A new study published in the BJOG indicates that by 6 weeks after a delivery 41% of women have resumed sex, 78% by 12 weeks, and 94% by 6 months.
Most health care providers recommend waiting 4-6 weeks after an uncomplicated vaginal delivery before resuming sex, the issue being an open cervix could increase the risk of infection (although I’m not sure if this delay has been rigorously studied).
But what if it’s 8 or so weeks after delivery, contraceptive needs have been addressed, the baby is actually sleeping, there’s a glimmer of libido and then you have to stop because it hurts!? A lot.
Painful sex is not normal. The three most common causes of painful sex after a baby include the following:
- Low estrogen levels in the vagina: estrogen keeps the vaginal tissues healthy, supple, and well-lubricated. Estrogen levels can sometimes be low enough with breastfeeding to cause pain. Many women also report dryness and/or a sandpaper-like feeling with sex in addition to pain. Using lube may help, but it may not be enough. The solution: a small amount of vaginal estrogen will solve the problem within a few weeks. Once regular menstrual cycles return the estrogen levels will be high enough and the vaginal estrogen can be stopped. Using a small amount of estrogen in the vagina is fine while breastfeeding.
-Problems with the scar: It’s not surprising that in the BJOG study women who required an assisted birth were less likely to have resumed sex by 6 weeks. The use of forceps or a vacuum increases the risk of a tear or an episiotomy, and a tear or repair needs to heal. Larger ones take linger. However, by 8 weeks things should be well on their way. If sex is painful at 8 weeks and you had a tear or stitches the area should be evaluated to make sure it’s healing appropriately.
-Muscle spasm: The muscles of the pelvic floor can become inappropriately tight after delivery (this can be see after c-sections as well, so it’s not unique to vaginal deliveries). Sometimes the muscle spasm develops in response to pain from other causes (for example, the original problem could have been low estrogen levels, but repeated episodes of painful sex attempts led to muscle spasm), but sometimes it just happens, even after the easiest and atraumatic deliveries. My personal theory is the rapid withdrawal of progesterone after the placenta is delivered predisposes to this muscle spasm as progesterone is a potent muscle relaxant. Women and their partners often feel line they’re “hitting a painful wall” during penetration. Specialized pelvic flood physical therapy is the treatment and highly effective.
The bottom line is sex shouldn’t be painful. If sex hurts your body is telling you there’s a problem of some kind. If you’re told that it’s normal for sex to hurt and you’re more than 6-8 weeks out from your delivery, then another opinion may be in order.
*this post does not represent individual medical advice