“Is Painful Intercourse Normal After Having a Baby?”

Scenario: Mandy gave birth to a healthy baby boy and was cleared to have sex at her six week visit. She was excited to be healing and getting back to her regular activities but was not as relieved to hear this news about sex.  She felt that she still looked pregnant, was tired and tense trying to adjust to her new life . . . having intercourse was the last thing on her mind.

Painful intercourse, known as Dyspareunia, is not as widely talked about as other post-delivery issues- like back pain and weak abdominal muscles- even though nearly 45% of postpartum women will experience this pain. Some common ways in which sexual pain manifests itself is: pain with vaginal penetration, inability to orgasm, decreased lubrication, perineal pain, and other symptoms. Dyspareunia is persistent or recurrent genital pain that occurs before, during or after intercourse that causes you personal distress.

Scenario: Mandy joined a local mothering group hosted by speakers who would touch on a variety of post delivery topics. A women’s health physical therapist was the speaker for the evening and educated the group on therapy options for issues such as lower back pain, weak abdominals . . . and painful intercourse. Mandy learned that the burning and stinging pain she was experiencing during intercourse was not normal and that there were modalities, treatments and exercises that would help her gain back the health of her pelvic floor, reduce her pain and increase her function.

Most women have not been taught the importance of the pelvic floor’s role in sexual functioning. When a woman has burning, stinging or spasms, sexual intimacy and desire for sexual intercourse can be greatly reduced.  For some post-delivery women, who develop increased muscle tension of the pelvic floor muscles, sex can be impossible. Even though most women want to get their sexy back after having a baby, they often do not know that specialized physical therapy can help them meet their goal.

Scenario: Even though she was hesitant to discuss her concerns about sex, Mandy spoke with her gynecologist. She was referred to a physical therapist specially trained in women’s health. Mandy received an individualized evaluation and treatment based on her specific diagnoses, symptoms and goals. She was told that her pelvic floor muscles did not return to their normal resting tension baseline. One of the manual treatments that was most helpful, was the use of vaginal dilators for soft tissue mobilization.

Vaginal dilation is a very effective tool in helping to eliminate the PC muscle reflex, the underlying cause of vaginal tightness, burning, and penetration difficulties. The pelvic health therapist educates regarding the anatomy of the musculoskeletal system and physiology of the involved muscles and sexuality. A patient is taught how to properly use and progress with dilators to achieve the desired soft tissue mobilization techniques and monitor the progression of dilator size to increase extensibility of muscles.  Dilator therapy, along with other treatments such as ultrasound, moist, heat, and pelvic floor muscle relaxation techniques are effectively used to treat this condition.

Scenario: After six weeks of consistent pelvic floor therapy and follow through with an individualized home program, Mandy is now happy. She and her husband are now able to enjoy intimacy, including pain free sexual intercourse and she also enjoys improved pelvic floor function which had affected her ability to urinate and have a bowel movement. Even though she was hesitant to speak up because sex is supposed be pleasurable not hurt, she is most grateful that there are specialized physical therapists who can assist. She now knows that muscles in the pelvic floor area need to be treated, just like you would seek evaluation and treatment of the muscles, tendons, ligaments and bones if you sprained your ankle.