Experiencing pain with intimacy postpartum is NOT uncommon, and it can be a distressing issue for new mothers. Understanding the physical changes that happen to the pelvic floor muscles during pregnancy and childbirth, as well as the potential impact of tearing or episiotomies on scar tissue formation, is important in managing postpartum pain with intimacy. In this comprehensive guide, we'll explore these changes, the various causes of pain with intercourse postpartum, and provide effective management tools to help alleviate discomfort.

Physical Changes During Pregnancy and Birth

Pregnancy and childbirth result in significant changes to a woman's body, particularly to the pelvic floor muscles:

• Stress on the Pelvic Floor Muscles: Throughout pregnancy, the pelvic floor muscles undergo a lot of stress to accommodate the growing fetus. This can result in weakening of the pelvic floor or increased tension throughout the pelvic floor to protect against this stress. These changes in the pelvic floor muscles can create discomfort during intercourse during pregnancy and postpartum.

• Hormonal Influences: Hormonal changes during pregnancy, such as increased levels of relaxin, further loosen ligaments and tissues in the pelvic area. While necessary for childbirth, these hormonal shifts can exacerbate postpartum pain with intercourse.

• Trauma from Childbirth: Vaginal childbirth, in particular, can cause trauma to the pelvic floor muscles. Tears, episiotomies, or instrumental deliveries can result in scar tissue formation, which may contribute to pain during intercourse postpartum.

Impact of Tearing or Episiotomies on Scar Tissue

Tearing or episiotomies are common occurrences during childbirth, and the subsequent healing process can lead to the formation of scar tissue:

• Tearing: Tears can range from minor to severe, affecting the perineum and surrounding tissues. The healing process may result in the formation of scar tissue, which can contribute to pain with intimacy postpartum.

• Episiotomies: Episiotomies, surgical incisions made to enlarge the vaginal opening during childbirth, can also lead to scar tissue formation. Depending on the extent of the episiotomy, this scar tissue may cause discomfort during intercourse postpartum.

Causes of Pain with Intercourse Postpartum

Several factors can contribute to pain with intercourse postpartum, including:

• Scar Tissue: Scar tissue resulting from tearing or episiotomies can lead to discomfort or pain during penetration.

• Pelvic Floor Dysfunction: Weakened or injured pelvic floor muscles can create changes in the muscles and connective tissue of the pelvic floor, leading to pain or discomfort with intercourse.

• Hormonal Changes: Fluctuations in hormone levels postpartum can affect vaginal lubrication, making intercourse uncomfortable or painful.

• Emotional Factors: Psychological factors such as anxiety, fear, or trauma related to childbirth can also contribute to pain with intimacy postpartum.

Management Tools to Alleviate Postpartum Pain with Intimacy

Managing postpartum pain with intimacy requires a multi-faceted approach:

• Breath work: Breath work can be a valuable tool for addressing pelvic floor discomfort during intercourse by helping to relax the pelvic floor muscles, improve body awareness, and reduce stress and anxiety. Here's how breath work can aid in alleviating pelvic floor discomfort:

  
  
  
  

  • Relaxation of Pelvic Floor Muscles: Deep, controlled breathing can help relax the pelvic floor muscles. When these muscles are overly tense, it can lead to pain or discomfort during intercourse. By practicing diaphragmatic breathing (deep breathing that engages the diaphragm and expands the belly), the pelvic floor muscles can relax, which may ease discomfort.

  • Improves Body Awareness: Breath work can enhance body awareness, helping individuals identify when their pelvic floor muscles are tensing up. This awareness can lead to more conscious control over the pelvic floor muscles, allowing for better relaxation and potentially reducing discomfort.

  • Stress and Anxiety Reduction: Stress and anxiety can contribute to muscle tension, including in the pelvic floor. Breathwork has been shown to activate the parasympathetic nervous system, which is responsible for relaxation. By reducing stress and anxiety through breathwork, the pelvic floor muscles can be more relaxed and less likely to cause discomfort during intercourse.

  • Increased Circulation: Deep breathing helps improve blood flow throughout the body, including to the pelvic region. Enhanced circulation can aid in muscle relaxation and overall comfort during intercourse.

  • Improves Focus and Presence: Practicing breath work during intimacy can help individuals stay present in the moment, which can facilitate a more enjoyable and connected experience. This presence can also help individuals become more attuned to their body's responses and adjust their breathing or positioning for comfort.

To practice breathwork for pelvic floor discomfort, start by sitting or lying down in a comfortable position. Inhale deeply through the nose, allowing the diaphragm to expand and the belly to rise. Exhale slowly through the mouth or nose, allowing the belly to fall. Focus on relaxing the pelvic floor muscles along with each inhale. This practice can be integrated into daily life and also used during intercourse to maintain a state of relaxation and comfort.

• Relaxation exercises and stretches: Relaxation exercises and stretches can help alleviate pelvic floor discomfort during intercourse by promoting relaxation, improving flexibility, and reducing tension in the pelvic region. Here’s how these practices can benefit individuals experiencing pelvic floor discomfort:

  • Pelvic Floor Relaxation: Just as breath work can help relax the pelvic floor muscles, relaxation exercises can further encourage the muscles to release tension. This can lead to more comfort and less pain during intercourse. Examples include guided relaxation techniques where individuals consciously relax each part of their body, including the pelvic floor muscles.

  • Stretching and Mobility: Stretches that target the pelvic area and surrounding muscles (such as the hip flexors, lower back, and inner thighs) can help improve flexibility and mobility. This can lead to a greater range of motion during intercourse and reduce the risk of muscle tightness or strain that might cause discomfort.

  • Improved Body Awareness: Practicing relaxation exercises and stretching can help individuals become more attuned to their pelvic floor and surrounding muscles. This increased awareness can help them recognize when they are tensing up during intercourse and consciously relax those muscles.

  • Stress Reduction: Exercises like progressive muscle relaxation and stretching can help reduce overall stress and anxiety. This can have a calming effect on the pelvic floor muscles, as stress and anxiety often lead to muscle tension.

  • Improved Blood Flow: Stretching can improve circulation in the pelvic area, which may help relax muscles and tissues and improve comfort during intercourse.

  • Improved Posture and Alignment: Stretching exercises can help improve posture and alignment, which may reduce strain on the pelvic floor muscles. Proper alignment can lead to more comfortable positions during intercourse.

Here are some relaxation exercises and stretches to consider:

• Pelvic floor lengthening: The opposite of a Kegel, pelvic floor lengthening can be used for relaxation when performed mindfully and in conjunction with deep breathing.

• Child’s Pose: This yoga pose helps relax the pelvic floor and stretches the lower back and hips.

• Butterfly Stretch: Sitting on the floor and bringing the soles of your feet together while gently pressing the knees down can help open the hips and stretch the inner thighs.

• Deep Squats: Holding a deep squat position can stretch the pelvic floor muscles and the surrounding area.

• Cat-Cow Stretch: This yoga pose alternates between flexing and extending the spine, which can help relax the pelvic floor.

• Happy Baby: Like child’s pose, happy baby’s deep hip and knee flexion allows for optimal relaxation of the pelvic floor.

Incorporating these exercises and stretches into a regular routine can help reduce pelvic floor discomfort during intercourse over time. As with any exercise routine, it is important to consult with a healthcare professional before starting any new program, especially if you have underlying health conditions.

• Pelvic Floor Physical Therapy: Pelvic floor physical therapy (PFPT) can be an effective approach for addressing pelvic floor discomfort during intercourse by focusing on assessing and treating the pelvic floor muscles and surrounding structures. Pelvic floor physical therapists are specialized healthcare professionals who provide personalized treatment plans based on a thorough evaluation of an individual's pelvic floor function. Here's how pelvic floor physical therapy can help with pelvic floor discomfort during intercourse:

  • Assessment of Pelvic Floor Function: A pelvic floor physical therapist begins by assessing the strength, tone, and coordination of the pelvic floor muscles. This assessment helps determine whether the discomfort is due to muscle weakness, tightness, or imbalances.

  • Manual Muscle Relaxation Techniques: If the pelvic floor muscles are overly tight or hypertonic, the therapist can guide the patient through techniques such as manual therapy, trigger point release, and stretching to help relax the muscles.

  • Strengthening Weak Muscles: In cases where muscles of the pelvic girdle are weak, the therapist may recommend exercises to help strengthen the muscles. These may include core, back or hip strengthening exercises. This can improve control and function, potentially reducing discomfort during intercourse.

  • Education on Posture and Body Mechanics: Proper posture and body mechanics can play a significant role in pelvic floor function and comfort during intercourse. A therapist can provide education on how to improve posture and align the body properly.

  • Pain Management Techniques: Pelvic floor physical therapists can teach patients pain management strategies, such as relaxation techniques and breathing exercises, to help manage discomfort during intercourse.

  • Customized Exercise Programs: Based on the individual's specific needs, a pelvic floor physical therapist can create a personalized exercise program that may include stretches, strengthening exercises, and relaxation techniques.

  • Lifestyle and Behavioral Modifications: A pelvic floor physical therapist can provide advice on lifestyle changes and behavioral modifications that may contribute to pelvic floor health and comfort during intercourse.

  • Support and Guidance: Pelvic floor physical therapists offer support and guidance to individuals experiencing discomfort during intercourse. This includes helping patients set realistic goals, providing emotional support, and addressing concerns.

Overall, pelvic floor physical therapy offers a comprehensive and personalized approach to addressing pelvic floor discomfort during intercourse. The therapy can help improve muscle function, reduce pain, and enhance overall quality of life. If you are experiencing pelvic floor discomfort, consider consulting with a pelvic floor physical therapist to discuss your specific concerns and develop an appropriate treatment plan.

• Lubricants: Using water-based lubricants can ease discomfort during intercourse by providing additional moisture and reducing friction.

• Communication: Open and honest communication with a partner is essential. Discussing concerns, fears, and preferences can help ensure a comfortable and supportive sexual experience postpartum. Taking a slow, controlled approach to managing this is key, and will reduce stress and frustration of the situation. Consider speaking with a licensed therapist if you are having difficulty with communication, or emotional and/or aspects of postpartum expectations. 

Conclusion

Experiencing pain with intimacy postpartum is a common concern for many new mothers, but not often talked about. It’s important to understand that this can be a temporary issue that can be effectively managed with the right approach. By addressing the physical changes that occur during pregnancy and childbirth, understanding the impact of tearing or episiotomies on scar tissue, and implementing effective management tools, individuals can work towards reclaiming comfort and satisfaction in their intimate lives postpartum. Seeking professional guidance can ensure a customized approach to each individual's unique circumstances.

Are you wondering if pelvic floor physical therapy can help you improve pain with intimacy postpartum? Reach out to us and see if we’re the right fit for your needs.