It’s eight weeks since the baby was born. The condoms and water-based lube beckon from the nightstand, the baby is actually sleeping, and there is finally a glimmer of libido. The problem? That was the exact scenario last night, but when you tried having sex you had to stop because it hurt so much.
Some people think painful sex after a delivery is normal, but it is not if everything is well-healed (which it should be by 6 weeks). The very first episode of penetration might be mildly uncomfortable for a few seconds, but within minutes sex should feel just like the good old days.
What are the causes of painful sex after having a baby?
- Too little estrogen. Estrogen keeps the vaginal tissues healthy and lubricated. If your period hasn’t started yet, your estrogen levels are low. This can happen from breastfeeding (every woman is different and some women will get a period while breastfeeding and some will not). A progesterone-only type of contraception (like Depo Provera or the Mini-pill) can also reduce estrogen levels. Lack of estrogen can produce pain on insertion and with deep penetration. Many women describe it as a “feeling like sand paper.” Using additional lubrication may help, but it won’t always take care of the problem.
- Problems with the scar from a tear or an episiotomy. This is only a concern for women who have delivered vaginally. Any scar, tear or episiotomy, should be healed by six weeks. An improperly healed scar typically produces pain on insertion.
- Muscle spasm. The pelvic floor muscles wrap around the vagina. Sometimes these muscles may develop excessive spasm after a delivery (this can happen after both a vaginal delivery or a c-section). The cause is unknown, but for some women the trigger may be the rapid drop in hormones in the immediate postpartum period. Muscle spasm is typically associated with pain on deep penetration.
- Vulvodynia. This is a nerve pain condition where the skin on the vulva and/or vestibule (the opening to the vagina) develops a heightened sensitivity to pain. Even the lightest touch can produce a terrible burning pain; some women even find underwear uncomfortable. Vulvodynia typically produces pain with insertion. For some women the pain may be present all the time and for others it may just be provoked by touching the area.
Make sure you use adequate lube (and there is enough foreplay) the first time you have sex after your delivery: a water-based or silicone-based lube are typically the least irritating. If there is pain with sex despite adequate lubrication then a trip to the gynecologist is in order. Each one of these conditions has a specific therapy, and the sooner the right treatment is started the faster you can return to your sex life.