You know what’s hard to talk about? Painful sex.
Even though it’s pretty damn common – especially after childbirth – people are a little bashful to talk about it.
So I thought I’d ask Sara from Sullivan Physical Therapy to write a little bit about it seeing as she knows all about the good china and how to keep it in good working condition.
On a side note, it’s almost impossible to find a stock photo of ‘normal people’ having sex. They all look like bronzed gazelles and not sleep-deprived parents just trying to get a little together time while Dora is blaring in the other room. If you’re a photographer, there’s a niche, man.
Let’s cut to the chase – sex can suck after having a baby. It’s not just that you still look pregnant, your nipples are leaking and you’re freakin’ tired, it’s that sex can actually hurt. No one will tell you this either! Your OB won’t tell you, your mom won’t tell you, your friends might not tell you. So why does it have to be this way?
Oh…let me count the ways….
Really. I’m counting the ways sex can hurt after having a baby and I can think of seven of them.
The Seven Unsexy Sins (cuz painful sex isn’t sexy)
1. The extra stitch
If you had a vaginal birth and tore naturally or the doctor cut the perineum (the space between the vagina and the anus) and you needed stitches and you have a really, really old-fashioned doctor…it’s very possible you got “the Husband Stitch”. This is an extra, unnecessary stitch at the perineum that is supposed to make your vaginal opening smaller. Sometimes women ask for this, most of the time they don’t. The doctors take it upon themselves to do this because they think they are doing you a favor – for your sex life. How thoughtful, right? Some women don’t even know they got this, all they know is that their vagina feels smaller and they have “no idea why”. This can cause pain with sex. It’s not that the stitch doesn’t heal correctly, it’s that your vagina is smaller. This opens up a whole can of worms that this post isn’t going into.
2. No extra stitches – just the ones you needed.
So, if you needed stitches and had an ethical physician, then you got exactly what you needed. These stitches will heal well, but sometimes they can leave you with scar tissue at the perineum. This can be really problematic with sex because scar tissue makes everything tighter and more sensitive. It can make your muscles in your vagina way too tense when they are supposed to be relaxing.
3. No stitches – just natural tearing.
Same thing as #2. Even with natural tearing you are going to have some scar tissue. If you don’t work through this scar tissue and massage it and knead it (yes, like bread) then it can create painful sex.
“Work the scar” means you move it around.
You can move it left, right, up or down. You can pick it up and you can drop it like it’s hot. You can do combinations of picking up a piece of the scar and twisting it or moving it in different directions. You can hold the skin of the scar like a stretch in any direction possible. You can even stretch the skin around the scar, that’s going to get tight too!
Some women can work the scar without a lubricant, others feel more comfortable with any type of lotion. Some sensitive skin types will do better with olive oil or coconut oil.
I feel comfortable saying that most women can work the scar three months after surgery if everything went smoothly. Honestly, many women can work on the scar before three months, just ask your doctor about it.
Why doesn’t your doctor tell you about this? Well – why is the sky blue? Why do birds sing every time that you’re around?
I don’t have a clue.
4. Breastfeeding and dryness and low libido
Breastfeeding can lower your natural hormone levels inside and outside the vagina making sex dry and lowering your sex drive. This is a snowball problem. No, not that kind of snowball problem (you are nasty!). But, if you don’t have sex drive, your vagina will not get wet. When your vagina doesn’t get wet enough, there is friction and this feels like sandpaper and tearing. You must, must, must use some sort of lubricant. I think that the most gentle lubricants for painful sex are coconut oil and olive oil or something water-based like Slippery Stuff. I really hate KY and Astroglide. They do great marketing, but they’re really not made for the sensitive vagina.
5. Having sex and worrying about the baby waking or being in the room
So, the really cool thing about the pelvic floor (the support muscles in the pelvis that keep up all your organs and span from all around your vagina and clitoris to all around your anus and from one hip to the other, basically) is that they respond to what we’re thinking. They are mind readers. Your pelvic floor is a mind reader. That is amazing, right? When you are scared, nervous, anxious or uncomfortable, your pelvic floor muscles will automatically respond and tense up. This makes your vagina and your anus smaller – in that moment. It’s a really primitive response. It’s your body’s old-fashioned way of trying to protect your reproductive parts so that you will survive and continue to make more humans. It’s fascinating! I really stress that if you have pain with sex, you really have to have sex when the timing is right for your mind. When your brain is more relaxed, your vagina is more relaxed.
Just like the stitch scenario, C-sections leave scars. If you don’t work this scar, the scar tissue will grown down into the layers beneath it and really create problems. This can cause bladder problems, bowel problems and…painful sex. No one really enforces how important it is to work that scar. And if you’ve had repeat C-sections – holy moly cannoli! – work the scar! You might not have problems now, but if you don’t work that scar, you will have problems later.
7. Attempted vaginal delivery and a c-section
You’re fucked. No, not really, I just thought that was funny. But, it’s not really funny because both your pelvic floor and abdomen have been through Hell and back. You might have perineal tearing and a C-section scar. You’ve got a lot of reasons why sex could hurt, so work the scars in both places to minimize and eliminate the problem.
So, if you’ve found yourself with any of the Seven Unsexy Sins, there is good help available. Pelvic floor physical therapy is a specialty of physical therapy that is completely devoted to pelvic issues – whether it’s pain or incontinence. In many countries (the United States not included) pelvic floor physical therapy is a standard aspect of care after delivering a child. In our country, you really have to ask your physician to send you to a therapist or you have to find one yourself.
What’s it like this pelvic floor physical therapy I speak of? Well – it’s intimate and it’s invasive, but it’s really not as uncomfortable as people expect it to be. A pelvic floor physical therapist will do an exam on your pelvic floor muscles, determine what your exact reason for painful sex is, then they will teach you things that you can do at home and they will do hands on work inside the vagina and outside the vagina. This is a really private, closed-door therapy. Literally – closed-door. You are not in an open gym. It’s just like being at the gyno – just with a therapist, no speculum, a lot more time, a lot more answers about painful sex, a lot more compassion and a lot better results.
If you have any questions, please email me at Sara@Sullivanphysicaltherapy.com or leave them in the comment section below.
Sara K. Sauder PT, DPT is author of the blog Blog About Pelvic Pain | by Sara K. Sauder PT, DPT. She is a pelvic floor physical therapist from Sullivan Physical Therapy in Austin, Texas. Sara’s primary interest is pelvic pain. Her goal is to help people living with chronic pain learn how to manage, improve and abolish their symptoms. She feels patient education is vital to recovery and she works to have open communication with each patient’s medical team. Sara believes that the mind and the body work together to both create and eliminate pelvic pain. Interesting facts about Sara: She was a contestant in the 2013 O’Henry Pun Off. Her guilty pleasure is watching The Bachelor and The Bachelorette while eating Doritos and yogurt. She can hula hoop for over an hour. In junior high she was voted “Most Likely To Become President”, but she has never served as President of the United States of America.