Illustration: Patricia Cavazzini
You just had a baby. And for weeks—maybe months—you are too sore, overwhelmed, maxed out on touch and desperate for sleep to even contemplate having sex. But when that impossible moment finally comes—your baby is sleeping and you’re finally ready to get it on—what happens if your postpartum body isn’t ready to join the party?
Pregnancy and childbirth change a woman’s body. And for a lot of us, resuming our sex lives can be, at best, a bit of a learning curve, and at worst, terribly painful. Baharak Amir-Wornell, a Halifax OB/GYN and pelvic-floor surgeon, says it’s not uncommon for women who have recently given birth to experience anxiety and discomfort during sex. “It’s important to understand that you’re not alone—a lot of women have these types of issues, and there are a range of treatment options available,” says Amir-Wornell.
Many couples start having sex again somewhere in the range of four weeks to six months postpartum. Most healthcare providers advise waiting at least six weeks to allow tissues to heal, but it’s common for women to feel ready earlier or, in some cases, much later. For many new moms, the first hurdle is getting used to their unfamiliar postpartum bodies. Montrealer Manuela Santiago remembers feeling like she had to get to know a brand new body after the birth of her son. “I had this sagging belly, lots of stretch marks, and at first I had a hard time feeling desirable,” she says.
Breastfeeding can make it especially tricky to think of your breasts in a sexual way. “My breasts used to be one of my erogenous zones, but right now I don’t want my husband to touch them. I’m not ready to blur that line,” says Andrea Thompson*, a new mom in Toronto. Maya Marchand*, a mom of one in Victoria, remembers being taken out of the moment during sex when she realized her breastmilk had started leaking: “Suddenly I looked down and noticed a puddle. It was really awkward for me at first,” she says. “Though my husband didn’t seem to mind at all.”
For some women, the problem isn’t getting your mojo back—it’s that sex is downright painful, most often during penetration, says Amir-Wornell. The discomfort may not necessarily be the result of any one kind of birth—women who experience no tearing during labour can still have pain related to muscles and nerves that were affected by pregnancy and labour in general, she says. Even those who have had C-sections without labouring can experience this kind of pain during sex.
Katherine Hunter*, a mother of one from Barrie, Ont., had just a few stitches after delivering her daughter, but remembers a strange sensation when she first had sex with her husband. “It felt like a little ridge of scar tissue on the inside of my vagina, something that he was bumping into,” she says.
Katherine took things slow and the discomfort eased after a few of months. Amir-Wornell says this is typical. “In most cases, the pain gets better as the body heals.” In the meantime, she recommends a water-based lubricant, since pain can sometimes be due to excessive dryness, especially if you’re breastfeeding—hormonal changes can reduce your natural lubrication. If over-the-counter lube doesn’t do the trick, a prescription topical estrogen cream can help add moisture.
If the pain is extreme or the discomfort doesn’t improve by about four to five months postpartum, it’s important to see a professional for an assessment, says Amir-Wornell. “A lot of women suffer in silence, but they need to be advocates for themselves, even if their healthcare providers aren’t asking the right questions.” Persistent pain during intercourse is sometimes caused by scarring or can be a sign that the tissue didn’t heal properly after birth.
Victoria mom Sara Daley* had significant tearing after the birth of both of her daughters in 2010 and 2013, and has struggled with pain during sex ever since. A tear in her labia didn’t hold stitches well and never fully healed. Now during sex she gets “hot, searing, shooting” pains. “I’ll be fine, and then we’ll shift positions and suddenly—bam!—I’ll feel it,” she says.
When Sara talked to her doctor about the pain after the birth of her first child, her doctor told her to wait to have corrective surgery until after she was finished having kids. Her youngest is now a year old, and she’s finally seen a plastic surgeon who will recut both labia and reattach them in a day procedure. “This will be huge for my relationship with my husband,” says Sara. “Because of the pain, I never initiate sex—and it wasn’t like that between us before.”
Ongoing pain can also be the result of problems in the pelvic floor: The muscles and tissue that are connected to the pubic bone in front and the tailbone in back and provide support to the internal organs are sometimes strained, injured or weakened during pregnancy and birth. Symptoms of pelvic-floor injury or dysfunction can range from a mild sense of soreness or heaviness in the vagina, to incontinence. More serious conditions include pelvic-organ prolapse, which occurs when the tissue between the pelvic organs and the vaginal wall weakens, allowing surrounding organs to bulge into the vagina.
Although corrective surgery is sometimes recommended in extreme cases, physiotherapy treatments aimed at healing and strengthening the pelvic floor are often enough to eliminate pain and allow women to regain lost muscle tone. Angelique Montano-Bresolin, a registered physiotherapist in Toronto who specializes in pelvic health, administers internal vaginal assessments, including soft-tissue techniques that stretch and strengthen, and pressure-point release treatments. She also teaches women how to coordinate breathing and Kegel exercises to gain control over their pelvic-floor muscles. “Many women notice a huge improvement within two to three months,” she says.
Aside from seeking treatment when sex becomes painful, women should also talk to their partners about it. Natalie Rosen, a clinical psychologist and assistant professor at Dalhousie University and the IWK Health Centre, has done extensive research on women’s postpartum sexual health. “Sex is necessarily interpersonal, and both partners suffer when it comes to their ability to enjoy it,” says Rosen. She urges couples to talk openly about the challenges and seek out a qualified sex or couples’ therapist if persistent pain is affecting their sex lives. It’s also important to consider expanding your repertoire, “which may mean moving the focus away from vaginal intercourse,” she says.
If you’re lucky, those postpartum changes might yield some happy discoveries: for Montreal mother of three, Marianne Holt*, and her husband, theirs was anal sex. Holt never felt as tight postpartum and is convinced her doctor “missed a stitch,” which pushed her to get creative. “Before giving birth, I don’t think I would have ever thought about trying anal sex, but now we both really enjoy it,” she says. Steph Brown*, another Montreal mom, who has struggled with the effects of bladder prolapse since the birth of her son 11 years ago, found that positions she once enjoyed were no longer comfortable, but discovered others that were better than ever. “All of a sudden one day, I could feel my G spot.” After getting beyond her leaky breasts, Maya had a similar revelation: “I would say I reach orgasm faster now,” she says. “I have no idea why, but I’m not complaining!”
* Names have been changed
Support your pelvic floor Toronto registered physiotherapist Angelique Montano-Bresolin offers three tips for showing this important area a little love:
• Get assessed by a physio who specializes in the pelvic floor six to eight weeks after delivery to help with healing. (Fun fact: In France, public health insurance has covered postpartum pelvic-floor “re-education” since 1985!)
• Don’t do crunches! Ab work, or any other intense exercise before you’ve healed, can actually make things worse.
• Master Kegels: Learn to do them in a controlled way to create a closure and lift of the pelvic-floor muscles—they’re not just rapid-fire squeezes.