prefer positions that allow them to control the depth and pace of penetration.
You can also experiment with pillows or wedges to help support your body and find more comfortable positions.
4. Understand the body's response to stress and trauma
Pregnancy, labor, and delivery place significant demands on the body. For some people, these experiences can contribute to increased pelvic floor muscle tension or difficulty relaxing the muscles.
When the body anticipates pain or perceives a threat, the pelvic floor muscles may tighten as a protective response. This can happen with penetration during sex or even with inserting a tampon. It is important to remember that this is not always the cause of pain, and pelvic floor tension is just one of several possible contributing factors.
If increased pelvic floor muscle tension is contributing to your symptoms, learning how to relax these muscles can be an important part of recovery. Pelvic floor physical therapy may include breathing techniques, relaxation strategies, and, when appropriate, gentle pelvic floor massage.
5. See a pelvic health physical therapist
When pain persists, you do not have to accept it as your new normal! Pain with intercourse can have many different causes, and the right approach depends on what is contributing to your symptoms.
A pelvic health physical therapist can help assess factors such as pelvic floor muscle tension, scar tissue restrictions, tissue sensitivity, and difficulty coordinating or relaxing the pelvic floor. Treatment is individualized to your needs and comfort level.
Whether you are a few weeks, months, or even years postpartum, it is not too late to seek help. You deserve to feel comfortable and confident in your body again.
You Don't Have to Live With Pain
Experiencing pain with intercourse after having a baby is common, but that does not mean you have to simply live with it. There are options to help you feel more comfortable, understand what is contributing to your symptoms, and return to intimacy on your own terms.
At Solstice Physical Therapy + Wellness, I provide individualized pelvic health physical therapy to help women navigate recovery, address pelvic health concerns, and feel more at home in their bodies.
If you have questions or would like to learn more about how pelvic floor physical therapy may help, visit solsticeptwellness.com to get in touch.
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