Cleared To Get It On Postpartum But Just Not Ready Yet?
You go to your 6 week postpartum visit. Your OB or midwife tells you that everything looks good and you can have sex….yay?
You might think you’re supposed to be excited, but let me tell you, most of my patients are not chomping at the bit to get back into penetrative sex. Understandably so, you’re tired, you have a new baby, and your hormones are all over the place.
Before you start wondering if this is how you’ll feel forever, remember, this is a season. You will get back to feeling like yourself and sex will be there waiting for you whenever you’re ready. Being medically “cleared” for sex by your provider does not mean that you need to feel ready to try. In fact, many people don’t feel ready until months later and that is perfectly OK.
But what should you expect when the time comes that you’re ready to give it a shot, be it 6 weeks or 6 months postpartum?
Between 60-70% of people experience some degree of discomfort postpartum. But notice that I said discomfort, not pain. An appropriate expectation is for sex to feel more like you haven’t had it for a while. It may hurt a little bit at first, but then should get better and better every time you have sex. In general, postpartum sex should feel back to normal in 3-5 attempts, getting progressively better each time you have penetrative sex.
What’s a sign that you need to seek help when getting back into sex postpartum? Severe pain that makes you feel like you can’t continue. No matter what, you do not have to have to live with pain with intercourse, particularly if it’s new since baby. Additionally, if you’re having mild pain that isn’t getting better, that’s another reason to consider seeking help. If either occur, it’s time to see a pelvic floor physical therapist.
Typically the pain with penetrative sex is caused by pelvic floor muscle tension, scar tissue or hormonal changes at the vaginal opening. Your pelvic floor physical therapist can help you determine which of these factors is contributing to your symptoms. Treatment usually includes reducing scar tissue and tension with manual therapy, teaching you how to work on the tension at home and referring back to your physician if there are any hormonal issues.
But what can you do in the meantime to reduce the pain?
Use lube! I could write a whole blog post on lube. I’m a big fan. Everyone should use it even if you don’t have pain, but especially if you do.
Make sure you’re ready. It may seem obvious, but penetrative sex will hurt less if you are aroused. Arousal relaxes the pelvic floor muscles, brings blood flow to the genitals and typically increases lubrication.
Go sloowww at first! Try lots of deep breathing right before and during initial penetration. This will help prevent your pelvic floor muscles from guarding and tensing before penetrative activities even begin.
Treat sexual activity a bit like an experiment the first time you try and have realistic expectations. Remember that you might have some discomfort, but it should get better and better. Whatever you feel the first time you engage in sexual activity is not what you’re going to feel forever.
Start small. Think finger insertion before penile or larger toy insertion.
What if I have the opposite problem.. I have LESS sensation?!
This can happen due to pelvic floor muscle weakness, or due to laxity in the pelvic floor muscles. Pelvic floor physical therapists can assess for laxity and weakness in your pelvic floor, allowing us to offer you exercises to appropriately address whatever impairments are contributing to your decreased sensation.
If you only remember one thing from this blog post, remember that you are not alone and pain with sex isn’t something you have to live with. Whatever the cause of your pain may be, treatment exists. If you’re hurting, pelvic floor physical therapy can help. Contact us today for in person or virtual appointments to discuss pain with sex!
By Dr. Jessica Chastka, PT, DPT, WCS
Jessica (she/her) earned her Bachelor’s in Exercise Science from the University of Louisiana at Monroe, while playing softball. She received a Doctorate in Physical Therapy from University of Texas Medical Branch in Galveston in August 2015. In 2019 she became Board Certified in Women’s Health, through the American Board of Physical Therapy Specialists.
For the last five years she has been working as a pelvic floor physical therapist, treating people who have pelvic pain, leakage, urgency, frequency and constipation. This includes the pregnant and postpartum population as well as people with chronic pain. She is passionate about making her patients feel heard and seen, validating those who feel that their problems are not worth mentioning because everyone has them or because embarrassed to talk about them.