Written by Raina Hawthorne
Registered Physiotherapist
It's almost Valentine's Day and love is in the air.... but for postpartum women, there are a lot of changes after having a baby - physical, emotional, logistical, hormonal - and all of these changes can impact intimacy. Fortunately there are things that can help, including easy strategies you can do at home.
This post will address common difficulties for women (AFAB) as that is what my current training is focused on. I will share some links at the bottom of the article for men and trans individuals because everyone can experience challenges with intimacy and help is available!
As a Pelvic Health Physiotherapist, one of the most common intimacy related concerns I see in postpartum women is pain with intercourse. While some discomfort when first resuming intercourse after birth isn't uncommon or automatically concerning, pain should not persist throughout a session and should not continue to occur in future sessions. Unfortunately, many women do experience continued pain but there are many things that can be done to address it.
In order to deal with painful intercourse, we first need to understand the various possible factors that can contribute to it including:
excessive muscle tension in the pelvic floor
hormonal related vaginal dryness (especially with breastfeeding/pumping/lactation)
hypersensitivity in local nerves
hypersensitive and/or restricted scar tissue
nervous system triggered guarding and protective responses
increases general stressors, interruptions to intimacy, etc.
arousal and libido changes
altered sleep patterns
stressors related to intercourse, personal changes, relationship challenges, etc.
It is also helpful to understand that pain is a predictive, protective response from our nervous system rather than an automatic sign of injury. (For example, it isn't helpful if we only experience pain after we burn our hand on a stove - pain is the signal that makes us pull our hand away before damage happens!) When having a baby, whether vaginally or via cesarean birth, our bodies experience significant strain, changes, and sometimes injury. Afterwards is completely logical for our nervous system to be on guard for possible future threats and protect against them. This is part of the reason why many postpartum women experience pain with intercourse even once fully healed. Women may notice increased muscle tone in the pelvic floor muscles and may also experience fear or anxiety around intimacy and penetrative intercourse. Hypersensitivity in local nerves can also amplify the messages received about healed scars, etc. The nervous system can use a variety of tools to attempt to protect an area that just experienced significant and challenging changes, even if it no longer needs that protection.
While understanding the protective role of the pain system is important, it doesn't mean that pain will simply go away if we tell ourselves it will, nor does it mean that the physical aspects don't also matter.
While we often see improvement in physical aspects like muscle tension and scar sensitivity over time and with relaxation strategies, sometimes hands-on treatments can be needed or at least help speed up improvements. Other physical aspects, like tissue dryness related to hormonal changes, can benefit from the use of certain products or medications. If you notice dryness and/or if you are breastfeeding or pumping and experiencing painful intercourse, checking with your doctor to determine if vaginal moisturizer or internal hormonal creams are appropriate for you can be helpful. I also want to caution that ignoring or pushing through pain can cause the pain to increase for some women. While intimacy is important in a relationship, if you are dealing with pain, finding alternative ways to connect with your partner that doesn't create pain until you have improved or resolved it, may be helpful.
A Pelvic Health Physiotherapist can help you to resolve many of these factors but there are some simple things that you can do yourself if you are experiencing this issue.
Deep Breathing / Belly Breathing:
Taking deep breaths, into your belly, can help in multiple ways. First, our pelvic floor moves with our breath - expanding as we inhale and drawing back inwards as we exhale. Imagining a balloon inside the pelvis that fills up as you inhale and shrinks as you exhale, moving the pelvic floor muscles with it, can be helpful. Secondly, deep breathing calms our nervous system, providing cues of safety which can help to lower pain levels and further reduce muscle tension.
If you experience pain with penetration, pausing with your partner while you take a few deep breaths and imagining your muscles relaxing can be helpful.
Affirmations:
Affirmations can be powerful tools to shift the protective state our nervous system may be in. An affirmation should not dismiss what we are experiencing but rather acknowledge the concern and then offer a more positive perspective. For example:
If you notice yourself worrying that your scar is causing pain you can: 1) Assure yourself that experiencing pain with intercourse postpartum is common and 2) remind yourself that your body is healed and safe (assuming you have been checked / know that it is fully healed).
Reduce stressors:
Trying to be intimate while half expecting to be interrupted by a hungry baby's cry can really pump the breaks on your arousal system. Or if you slept poorly the night before and spent the day dealing with a clingy baby and jealous sibling, your system may already be a little fried. All these factors can impact stress, arousal, and as a result pain.
Taking some time to relax before attempting intimacy, timing the moment when you have the best chance of not being interrupted, and rebuilding emotional connection with your partner first may increase the likelihood of pain-free intercourse.
Finally, understanding the sexual arousal system can be incredibly helpful both for dealing with pain and as well as supporting reduced libido, anxiety, and other challenges with postpartum intimacy (or intimacy at any point)!
If this sounds helpful, 'Come As You Are' by Emily Nagoski, Ph.D. is a great book to check out that explains the science of female sexuality and provides tips for addressing common problems. https://www.emilynagoski.com/
And if you or someone you know is dealing with challenges around intimacy, but aren't the intended audience of this post, check out these other resources for information and support because everyone deserves support with these issues.
'Addressing Men's Pelvic Floor Issues' (blog post) by Linc Pisio which explains common pelvic floor related concerns in men including pain, erection difficulties, and more as well as what supports and treatments are available. Check it out here: https://lakeviewphysio.ca/blog/addressing-mens-pelvic-floor-issues
Some Pelvic Health Physiotherapists have taken training to be able to properly support trans individuals and the specific factors relevant to them (ie- after gender-affirming surgery). Kelsey Drew is a pelvic health physiotherapist in Calgary who can offer this kind of support. Check out her info here: https://transwellnessinitiative.ca/providers/drew-kelsey/