Pregnancy, as well all know, does not leave any area in your world - or body - unchanged. In some ways, it’s amazing how completely the body can change! Unfortunately, some of these changes are less than positive. One such change, painful sexual intercourse or dyspareunia is a very common issue. In fact, almost 25% of new mothers report pain during sex at 18 months.
Am I at risk of postnatal sexual pain?
Dr. Annemarie Everett is a board certified Women’s Health Specialist with a doctorate in physical therapy, and has years of experience helping women through pelvic and pre/postpartum physical therapy. And one of the first questions that Dr. Everett gets from her clients is "Am I at risk of postnatal sexual pain?"
"While painful postpartum sex is common, there are some factors that will increase the likelihood of it happening" says Dr. Everett. Painful sex after childbirth is more common if the child was delivered via emergency or elective cesarean, or vacuum-assisted vaginal delivery. It also is more likely to happen if there were issues with painful sex pre-pregnancy, or if the mother has perineal tearing. According to a recent study, a significant portion of women who had perineal tearing, also reported pain during sex a full year after childbirth, with the many women reporting pain increasing with the degree of tearing .
Breastfeeding can also lead to painful sex, as production of the hormone prolactin, needed for successful milk production, suppresses the production of estrogen. A lack of estrogen can lead to vaginal dryness, itching, burning, irritation, painful sex and urination. In these cases, once the child is weaned, the issues typically go away.
While all of these factors can lead to postnatal sexual pain, it is important to note that some women who have these risk factors will not experience it, and some women who do not have them will be dealing with pain. As with all things in pregnancy, your body is unique and will respond to the stresses in a unique fashion. For most women, the incidences of sexual pain will lessen over time, especially with proper treatments.
When you should seek medical treatment for painful sex?
If you are experiencing pain, though, it is important to know when you should seek care from a physician. According to Dr. Everett, if there is pain during intercourse, especially in combination with bleeding and other signs, this can indicate a condition that will require medical intervention. If you are experiencing abnormal vaginal discharge, warmth to the touch, and/or bad smells, these can all be signs of a possible yeast or bacterial infection. Significant or prolonged bleeding past the early postpartum stage can indicate retained placenta.
With perineal tears, you might find that there are abnormal or delayed healing patterns. Granulation tissue, a local overgrowth of healing tissue, can cause pain and bleeding. A close examination of the tissue will show red or inflamed ‘polyps’ of new tissue growth. If you have granulation tissue, you may benefit from medical intervention through either topical medication or an in-office cauterization, both of which will promote complete healing more rapidly. This is a non-emergency issue, so if you do see granulation tissue, do not worry! It can be resolved at your convenience.
When it comes to painful sex after baby, there are actually a few different types, with different root causes, and the treatment will differ depending on what type of pain you are experiencing. So, what one mother experiences is not going to be the same as what another mother experiences, nor will the solution be the same. To learn more about the types of pain, what causes them, how you can self-assess for the type of pain, and what treatments you can turn to help solve the problem, please enroll in Dr. Everett's class, 'Sex after baby: why it can hurt and how to make it less painful'.
 McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015;122:672–679.
 Gommesen, Ditte et al. “Obstetric perineal tears, sexual function and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study.” BMJ open vol. 9,12 e032368. 16 Dec. 2019, doi:10.1136/bmjopen-2019-032368.