A recent study revealed that 90 per cent of women experienced pain the first time they had sex after birth and it was just as common for both caesarean and vaginal births.
The study even showed that 25 per cent of women still reported sex as being painful up to 18 months later! While many mums experience painful sex after birth, it can be helped – early diagnosis of the reason behind the pain and discomfort is essential.
Women's Health and Continence Physiotherapist and FitRight founder Taryn Watson discusses why you might be experiencing painful sex and what to do about it.
Why might you experience painful sex after birth?
1. Vaginal dryness
When you breastfeed your oestrogen decreases, which is why you usually don't have a period. Much like menopause, breastfeeding mothers commonly experience decreased lubrication and thinning of the vaginal tissues, which leads to vaginal dryness and sexual pain.
What can you do to manage the issue?
The main management strategy for this is to realise it's normal and to pre-emptively use lubrication. Most lubricants you can find in your local supermarket contain lots of chemicals and an ingredient called glycerine, which can further dehydrate the tissues.
It's important to find a good quality lubricant that doesn't irritate the sensitive tissues even more.
2. Healing tissues after a vaginal birth
Trauma to the perineum (the skin between the vagina and the anus) and the vaginal wall is common in 90 per cent of vaginal births. The vast majority of women experience 1st or 2nd-degree tears, which affect the skin and superficial pelvic floor muscles.
A small proportion also extend to the anal sphincter muscles (3rd and 4th-degree tears) and sometimes an episiotomy is performed during labour which is when a surgical cut is made in an attempt to prevent a 3rd or 4th-degree tear (usually equivalent to a 2nd-degree tear).
Most tears and episiotomies heal very well and don't cause ongoing pain but it's important to be aware that in some women, even small tears or grazes (especially in the vaginal walls) can lead to scar tissue forming which is more sensitive or tighter than normal tissue – this can cause discomfort or pain when it's stretched during intercourse.
How can you help speed up the healing process?
Gentle stretching or self-massage to the area can be done or a physiotherapist with extra qualifications in pelvic health can help desensitise the tissues and prepare them for the stretch of intercourse.
Sometimes the physiotherapist will prescribe devices to assist with stretching such as dilators or massage wands, which can help women feel more confident in their body's ability to tolerate friction and stretch in that area without pain.
In some cases, physiotherapists can also use ultrasound or laser treatment on the perineum to help solve this problem. These treatments are not painful and help to further soften the scar tissue and bring new blood flow into the area to assist healing.
3. Tight, tense pelvic floor muscles
Pelvic floor muscles that don't know how to relax properly, or 'overactive pelvic floor muscles,' are more common than you might think. While you've probably heard about the importance of Kegel exercises and the 'squeeze and lift' for strengthening the pelvic floor, a large proportion of women experience dysfunction because they haven't learnt how to fully relax these muscles.
Pelvic floor muscles can tense up in response to a physically or emotionally traumatic experience, and over time become so used to being in 'protection mode', that they forget how to relax and make space in the vagina. 'Vaginismus' refers to pelvic floor muscles that tense up in anticipation of penetration, such as with sex, a pap smear, or inserting a tampon – causing the area to be tender, which can be the reason behind painful intercourse.
Sometimes the muscle tightness can be deeper inside the vagina, and although penetration is possible, the woman might experience a deeper pain that may radiate to other areas such as the lower abdomen or the buttocks.
It's possible for pelvic floor over-activity and tightness to occur at any time of life, after recurrent urinary tract infections, in response to ongoing lower back pain, or after sexual abuse – however it's also possible for a traumatic or painful experience of childbirth to be the instigating event that causes pelvic floor muscle over-activity.
This can become a vicious cycle, with the brain pre-empting pain, and further tensing the pelvic floor muscles in anticipation, which in turn causes more pain.
How do we treat pelvic floor muscle overactivity?
Unfortunately, because new mothers have it drummed into them how important it is to 'uptrain' the pelvic floor, many women with pelvic floor muscle tightness will make this worse by continuing to squeeze and lift without ever fully relaxing the muscles.
This overactivity can be helped by 'downtraining' exercises (sometimes known as 'reverse Kegels'), which involves using breathing and mindfulness to learn how to relax the pelvic floor to its normal resting state.
This is why it's so important that new mothers who experience any pain during sex have an individual assessment of their pelvic floor muscles. Tight, tense pelvic floor muscles are not strong muscles and are so overworked and fatigued that it often results in symptoms like bladder leakage.
A cookie cutter recipe prescription of pelvic floor muscle exercises, or core exercises like Pilates and abdominal muscle training, is likely to make a reasonably large proportion of new mums worse. The physiotherapy team at FitRight understands this, which is why an individual pre-assessment is essential before joining our postnatal Pilates and fitness classes.
Don't be afraid to ask for help.
While painful sex after childbirth is very common, it shouldn't be seen as normal or something you should put up with just 'because you've had a baby.' Expert help from specialist physiotherapists like those who work with FitRight means that new mums can return to exercise safely and with a modified program which addresses pelvic floor muscle overactivity and any issues with pain or discomfort during intercourse.
This post was originally published on Wholehearted Family Health and has been re-published here with permission.