Painful sex solutions.
You’ve finally got the energy and desire to get busy between the sheets - but your mind is racing with questions. Will it be the same as pre-baby? How does sex after a c-section differ from sex after a vaginal delivery? And the big one: Will it be painful?
In this blog, we'll dive into the common causes of painful sex after childbirth and explore practical solutions to help you overcome these challenges. Our goal is to empower you with the knowledge and tools needed to rediscover intimacy with confidence and excitement. Whether you're navigating physical discomfort or emotional hurdles, we'll provide actionable tips to enhance your postpartum experience and support your journey toward a fulfilling sex life.
What is painful sex and how common is it after childbirth?
Pain during intercourse, known as dyspareunia, can occur with penetration or other forms of sexual stimulation. It’s categorized as either deep dyspareunia, which happens inside the vagina, and superficial dyspareunia, which causes pain on the outer areas.
As many as 60% of women find sex painful up to seven weeks postpartum. And even six months later, 30% of women report painful intercourse.
Common causes of painful sex:
Hormonal changes.
Estrogen and Progesterone
These two hormones play a crucial role in the strength and elasticity of the pelvic floor muscles. Estrogen boosts blood flow to the pelvic area and promotes tissue growth, while progesterone relaxes these muscles, increasing their flexibility. These hormones also influence collagen and elastin production, vital for pelvic floor strength. Fluctuations in hormone levels can result in either weakened or overly tense pelvic floor muscles. Furthermore, low estrogen is a main contributor to vaginal dryness. Low estrogen is common for at least the first two months postpartum and breastfeeding extends this timeframe.
Prolactin
Prolactin supports milk production but can also affect the hormonal changes during sex. It counteracts dopamine, which is involved in sexual arousal and pleasure, potentially lowering your libido.
Additionally, some mothers report feeling "touched out" from constant breastfeeding, which can diminish their interest in physical intimacy with a partner.
Testosterone
Although testosterone is commonly associated with men, it is also present in women and influences overall libido. During the postpartum period and breastfeeding, testosterone levels decrease, which can lead to reduced sexual desire.
Scar tissue.
Vaginal tearing or an episiotomy can create scar tissue that may make sex uncomfortable or painful.
If you had a c-section the scar may become irritated in certain positions, so you may have to experiment to find what works for you.
Pelvic floor dysfunction.
Pregnancy and childbirth can significantly alter the pelvic floor, which may result in discomfort or difficulty during intercourse. These changes can affect muscle tone and support, making it important to address any issues with a healthcare provider.
Psychological factors.
Psychological factors deeply influence our experience of sex, often in ways we might not even be aware of. Our mental and emotional state can shape our comfort, desire, and overall sexual well-being.
During the postpartum period, adjusting to a new body can make being intimate with your partner feel particularly vulnerable. Embracing this vulnerability and allowing time for self-acceptance is a crucial part of the process.
Anxiety regarding the unknown—whether penetration will be painful or not—can cause your entire body to tense up, including the muscles around your vagina (known as vaginismus). This tension can amplify discomfort and make intimacy even more challenging.
Experiencing trauma, whether from past events or a difficult delivery, can profoundly affect your overall well-being, and sexual health is no exception.
Pelvic congestion syndrome or vulvar varicosities.
Varicose veins aren't just limited to the legs; they can also occur elsewhere, such as hemorrhoids during pregnancy. With blood volume increasing by about 45%, veins stretch and valves may fail to close properly, causing fluid back-up. The growing fetus can further compress veins, slowing blood return to the heart, while high estrogen may affect vein wall elasticity. Together, these factors can lead to lingering blood flow issues (sometimes lasting months post-delivery) and swelling in the pelvis and vulva, resulting in discomfort before, during, and after sex.
Sex after a c-section:
While painful sex after a C-section is rarely talked about, women can still face the same contributing factors as those who have had vaginal births. One of the most common causes of discomfort is vaginal dryness, often linked to hormonal changes. After a C-section, you’re not just healing from pregnancy; you’re also recovering from major abdominal surgery, which can add emotional stress, especially if the surgery was unplanned. It’s crucial to approach your sex life with patience, self-compassion, and understanding as you navigate this transition.
Practical solutions to ease discomfort:
See a pelvic floor therapist.
You should absolutely discuss any issues you are having with your Ob/Gyn or Midwife, just be aware that they often do not have the training to do a full pelvic floor screening and assessment.
A pelvic floor physical therapist is a specialized expert dedicated to addressing a range of pelvic floor issues, including painful sex. Their knowledge and skills can be a game-changer in helping you regain comfort and confidence in your intimate life.
Self love.
Get acquainted with your postpartum body. Depending on your comfort level this may mean spending some time naked in front of a mirror. Be compassionate with yourself, this body has done incredible things! Sometimes feeling ultra confident and/or accepting of your postpartum figure can feel like a stretch, so for some it can be helpful to try to reach a state of body-neutrality instead. Body neutrality is a balanced perspective that lies between body positivity and negativity, focusing on acceptance and respect for one’s body rather than love or hate. This perspective encourages people to prioritize their body’s function over its appearance. It recognizes that the body is just one aspect of identity and should not define overall self-worth.
Masturbation is an excellent way to explore your postpartum body in a safe and enjoyable way. This practice allows you to discover what feels different, uncomfortable, or pleasurable, so when the time comes to involve another person, you’ll be better prepared to advocate for your needs and ensure a satisfying experience.
Perineal and c-section massage.
If you had a tear or an episiotomy perineal massage can help gradually loosen scar tissue and increase circulation, which improves overall sensation and reduces pain.
If you had a c-section massage and other sensitization techniques along the scar can improve tissue healing and mobility, which reduces tightness, tenderness and pain.
Relax into it.
Whether it’s taking a hot shower, exchanging massages, lighting candles, or playing soothing music, there are countless ways to create a relaxing atmosphere that makes intimacy feel inviting rather than intimidating.
Play around with positions.
Focus on finding a position that feels right for you, even if it takes a few tries. Take it slow, be patient and kind to yourself, and communicate openly with your partner. They should be just as invested in making sure you feel comfortable and satisfied as you are.
Use lots of lube.
Don’t skimp on the lube! In particular, a good water-based lube or a natural oil lubricant such as coconut oil are good options. Not all lubricants are created equally and it’s important to use a high-quality product - see our recommendations here.
Support your hormones and rebuild your energy.
Psychological support is crucial.
If you’re dealing with trauma, postpartum mood or anxiety disorders, relationship challenges, or any mental health concerns, seeking professional help is essential before tackling issues with physical intimacy. Addressing these underlying issues first can pave the way for a healthier, more fulfilling intimate connection.
Lots of communication.
Many women experiencing painful postpartum sex worry about disappointing their partners. It’s important to understand that if you’re uncomfortable, it doesn’t mean there’s anything wrong with you; your body simply needs time to heal and for hormones to stabilize. If you’re not ready for intercourse yet, don’t hesitate to share this with your partner. In the meantime, there are plenty of other loving and affectionate ways to connect!
Don't overlook the power of foreplay—it's just as crucial now as ever! With hormonal fluctuations and a busy mind filled with to-do lists, your brain and body need extra time to warm up before the main event. Taking the time to connect intimately can enhance your experience and help you feel more relaxed and engaged.
Don’t rush!
Women are often told that the 6-week appointment is when their OB or Midwife will give them permission to resume sexual intercourse. But let me be very clear, “permission” is only something you can give. They are simply checking to verify that the risk of infection is low and that tears and/or bleeding have resolved. While this exam is crucial for evaluating healing from tears or episiotomies, checking for the resolution of bleeding, and ensuring your uterus has returned to its pre-pregnancy size, it's just one part of the picture. During this exam if you do feel pain, be sure to let your provider know - this might clue them into other underlying conditions that may not be as obvious such as - vaginal dryness, granulation tissue, infection, vaginismus, pelvic inflammatory disease, endometriosis, prolapse, symphysis pubis dysfunction (also known as pelvic girdle pain), or fibroids. Although most of these conditions likely will have been identified during your prenatal care, pain during a pelvic exam is always a cause for further discussion,
Keep in mind that there’s no sudden change at six weeks postpartum; you're still navigating the recovery journey, whether you had a cesarean or vaginal birth. Pain serves as a key sign that your body may not yet be ready for intercourse. Listen to your body and slow down, communicate openly, make adjustments, and get professional help if needed.
Painful sex after childbirth is common, but that doesn’t mean you have to accept it as part of your life. While postpartum sex may feel different, it’s crucial to remember that sex should never be painful. It's common to experience some discomfort initially, but that doesn't mean you have to endure it. Continuing despite pain can create a fear of recurring discomfort, making it hard to relax and potentially leading to more pain. This fear might cause you to avoid sex altogether if you begin to associate it with pain. There are numerous at-home remedies for alleviating painful postpartum sex, but if these don’t provide relief, don’t hesitate to seek professional guidance. Your body has undergone significant physical, hormonal, and emotional changes during this time, and it can take a while to return to your pre-baby sex life. Don’t rush it - it’s important to be patient with yourself and wait until you’re mentally, physically and emotionally ready to have sex after baby.
Note: It's important to remember that having recently given birth doesn’t mean you can't get pregnant again. In fact, conception is possible as soon as three weeks postpartum, even if you haven't had a period yet or are breastfeeding.
This is for informational purposes only. For medical advice or diagnosis, consult a professional.
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