Returning to sex after birth can be a scary thought. Especially if you experienced trauma to your perineal area during the birthing process. You may be worried if it’s going to hurt? Will sex feel the same? Will my libido be in full swing like before? What do I do if I’m uncomfortable and it starts to hurt?
You are not alone in these thoughts, feelings, and fears. I want to assure you that these are all NORMAL feelings when it comes to returning to sex postpartum. Helping moms return to a happy and healthy sex life is one of the things I do daily.
Let’s explore some of the reasons returning to sex may be scary after having a baby.
Your Body Has Undergone Significant Changes!
This one seems like a no-brainer. But many women forget about the 9 months of work their bodies did to grow a baby and then the added marathon of birthing a tiny human. Your body had to stretch, shift, and accommodate for that tiny human to grow inside you and then make their exit.
Sex with penetration may either feel not feel quite as “tight” or maybe tighter. You may have discomfort or pain, or you may not experience as much sensation as you did pre-baby. For some women, however, penetration becomes more enjoyable after birth. For these women, the stretching and shifting of their tissues puts them in a better position to be stimulated during sex.
Birth and momhood can also affect your sensitivity to touch. You may need more stimulation or you may not want to be touched at all because you’re putting all of your energy into caring for your baby The important thing is to beware of these changes and communicate them to your partner. You shouldn’t feel pressure to do anything that doesn’t feel comfortable to you.
Your Hormones Are Shifting
After pregnancy, your hormones don’t just go back to “normal”. Hormones adjust, change and level off for a few months after birth. These shifts in hormones can lead to the “baby blues” to full-on postpartum depression or anxiety and problems with vaginal dryness. Using additional lubrication is one way to address vaginal dryness. Use this lubrication reference sheet to determine which lubrication is the best fit for you after birth.
Taking your time during intimacy and incorporating lots of foreplay prior to penetration leads to increased arousal, increasing the vagina’s natural ability to lubricate itself. Studies have also found that quality stimulation during foreplay and a strong feeling of love and affection between partners can increase the probability of reaching orgasm during intercourse. (Reference: The Human Sexual Response Richard E. Jones PhD, Kristin H. Lopez PhD, in Human Reproductive Biology (Fourth Edition), 2014, Chapter 8).
It’s also important to note that breastfeeding hormones, prolactin and oxytocin, also interfere with sex drive and cause you to lack desire. Again, communicate with your partner about all aspects of sexuality and what feels good and what doesn’t.
There Could Be Pain
If you have pain with sex, you’re not alone. Did you know that 3 out of 4 women experience painful sex at some point in their life? Even though it’s common, pain with sex is not normal and you don’t have to live with it!
Pain with sex after a baby can be caused by a few different things like:
Residual pain from tearing or an episiotomy.
Pelvic floor hypertonicity and overactivation
Nerve damage from your baby sitting on the pelvic floor muscles or the birth process
Lack of vaginal lubrication
Fear and anxiety about returning to sex or having pain with it can exacerbate pain symptoms. The pelvic floor is responsive to stressful situations and will spontaneously guard in response to your emotional stress. Addressing this fear and anxiety prior to engaging in sexual activity can help improve symptoms.
You May Leak During Sex
Urinary incontinence is pretty common after birth. In fact, 60% of women with urinary incontinence have reported leaking during sex. Again, even though leaking is common, it’s not normal and you don’t have to live with it!
Penetration and orgasm increase stress on the pelvic floor muscles which can lead to urine leakage during sex. This is called stress incontinence and it happens when the pelvic floor muscles are too weak or too tense to hold back urine during periods of stress.
What can you do to reduce the scariness of sex?
Consult a pelvic floor physical therapist! A thorough past medical history and exam can help identify the underlying causes of pain or leaking during sex. Examination and treatment can include:
Identifying muscle holding patterns or increased muscle tone
Assessing scar tissue mobility or adhesions
Desensitization to the perineal area/vagina
Releasing your pelvic floor muscles
Reconnection to your pelvic floor through breath-work, stretching, and strengthening exercises
As pelvic floor therapists, we also take into account the psychosocial/emotional aspects of sex. As stated above, emotions such as fear and anxiety can play into the tightness of the pelvic floor and resulting sexual function.
If you’re experiencing pain, leaking, or discomfort with sex please reach out to your pelvic health physical therapist. You don’t have to live with painful sex, leaking, or discomfort.