Rachel Gelman, PT, DPT, pelvic floor PT, sexpert, educator, @pelvichealthsf

If you are reading this there is a chance you either had or will soon be having a baby! Pregnancy and childbirth is mindblowing. The uterus is the original 3D printer and a whole person is growing inside of you. If that isn’t enough, then that person will either come out through your vagina or through a major surgery. Then you are sent home and told “Take some stool softener. Wear some mesh undies and good luck!” 

After the initial shock of delivery and adjusting to having a new person in your home you will most likely take a trip to your doctor for a follow-up appointment. This is typically six weeks after your delivery and at this point the doctor usually says: “You and your vagina are doing well. You can return to having sex!” 

Sex may be the last thing on your mind, and that totally makes sense. Again, you just had a baby come out of your body! That is a lot for someone to experience. You are also adjusting to a new routine with your little one that includes sleep deprivation and being a possible food source. Furthermore, consider the fact that you were pregnant for roughly forty weeks. Your body went through a lot of changes during that time, so it will most likely take a similar amount of time to recover. Bottomline, be patient with yourself. Whatever you may be feeling — just know that it’s common and you are not alone. If you don’t want to have sex, don’t feel pressured to do so, just because the doctor told you to go for it. 

Now if and when you do feel ready to attempt penetrative intercourse, keep a few things in mind.

Lube is key.

In my opinion, lube is always a good idea. But for postpartum women, lube is almost essential. This is primarily due to hormones. Hormonal changes after delivery can lead to a lack of vaginal lubrication.  When you delivered your baby, your estrogen levels went from high to low. Since your vulvar tissue is mediated by estrogen (and testosterone) this lack of estrogen can lead to vaginal dryness or pain with sex. Therefore lube is necessary when you have sex after having a baby. There are many good water based lubricants on the market. Some people like to use oil-based products or even coconut oil. Keep in mind that oils will degrade latex, so do not use it if you are using condoms as birth control. 

Remember to go slow.

If you had a c-section, an episiotomy or a perineal tear you may have scar tissue that can cause pain with intercourse. So slow and steady wins the race here folks. Sometimes it helps to start with a finger or a small dildo to see how things feel. If you find that things are painful or don’t feel quite right you are not alone! Keep in mind that pain with sex postpartum is very common. In a study of postpartum women in Australia, 64.3% of women reported sexual dysfunction in the first year following childbirth. In that same study, 39.4% reported pain with sex and 43.4% reported difficulty with lubrication. Other Research shows that 41-83% of new moms experience sexual dysfunction (low libido, pain with sex, not finding sex pleasurable) 2-3 months postpartum and 17-36% of new moms experience painful sex 6 months after birth. 

Pain can be due to many things including scar tissue, hormonal changes and/or pelvic floor muscle dysfunction. Luckily there are many ways to treat painful sex so talk to your doctor. They can determine if medication or other procedures are warranted. They can also refer you to a pelvic floor physical therapist,  who can help address any myofascial impairments that are contributing to your symptoms. If you are one of the many women that report a lack of libido and/or diminished sexual satisfaction. You may benefit from working with a psychologist/sex therapist or sex coach. You may need more than one provider to help. 

Remember that sex does not just mean penetration.

Think of sex like an ice cream shop, there are a ton of flavors. This can include mutual masturbation, oral sex or erotic massage. Consider trying a new sex toy or two. Basically, there are plenty of ways to experience non-penetrative pleasure with your partner or alone. However, you need to communicate what you want. Tell your partner how you are feeling and what you are up for. 

If you are struggling to have those types of conversation or you are having pain with sex or sexual dysfunction just know that you are not alone and there are providers ready and waiting to help you. Myself included!