Returning to intercourse after delivering a baby can be daunting for many women. Whether you had a cesarean or vaginal birth, intercourse may not feel the same as it was before baby. Common statements I hear from postpartum mamas include “I had an episiotomy and/or vaginal tearing, will I re-injure myself if I have sex?” or, “Sex is excruciating” or “I feel like I am going to pee during intercourse” or “I no longer have a sex drive” or “My sensation down there just is not the same.” Unfortunately, the majority of women with these same fears, pains or questions do not end up in a pelvic floor physical therapist’s treatment room. I am here to tell you (as always) that pain, unintentional peeing, discomfort, or weird sensations do not have to be your normal!
Let me repeat that, you do not have to settle for painful sex!
First, it is important to give some praise to your pelvic floor muscles. During pregnancy, our pelvic floor muscles are working overtime to support our pelvic organs (rectum, bladder and uterus). As the baby and belly grow during pregnancy, more pressure is placed on the pelvic floor. In turn, the pelvic floor muscles are in a constant state of contraction for well near 9 months. Check out this picture to understand what the pelvic floor is going through during pregnancy:
As you can see, the pelvic floor muscles are the supportive hammock to our pelvis and core. When these muscles contract, they not only provide structural support but also keep us from accidently peeing or pooping our pants. On the flip side, these muscles need to relax fully and allow a certain amount of stretch/lengthening to occur in order to have intercourse or birth a baby. With all that in mind, it should come as no surprise that these muscles may prevent an easy labor and delivery. Remember when I said that these muscles are in a semi-contracted state throughout pregnancy? Well, imagine if you walked around for 9 months performing a bicep curl aka bicep contraction. After 9 months of that nonsense, it would most definitely be difficult to straighten your elbow, allowing the bicep muscle to relax fully. Apply that same concept to your pelvic floor and suddenly you realize how difficult it can be to relax these muscles during labor. Irregardless of having a c-section or a vaginal delivery, it is time to show these muscles some love before returning to intercourse. Here is how:
Tip #1: Allow Time to Heal
When vaginal tearing or an episiotomy occurs, what is actually tearing (or being cut) is a very important intersection of your pelvic floor muscles and fibrous tissue which is called your perineum. See picture below. The perineum is the area between the introitus aka vaginal opening and the anus. When this area is injured during childbirth, like any other tissue injury, it needs at least 6 weeks to recover. Depending on the extent of the injury, it can take closer to 8 weeks to fully heal. If you tore your bicep muscle, you probably wouldn’t hit it with a baseball bat. The same goes for the pelvic floor muscles and penile penetration. These muscles needs rest.
Tip #2: Perineal Massage
To help promote healing and blood flow, gentle massage to this area 6 weeks will help prime the perineum for intercourse. At first, it may seem hypersensitive, painful or irritating. Some mamas describe it to me as a “muscle tearing” sensation when that area is touched. However, once the tissues have healed, you do not need to worry about re-injuring the area. Priming the perineum for intercourse can be done through self or partner-led massage. Many of my patients use perineal massage as foreplay. I recommend using organic olive oil or medically graded lubricant. Stay away from KY Jelly and other brand name lubricants since they may contain harmful ingredients which can upset vaginal pH and destroy healthy microbes. Bottom line: Start with light pressure massage and go slow. Eventually, you will be able to tolerate increased pressure.
Tip #3: Diaphragmatic Breathing
Diaphragmatic breathing helps calm the nervous system, which in turn will help relax your pelvic floor muscles. If you have any apprehension about penetration, this is for you! Our diaphragm is a dome-shaped muscle, similar to the pelvic floor muscles. When we take a deep breath into our belly, our diaphragm descends into our abdominal cavity and the pelvic floor descends as well. These two muscles work together to regulate pressure within our body. When we are in pain or stressed out, we tend to breathe into our upper chest which inhibits the diaphragm and pelvic floor from lengthening. Before intercourse, practice several deep breaths into your belly, imagining that you are breathing into the lower lobes of your lungs. This breathing practice is going to prime you for pain-free intercourse and help the pelvic floor muscles relax and allow penetration to occur.
Tip #4: Use a Lubricant During Intercourse
Again, a natural oil like organic olive oil will do wonders for your perineum and pelvic floor muscles as you return to intercourse. Typically, a dime-sized amount should suffice but you do you.
Tip #5: Initially, Thrust Less
During this time, you should not be afraid to vocalize to your partner what speed will feel comfortable for you. Certain positions, especially those that allow for deeper penetration may initially feel uncomfortable. If you need to take it at a slower pace than usual, there is no shame in that game. He is not going to have any idea what you need unless you tell him. Trust me.
In closing, our bodies are equipped to heal themselves beautifully. If your labor and delivery story was not what you were hoping for or labor has left you feeling unlike yourself, do not hesitate to bring up your concerns with a healthcare professional. As a pelvic PT, I am biased to my profession because I have seen how much our work can help women postpartum. That being said, I encourage you to always be open and honest with your OBGYN or physician and never let a healthcare professional tell you to just “deal with it.” There are thousands of us out there that are ready and willing to help!
Questions? Comments? Please do not hesitate to contact me.
From your girl on the internet that cares about your motherhood journey,
xo, Dr. Betsey
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I have a wound breakdown. My sutures of the episiotomy gave way. At 8 weeks pp now still dreading the wee and poo leave alone think about intercourse. Any heads up on when I can start the oath towards intercourse?
Do I have to wait for the wound to heal completely which seems like it would take an eternity.
How often should I do the perineal massage ?