with Physical Therapist Dr. Sara Reardon
WHAT YOU’LL LEARN
- Common Postpartum Vaginal Issues
- Ready For Postpartum Sex
- Sex Shouldn’t Hurt
- Dealing With Painful Tears or Scars
- Common Issues During Postpartum Sex
It’s six weeks postpartum. Your OB/GYN visit went well. Exciting things are happening. If you had a c-section, you can likely drive again, and you’re probably cleared for sex too.
But are you really ready? You may still be bleeding six weeks after a baby. Even if your body has completely healed, are you really ready? Are you prepared mentally after the trauma of giving birth and the mental toll of being responsible for a new human? Board-certified women’s health physical therapist Dr. Sarah Reardon will help us unpack some of the vaginal issues and issues related to postpartum intimacy that may come up.
Common Postpartum Vaginal Issues
“The two most common ones are urinary leakage and painful sex,” Dr. Readon said.
She explained that the muscles of the pelvic floor are like a hammock built to support a growing fetus. “When you have a lime or a lemon in a hammock, it’s not going to change much. But if you put a watermelon in that hammock, we see it stretch out,” she said. “And that’s just what happens through pregnancy and then going through birth and then postpartum recovery.”
Dr. Reardon focuses so much on pregnancy and postpartum, because it changes our bodies so much and at least in the U.S. there is so little support during recovery.
Returning to intimacy after giving birth is a puzzle. It’s not just the physical healing of a vaginal birth or cesarean. But that’s such an emotional experience too. You need to be ready in both areas.
Cesarean or vaginal birth, delivery is so hard on your body and can leave lasting effects. A lot of women experience incontinence when they sneeze or cough. After my third child, I had pubic symphysis that hurt so bad I couldn’t raise my legs to get in and out of the car.
And in addition to navigating all of these changes to our bodies, we’re navigating new motherhood.
“Six weeks means nothing,” Dr. Reardon said. But she does think it’s a good time to check in with your medical provider and a pelvic floor specialist. She’s seen women in her clinic who have been cleared to return working out, sex, and life but still have stitches healing! “What if it were eight weeks or twelve weeks?” she asked. “We would probably follow that guideline.”
“Nine out of ten mothers have pain after the first time they have intercourse,” she said. But no amount of pain is normal. And there are so many things we can educate mothers to have a better experience. We don’t have to just give them the thumbs up to return to intercourse.
Being physically ready and mentally ready are two different things.
The female arousal looks different than the male arousal system. Leaky boobs, cracked nipples, painful sex are all reasons women might not want to have sex. But at six weeks are you sleeping? Are you still bleeding? There are lots of reasons you might not want to have sex.
If emotionally, you’re not ready, that’s okay. There are things you can do to get ready, but it doesn’t have to be a race. “I did not even attempt intercourse for twelve weeks after my second child,” Dr. Reardon said. “Our hormones play a big role in sexual desire and when you’re breastfeeding or lactating your estrogen level is really low.”
“A lot of it is giving ourselves permission to heal in various ways,” Dr. Reardon said.
Sex Shouldn’t Hurt
“Pain gives us information that something is going on. Let’s address it,” Dr. Reardon explained. Once you’ve experienced pain, you anticipate pain. Of course, anxiety causes your muscles to tense so expecting the pain causes more pain. It can become a cycle.
“Vaginismus is a spasm of the vagina,” Dr. Reardon said. It basically feels like nothing can enter the vagina. It doesn’t matter what it is. It’s like it’s hitting a wall. Since this is caused by a clenching of the muscle, the place to start is with the muscles. And the goal is to introduce an experience that isn’t going to be painful, so you can stop associating the action with pain.
“Actually women who have a cesarean birth are more likely to experience painful intercourse than those who have vaginal births,” Dr Reardon said. She explained that gently massaging the cesarean scar and working on pelvic floor PT can be really helpful in reducing that pain. Dr. Reardon recommends trying this independently at first. You can do this before intercourse, but it’s a good idea to get more comfortable with it first.
Dealing With Painful Tears or Scars
“A perineal tear is typically when there’s a tear from the size of paper cut all the way to a tear that goes from the vagina to the anal.” Dr Readon explained. But those larger tears—third or fourth degree tears—are a smaller percentage of people. “The majority of individuals do have some sort of tear,” she went on to say.
We focus on perineal massages during pregnancy but this is something we can do after in postpartum. Put pressure on the vaginal opening and if you feel pain breathe into it and sweep your finger across to relax the muscle.
Common Issues During Postpartum Sex
“As you are aroused, you create natural lubrication in your vagina. So, I think, sometimes jumping from 0 to 60 that’s a hard place to go. We’re expecting our body to behave a certain way when we haven’t really stretched or warmed up,” Dr. Reardon said.
“Use a water soluble lubricant,” she suggested. She explained that water soluble lubricants absorb well where an oil based lubricant can put you at risk for infections. It might feel strange to use a lubricant if you haven’t had to before, but your body has changed. You grew another person. But as your hormone levels change, you may have more natural lubrication and desire again.
Part of the problem is that a lot of women feel shame around expressing their needs or talking openly about their bodies. If you come from a background where sex is associated with shame for women this can be hard to navigate. But how are we going to raise the next generation of women if we can’t advocate for ourselves? “The more we talk about it, the more comfortable we may get,” Dr. Reardon said.
Finding ways to ease yourself into it can be helpful. Because anxiety tenses your muscles, and your vagina is a muscle.
If you’re not ready for full on intercourse or you haven’t had your first orgasm since the baby, you might want to stimulate yourself to get comfortable with it. “It’s okay to practice on your own,” Dr. Reardon explained. There are vibrators and other tools you can use.
“Your pelvic floor sits at the base of your pelvis like a hammock, but at the very top of your abdominal cavity is your diaphragm,” Dr. Reardon explained. If you’re stuck in your pelvic floor and your abdomen isn’t moving, you’re chest breathing. Working on deep breathing relaxes that pelvic floor and that’s something you can do while breastfeeding or sitting in the carpool lane. That can be a really simple fix. Yoga based stretches help too. “Getting into the squatting position helps relax your pelvic floor.” Dr. Reardon said.
She explained internal massages can also be used. When a tender pressure point is found, it’s massaged out similar to the way you might get a knot in your neck massaged. Once you’ve worked with your pelvic specialist to find the pressure points, this is something that can be done at home with your partner or a home device. A pelvic floor massage might be uncomfortable at first, but the more we talk about these things and seek treatments that may be outside of our comfort zone initially, the more comfortable and confident we become.
And if we’re experiencing painful sex, incontinence, or any of the other issues you’d need a pelvic specialist for, it’s important to seek treatment. Our bodies shouldn’t be embarrassing, and getting treatment makes a difference to our quality of life. “We don’t deserve to live in pain, discomfort, or have a lower quality life, because we had children,” Dr. Reardon said.
Part of returning to intimacy postpartum is allowing for changes to your relationship and communicating your needs. Your family and whole life has changed, so you can’t expect it to be the same. You may never get back to the old relationship, but if you’re intentional about communicating and supporting each other, the new relationship can be just as good.
Postpartum is a hard season. You’re doing great, mamas. Keep showing up!
If postpartum intimacy is something you’re still struggling with, the Navigating Intimacy After Children Workshop is available for additional support.
Sara Reardon is a doctor of physical therapy and board-certified women’s health physical therapist. Sara specializes in the treatment of pelvic floor disorders, including pelvic pain, bowel and bladder dysfunction, painful sex, and pregnancy and postpartum recovery. She is the founder of The Vagina Whisperer, an online resource for pelvic health education to support, empower and educate women worldwide. She is a mom to two boys, wife, Saints fan and wanna-be yogi. You can find her on Instagram at @the.vagina.whisperer.