Tips for Birth Providers: Painful Intercourse after Childbirth

 Painful intercourse after childbirth puts a huge damper on intimacy and often strains relationships. So let’s talk about how you can give hope to parents affected by dyspareunia or painful sex. 

6 Week Postpartum Visit – What’s on Parents’ Minds 

Mom and dad have waited 6 long weeks to have sex after baby arrived. They were fully aware that intimacy and sexual desire after baby would be different, but what if intercourse after childbirth feels completely miserable?

Typically at the 6 week postpartum visit with their Midwife or OB-GYN, women are asked how they would like to handle birth control and if they have any concerns. However, since most moms have been waiting to resume sex and other activities until after this appointment, they’re not yet aware that they have concerns about their sex life.

Sexual health is a very private topic for many women. It’s important that when a new mom confides in us as a provider we are aware of the obstacles they may be experiencing and be able to offer solutions that will improve their intimacy after baby.

Intercourse after Childbirth May be Complicated by the Following:

• Vaginal dryness leading to irritation with thrusting
• Experiencing pain during penetration after having a baby
• Experiencing pain during orgasm in the postpartum
• Pelvic floor muscle tightness causing pain during sex after pregnancy
• Scar tissue hypersensitivity or immobility causing painful sex
• Postpartum depression impacting sex drive and intimacy after baby
• Limited time and energy to spend enjoying postpartum sex

Top Reasons for Painful Postpartum Sex and Tips to Help 

Low Estrogen Levels 

With low estrogen levels in the postpartum that only decrease further while breastfeeding, vaginal dryness is a common cause of painful intercourse after childbirth.  While an estrogen cream may seem like a logical recommendation, some new moms may be hesitant to use it in the months postpartum because of the fear that it will lower their milk supply. 

An alternative recommendation would be to use lots of lubricant before and during postpartum sex instead.  Oil based lubricants such as coconut oil are typically longer lasting than water based lubricants; however, they are not a good option when using condoms as a form of birth control after childbirth.  Water-based lubricants are safe to use with condoms, but it’s important that they look for a water-based lubricant with an osmolality similar to that of the vaginal tissue to prevent accidentally making their vaginas more dry.  

Tightness in the Pelvic Floor Muscles 

Women that are experiencing pain with penetration or orgasm likely would benefit from information best provided by a pelvic floor physical therapist.  Painful sex after baby is often due to tightness in the pelvic floor muscles, scar tissue that is restricting movement of the vaginal or abdominal tissue, or residual hypersensitivity due to the natural trauma associated with childbirth.  Physical therapy can teach women how to relax pelvic floor muscles, desensitize and mobilize scar tissue and ultimately help women resume sex that actually feels good.  

Sleep Deprivation 

As we all know sleep deprivation, new and busy schedules, along with fluctuating hormones and moods make intimacy after baby very challenging, but adding pain into the mix makes intercourse after baby almost impossible for many new moms.  Encouraging communication with their partner, reassuring them that asking for and accepting help is a good thing, and pointing them towards various types of therapists can save floundering relationships. 

What Can You Do to Proactively Help 

Since research shows that 28% of women experience dyspareunia or pain with intercourse at 12 months postpartum, it’s essential that we educate women about what is normal to experience during intimacy after baby and what is abnormal.  Offering women resources to address pain just in case they experience painful sex can normalize the idea of seeking out treatment options.  Warning women about things they may experience when they DO have intercourse after childbirth assures women that they aren’t the only one experiencing pain.

Things that are Considered Normal During Intercourse After Having a Baby Include:

• Discomfort with initial penetration and/or during thrusting, 
• Requiring multiple attempts to successfully complete intercourse
• Using new sex positions compared to before or during pregnancy
• Longer time spent on foreplay 
• Using more lubricant to avoid irritation from dryness 

It would be considered abnormal if a woman experienced pain, burning, numbness, or is unable to achieve orgasm during intercourse after baby. 

Valuable Resources for Women Experiencing Abnormalities with Intercourse Include:

Online Postpartum Recovery Courses by licensed professionals

Virtual Consultations with Pelvic Floor Physical Therapists

In-person Physical Therapy Evaluations by a Pelvic Floor Physical Therapist

Talk Therapy with licenced counselors and therapists

Although painful intercourse after childbirth and sexual dysfunction are relatively prevelant, women are often embarrassed and unlikely to discuss their sex-life with their provider.  Unfortunately, even those that are brave enough to ask questions are sometimes told that what they’re experiencing is normal, not a big deal, or they may be advised to wait it out. According to the American College of Obstetricians and Gynecologists, many providers are uncomfortable asking about sexual health for a variety of reasons including a lack of adequate knowledge/training in diagnosis and management, an underestimation of the prevalence of the issue, or lack of clinical time to address the issue. 

Each provider’s goal is to provide the best possible care for their patients, but we can’t be the experts on everything. Providing our patients with the resources that they need to address their postpartum needs is important in order to support and heal the whole person. 

— Pregnancy by Design was born out of a desire to provide a resource to help Obstetricians, Midwives, Childbirth Educators, Hospitals, Birth Centers and Healthcare Systems provide excellent maternal care to all patient populations through education. If you  would like more information about our HIPAA compliant digital communication programs, telehealth, secure text messaging, digital childbirth education, social media integration or would like to become a Pregnancy by Design Preferred Provider, email us at [email protected]. 

Cited Research

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Female Sexual Dysfunction: ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists, Number 213. Obstet Gynecol. 2019 Jul;134(1):e1-e18. doi: 10.1097/AOG.0000000000003324. PMID: 31241598.

McDonald, E. A., Gartland, D., Small, R., & Brown, S. J. (2015). Dyspareunia and childbirth: A prospective cohort study. British Journal of Obstetrics & Gynaecology, 122(5), 672-679. 

Disclaimer: Pregnancy by Design’s information is not a substitute for professional medical advice or treatment. Always ask your healthcare provider about any health concerns you may have.