If you have given birth, you may have heard this well-intentioned wisdom: “The first time you have sex is going to hurt - but after a little while it will get better.” While this is meant to ease anxiety, it makes light of a significant postpartum concern, and it implies this pain is normal.
Pain with intercourse, or dyspareunia, after childbirth is common, but persistent pain is not normal, and it can be treated.
How common is postpartum dyspareunia?
According to a 2022 study in the Journal of Obstetrics and Gynecology, roughly 31% of first-time mothers experience pain with intercourse at three (3) months postpartum. Of the people surveyed, 11% continued to have pain 24 months postpartum.1
Despite its prevalence, postpartum dyspareunia is largely under-reported and therefore often goes untreated. According to a survey of 484 postpartum women, only 15% who experienced sexual health concerns shared this with their provider.2
While most people receive sexual counseling at their six-week postpartum visit, this counseling tends to focus on birth control options and recommendations for resuming sexual intercourse. This means that pain or difficulty with sexual activity beyond this appointment can be easily overlooked.
What factors can contribute to postpartum dyspareunia?3
- Birth trauma:
a. Physical trauma - such as perineal tearing, muscle strain, or nerve injury. Vacuum or forceps-assisted delivery and pushing for longer than two hours or less than 20 minutes increases the chance of incurring a physical trauma.
b. Emotional trauma - can be experienced when serious concerns for the health of the birthing person or infant arise, or when unplanned medical interventions are needed which can increase distress.
- Estrogen changes: Reduced estrogen can cause thinning or dryness of the vaginal tissue which may contribute to irritation during intercourse. This may be prolonged with lactation.
- Pelvic floor dysfunction: In addition to birth injuries during delivery, changes to posture, core strength, joint mobility, returning to exercise to soon, or progressing exercise too quickly after
childbirth can all influence pelvic floor muscle dysfunction.
- Complications from Cesarian delivery: A painful abdominal scar or decreased cervical mobility can create pain with intercourse.
- Dyspareunia or pelvic pain during pregnancy: Pain during pregnancy that is not addressed can persist beyond delivery.
- Other factors - such as fatigue, stress, depression, and/or anxiety may impact your pelvic pain in the following ways:
a. Decreased desire or arousal
b. Delayed tissue healing
c. Increased muscle tension
How is postpartum dyspareunia treated?
As mentioned earlier, there are several factors that can contribute to painful sex after childbirth. So, it is helpful to have a health care team to comprehensively address whatever factors are driving painful sex.
This team may include an OB-GYN or midwife, a pelvic floor therapist who can address muscle and tissue dysfunction, or a mental/behavioral health specialist who can address factors related to stress or postpartum mental health concerns. Each of these disciplines can offer individualized care to support your sexual health.
The Spaulding Outpatient Center for Pelvic Health at Care New England offers interdisciplinary treatments to support you on your journey into parenthood. If you are experiencing painful sex after childbirth, do not wait it out. Talk to your healthcare provider today.
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Disclaimer: While I am a doctor, I am not your doctor. The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.
References
1. Rosen NO, Dawson SJ, Binik YM, Pierce M, Brooks M, Pukall C, Chorney J, Snelgrove-Clarke E, George R. Trajectories of Dyspareunia From Pregnancy to 24 Months Postpartum. Obstet Gynecol. 2022 Mar 1;139(3):391-399. doi: 10.1097/AOG.0000000000004662. PMID: 35115480; PMCID: PMC8843395.
2. Barrett, G., Pendry, E., Peacock, J., Victor, C., Thakar, R. and Manyonda, I. (2000), Women's sexual health after childbirth. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 186-195. https://doi.org/10.1111/j.1471-0528.2000.tb11689.x
3. Alligood-Percoco NR, Kjerulff KH, Repke JT. Risk Factors for Dyspareunia After First Childbirth. Obstet Gynecol. 2016 Sep;128(3):512-518. doi: 10.1097/AOG.0000000000001590. PMID: 27500349; PMCID: PMC4993626.