You may be feeling some trepidation at the prospect at having sex after having a baby, especially if you’ve had some tearing or episiotomy during your labour. Surprisingly, moms who have given birth by Cesarean may find that sex can be uncomfortable, even though their pelvic floor was not affected.
We want to give you some information as to when it’s safe for you to resume sex after giving birth, how you can prepare for it and how you might be able to resolve some of the issues that can hinder your enjoyment of sex after your miracle comes.
It’s normal NOT to want to have sex after you just gave birth
Even if you did not have any tearing during birth, chances are, you probably won’t be in the mood to have sex when you just had a baby because you are probably dealing with exhaustion from sleep deprivation. If you are breastfeeding, this releases oxytocin which helps you bond with your baby – but suppresses your libido. Some moms might also feel “touched out” from being with their baby 24/7 and the last thing they’ll want is more physical closeness.
It seems like nature is against parents having sex too soon after having a baby for a reason (as you will find out in the next section). The good news is, all of this will eventually pass.
So when is it safe for you to have sex after a baby?
Your doctor or midwife will probably tell you to wait at least 6 weeks postpartum before having vaginal intercourse. If you’ve had a vaginal birth and you’ve had some tearing down there, it takes at least 6-8 weeks for the tissue to heal properly. If you’ve had a Cesarean birth, your incision site will need 6-8 weeks to heal as well, assuming there is no infection or complication. Whether you birthed vaginally or by Cesarean, your uterus will need time to heal and not have anything entering the vagina while the healing takes place. This is especially important in the first 6 weeks while there is an increased risk of uterine infection. If you have had a third or fourth degree tear where the external anal sphincter was also injured, you will need at least 6 months before having anal penetration. To be sure that your tissue has healed properly, we recommend you see your doctor or midwife to confirm.
Your care provider tells you that your tissue has healed, should you go ahead and have sex?
Once you’ve gotten the Ok from your doctor or your midwife, we recommend that you do some self-exploration before having sex. We are going to discuss vaginal sex readiness in this case because this is where we get most of the questions from.
To prepare, gently touch the area between your vaginal opening and your anus (the perineum) and notice how it feels to you. Does this tissue feel relaxed and plump or does it still feel tender and tight? Some mamas might have a really hard time touching their lady bits if they’ve had an injury to their pelvic floor and this is totally understandable. If this is the case and if it’s oK with you, have your partner do the touching for you. If touching the tissue does not cause you any discomfort, you might consider gently stretching around the vaginal opening and see how it feels. If there is no pain then you are good to go. However, if you experience any discomfort then read on.
Even though your tissue has healed, you feel tenderness touching/stretching your vagina or you have discomfort or pain with intercourse
There are a few factors that cause pain with intercourse. They are:
- Vaginal dryness
- Scar tissue from tearing or episiotomy or Cesarean section
- Hypertonic/overactive pelvic floor
- Orthopaedic dysfunctions
- Emotional stress
Did you know that 40 to 50% of women have pain with sex 3 months postpartum? This number improves over time but for some women, pain with intercourse does not improve when time progress. Don’t worry, pelvic health physiotherapists are trained to help you overcome this issue.
If you are still breastfeeding your baby, your body is in a low estrogen state which may lead to the thinning of the vulva tissue and vaginal dryness. Consider using a very generous amount of lubricant if this is the case. We recommend you use a lubricant that is free of chemicals (e.g., parabens, phthalates, glycerin, petroleum, etc..) or anything that has sparkles or causes tingly sensations.These chemicals may affect your hormonal system and the pH level of your vagina (which may increase the risk of infections).
Although coconut oil has been suggested as a good lubricant by some health professionals, we don’t recommend it because it is antimicrobial (which affects the pH level of your vagina’s microbiome) and it can also dissolve the condom (please note that some condoms can irritate your vagina as well). We recommend “Good Clean Love” or “Sliquid” lubricants based on these criteria. If you are finding that using lubricant isn’t adequate to address your vaginal dryness, you might want to check with your doctor about the possibility of using a topical estrogen cream, which can also help with vaginal dryness.
Scar Tissue Management
If you have had a tear, an episiotomy or a Cesarean section, there may be adhesions around the scar which causes discomfort with penetration. You might be surprised to hear that a Cesarean scar can affect the pelvic floor but the Cesarean incision cuts through multiple layers of tissue, one of which is a fascial layer that goes from your abdominal to the pelvic floor. As a result, the Cesarean scar can cause tightness in the pelvic floor. Thus, it is important that all scar tissue gets worked on.
We recommend that you see a pelvic health physiotherapist or our registered massage therapist to get the perineum scar tissue or the Cesarean scar tissue mobilized and to learn how to do it yourself.
Hypertonic/Overactive Pelvic Floor
Your penetration pain may be due to hypertonic or overactive pelvic floor muscles. This may happen because you might be habitually tightening your pelvic floor. It could also happen because your pelvic floor was strained from the birthing process, and you may have leaked a little at the beginning of your recovery, so you tighten the pelvic floor muscles to support yourself and to prevent leaking and it has now become a habit. It could also happen because of a painful experience or traumatic experience with your perineum, and your pelvic floor is tightening to protect yourself.
Whatever the reason is, a pelvic health physiotherapist can help you figure out the reason why your pelvic floor is tight, do manual therapy to release tightness and recommend breathing and stretching exercises to complement the manual treatment.
If you are having hip pain, low back pain, pubic pain or sacroiliac joint pain, these orthopaedic dysfunctions can potentially affect your pelvic floor and causes pain with sex. Consider getting these conditions assessed and treated by one of our chiropractors, osteopaths or physiotherapists.
When it comes to discomfort with sex, it’s really important to consider the emotional and mental aspects as well as the physical aspect of a person. Pain science has shown us that “pain” is not only caused by biomechanical issues but also by emotional issues. How you are feeling about yourself & your partner, your new role as a parent, your birthing experience and past traumas, whether you feel supported and having time for self-care…all come into play with pelvic pain issues because they affect your nervous system’s sensitivity. In addition, your tissues can hold on to unresolved emotional memories, and until these emotions have been processed, your tissue cannot release fully and you might experience pain even though the tissue appears to be perfectly healthy.
Consider talking about this with an experienced psychotherapist if you might have an underlying emotional issue that could cause discomfort with sex.
In conclusion, we want to let you know that you should only have sex when you feel ready, not because you feel that it’s your duty or it’s the only way to regain intimacy with your partner. Sex should be pleasurable and should not cause you pain. We want you to have the best sex life possible and we have a multi-disciplinary team that can help you resolve any issue that can arise in your journey to resume sex after having your baby.