Cue the Salt-N-Pepa... let's talk about painful sex. Pain with intercourse can be really distressing, and anywhere from 40-75% of women will experience it at some point in their lives. There are many different diagnoses that lend to painful intercourse and these are not limited to the postpartum period. Women report pain with intercourse even in the absence of trauma or injury, which can be particularly frustrating to deal with. 

Sex Shouldn’t Be Painful Postpartum

Painful sex postpartum can lead to an emotional rollercoaster. Painful intercourse limits intimacy with a partner. This can be a very hard issue to talk about for many people, it can seem especially isolating. That being said, there are answers and solutions to this problem. When we see women in the office for this, they are so grateful to learn that PELVIC FLOOR PHYSICAL THERAPY can offer a solution that they were unaware even existed.

Common Causes of Painful Intercourse

• TIGHT pelvic floor muscles***
• Compressed nerves impacting function & sensation [burning//tingling]
• Scar tissue affected blood flow
• Hormonal changes - low estrogen causing decreased lubrication

***If you have tight pelvic floor muscles, you may also experience other symptoms stress incontinence or urinary urgency.  

How Pelvic Floor Physical Therapy Can Help

All hope is not lost! You can get back to being intimate with your partner - without the discomfort. From a PELVIC FLOOR PHYSICAL THERAPY perspective, we can address any muscular imbalances, usually pelvic floor tightness, that are contributing to painful intercourse postpartum. Ultimately the goal is to increase blood flow and lengthen any tight pelvic floor muscles. Releasing tension in the pelvic floor is accomplished by a direct internal release -- performed by a pelvic floor physical therapist or you at home using a wand or your finger.

Directly treating the pelvic floor muscles internally / vaginally can be a really helpful tool for postpartum women, but we also have to make sure we are addressing all the muscles surrouding the pelvis. There is a lot of work you can do at home that will be effective to improve your symptoms OUTSIDE of internal release.

By increasing blood flow to the muscles that attach to the pelvis externally, we get a secondary increase in blood flow to the pelvic floor. The stretching video playlist and mobility video playlist

Scar Tissue & Painful Intercourse 

If you are experiencing pain with sex after your pregnancy, scar tissue may be contributing to your symptoms. Scar tissue can develop from perineal tears that occur during vaginal delivery. Addressing this perineal scar tissue can be an important part of the puzzle especially if you are battling painful intercourse postpartum.

There is really no wrong way to work scar tissue as long as you aren’t doing it too hard, causing significant pain, causing bleeding, or doing it too early in the healing process. We can work directly on the perineum, rubbing across the scar tissue or in circles, will  increase blood flow superficially. We can also think about trying to get the skin to slide and glide better across other layers of tissue by using a little more pressure and trying to grip the skin and getting it to slide.

Also, by using your thumb in the vaginal opening and then index finger over the perineum externally, you can approximate your two fingers and massage the tissue between them. You can rub back and forth, side to side, and in circles. The goal is to get lumps and bumps of scar tissue to soften over time. The shower can be a nice place to try any of these techniques. 

How to Make Sex Less Painful Postpartum 

You can perform mobility exercises to 'prep' for intercourse. Pick 2-3 favorite stretches in the stretching playlist and add it before or after intercourse as a nice, gentle way to prepare your pelvic floor muscles for intercourse.

You can also do some manual internal release before sex with your finger/wand/dilator. This isn’t always the sexiest thing, so stretching might be a more accessible tool. If those muscles tighten up after having sex, apply some of these breathing and stretching techniques afterward. Gentle breathing techniques can be a nice way to help support your body and make it feel safe.

Along those lines, when you have had painful intercourse for any period of time, it can start to 'mess with your head'. Your brain begins to perceive the painful event and anticipates that every sexual encounter is going to be painful. Our job is to teach your body that intercourse can be SAFE and ENJOYABLE.

You might have to start slowly when working on rehab and returning to intercourse. As you need to build positive sexual experiences for you brain and body. This might mean trying some non-penetrative things with your partner initially and working up to penetration to help maintain intimacy. Additionally, using some breathing techniques to both calm the nervous system and bring length to the pelvic floor can be useful.

If you have been experiencing painful intercourse postpartum or otherwise, PELVIC FLOOR PHYSICAL THERAPY can be a really helpful tool to get you back to feeling good and resuming this part of your life confidently. There are solutions for the problems you are having and you don’t have to be ashamed. We are here to help.