Painful Intercourse: Why this can happen postpartum and what to do about it
Pain with sex is one of the more common symptoms women may experience postpartum, but it can also be a symptom that happens even if you are NOT postpartum. Either way, this blog post will help if you are someone who has suddenly started having pain with intercourse or if it’s been going on for quite some time. In this blog, we will talk about why you may be experiencing pain with sex, as well as a few things to try to help alleviate your symptoms. And trust me, these tips have NOTHING to do with having a glass of wine or lubing up.
Why am I experiencing painful intercourse??
Before we jump into the “why” behind this, I do want to emphasize the fact that having pain with sex is a LEGITIMATE issue. This is not something that you should just play the “wait and see” game with (or whatever other ridiculous and non-validating suggestions you may have heard), this is something to take seriously, advocate for yourself, take active steps towards improving and ensure that your healthcare providers are taking it as seriously as they should be.
Now, as far as WHY this may be happening, there are many reasons and factors that can apply, and finding the root cause of the issue is crucial for figuring out how to address it. Some may experience pain with sex only in the beginning (with penetration), others may experience pain the entire time. Some may experience pain when postpartum, pregnant or none of those! Your specific scenario and situation has relevance for figuring out what to do about it and how to alleviate your particular symptoms.
If you are experiencing pain with the initial penetration, it could be an issue with your ability to relax the first layer of your pelvic floor muscles. Remember that the pelvic floor is not just one muscle, it is multiple muscles layered on top of each other moving in various directions. With penetration, the first layer must relax to allow entry, and if it’s not relaxed and entry still happens, pain is more than likely to occur.
Here are a few other common factors that can contribute or cause painful intercourse:
Tight pelvic floor
Physical traumas
Emotional Trauma
Postpartum timeline
Pregnancy
Vaginal dryness - from hormonal imbalance or other (very common with breastfeeding as estrogen is quite low during this time)
Change in blood flow to the vaginal area (common postpartum and with breastfeeding)
Pelvic floor dysfunction
Menopause
Time of your cycle
Other medical conditions
Maybe you feel like you have one of these factors, or maybe you think you have a few of them that are contributing, but either way, read on for where to start and what to try to help alleviate your symptoms!
Where to Start When Addressing Painful Intercourse:
Working through the discomfort and legit PAIN of painful intercourse is a process and it’s important to note that this can take time to improve. You may start to have some improvement right off the bat when you start to address the issues, but for others, it may take some patience to see improvement.
But by finding the root issue, you will be well on your way to pain free intercourse/penetration, and of course the gold standard for finding the root issue is to make an appointment to see a pelvic floor physical therapist. A pelvic floor PT can help to pinpoint why you are having pain with sex and offer individualized options.
If in-person pelvic floor physical therapy isn’t an option for you, or you have a wait before you can be seen, here are some things to consider and options to try:
Open communication with your partner. Make sure they know how you are feeling mentally and physically about it. And make sure they are on the same page.
It is okay to stop during! If it is feeling uncomfortable, YOU CAN STOP. You don’t owe your partner anything - this is YOUR body.
Pelvic floor relaxation exercises prior to intercourse
Deep diaphragmatic breathing upon penetration to help relax the pelvic floor - it’s okay to have to focus on your body and pelvic floor as you are getting back into pain-free sex!
Different positions where you are in control can help ease discomfort or calm your nerves
Perineal massage can be helpful to stretch the tissue gently
Dilators are another good option to try - find the size that fits to your partner and work up to that size.
Lubrication can be another option to try along with pelvic floor relaxation. You want to try water-based or silicone-based lube and NOT oil-based (oil can break the condom down if you’re using). Some of my favorites (links included) are:
How to Relax the Pelvic Floor
Anytime someone is struggling with pain with intercourse, it’s almost inevitable that they likely are also struggling with a tense pelvic floor. It can be somewhat of the chicken or the egg scenario where it may not have started off tense, but due to various other factors happening maybe it then responded with tension, OR perhaps you’ve always had a tense pelvic floor, and now after child birth you find yourself healing with increased scar tissue and tension, and now also are experiencing pain with sex. Regardless, whether you started with a tight pelvic floor or ended up with one, the first place to start to address it is to start with your breathing.
start with diaphragmatic breathing
Diaphragmatic breathing is the very FOUNDATION of healing postpartum (vaginal or c-section) and also when healing any pelvic floor dysfunction. Diaphragmatic breathing allows us to connect to the pelvic floor, deep core, and diaphragm in order to be able to fully lengthen (relax) the muscles and then shorten (contract) the muscles.
If you’re needing a reminder on diaphragmatic breathing, make sure to check out my blog, “Where to Start with Early Postpartum Recovery”, but simply put, diaphragmatic breathing is using our diaphragm and pelvic floor together to allow for full lung expansion, organ movement, and full muscle range of motion.
For a quick recap:
When you inhale…
The diaphragm CONTRACTS and goes DOWN
And the pelvic floor RELAXES and goes DOWN
When you exhale:
The diaphragm RELAXES and goes UP
And the pelvic floor CONTRACTS and goes UP
When promoting pelvic floor relaxation, you want to focus on the inhale portion of diaphragmatic breathing. Typically, when learning proper diaphragmatic breathing, you want to fully relax on the inhale and fully contract on the exhale, but for the purposes of just working on pelvic floor relaxation, you want to focus on the inhale and relax portion.
The reasoning behind this focus is because a muscle that cannot lengthen will have a hard time being able to fully contract and actually get strong. You want to be gentle with your contractions and instead, give a good focus to the inhale-relaxation portion.
Where to start after diaphragmatic breathing
Once you’ve mastered diaphragmatic breathing on it’s own, the next step is to add in slow paced exercises that will address pelvic discomfort with intercourse or penetration. I have several exercises you can try listed out below!
Also, aside from adding in pelvic floor relaxation exercises to your normal exercise routine, another way to improve pain with intercourse is to perform these pelvic floor relaxation exercises right before intercourse. Think of it as a warm up prior to the actual moment.
And lastly, another option to consider is trying a pelvic wand (could even start with your finger at first) to work on perineal stretching in order to hit trigger points and help with overall pelvic floor relaxation.
Pelvic Floor Relaxation Exercises
Remember, add these exercises in AFTER you’ve already mastered diaphragmatic breathing with your emphasis being on the inhale/relaxation portion. Once you’ve got that down, now it’s time to combine that diaphragmatic breathing with a few exercises and movements that will promote pelvic floor relaxation/lengthening. You want to perform these slowly, with great control and while focusing on relaxing while feeling your pelvic floor open and descend. Consider trying 5-10 breaths per side or per exercise.
Here are FIVE exercises you can try:
1. Pigeon pose
2. Happy baby
3. Child’s pose
4. Downward Child’s Pose
5. Adductor Rock Back
Exercises to try prior to intercourse
The 5 exercises outlined above can also be utilized as a “warm up” prior to intercourse. Of course, intimacy is not always planned out, but if you CAN, try these exercises and breathing techniques prior to intercourse to set your pelvic floor up and your body and mind up for success as well.
Each exercise can be performed as long as needed. But what is recommended is at least 1 minute of each exercise focusing on pelvic floor relaxation.
Using a Pelvic Wand
Pelvic wands are a great option for treating painful intercourse, painful penetration or pelvic discomfort in general! If you’ve never used a pelvic wand before, I do highly recommend seeing an in person pelvic floor physical therapist for diagnosis and guidance on how to use this kind of tool and to confirm where you might have trigger points or dysfunction. However, if you’re interested in gaining some understanding on what a pelvic wand is and how it might help for painful intercourse, read on!
A pelvic wand really is no different than say a foam roller or lacrosse ball that you might use to alleviate muscle soreness, stiffness or tightness on another body part…a pelvic wand is the same concept, but just designed to reach the pelvic floor muscles! Using a pelvic wand should never be painful and you can even use lubrication (water-based to protect the silicone) to help with comfort and ease.
A few tips for using a pelvic wand:
Find a comfortable position (usually assisted sitting or captain position).
Work the first layer of tissue and find any points that feel tender or tight.
Gently stretch the tissue and hold for 10 seconds while working on deep inhales.
Work all the way around and repeat 3-5 times!
If you’re looking for a little more on how to use a pelvic wand and a few positions to try, make sure to click HERE to watch this quick video demonstration I did using Intimate Rose pelvic wand (which I HIGHLY recommend).
Again, using a pelvic wand should NOT be painful and if this is a method you’re interested in trying, remember to seek out guidance and instruction from an in-person pelvic floor physical therapist for more of an individualized protocol.
Looking for more guidance with OVERCOMING painful intercourse?
Aside from the postpartum and prenatal Mind Body Core programs, MBC also offers smaller, additional programs that are focused on one specific symptom. Although the full MBC Postpartum Program is the most comprehensive and gives you all the tools for your tool box, the smaller programs can be a great alternative. The Mind Body Core - Pain with Intercourse program is a 4-week program that includes:
Resource Library
Why is it painful?
Pelvic Wand and Perineal Stretching
How to Use a Dilator
Prior to Intercourse Exercise
Diaphragm Breathing
Full Anatomical Education
Video Demonstration for Proper Diaphragmatic Breathing
Week 1 - Weekly Workouts
Week 2 - Weekly Workouts
Week 3 - Weekly Workouts
Week 4 - Weekly Workouts
If you are wanting step-by-step guidance on improving your symptoms and moving towards pain-FREE intercourse, this program is a MUST. Learn more by clicking the button below.