Every woman assumes that the first time they have sex after childbirth probably won't be particularly comfortable, but the hope is that with a little time (and a lot of patience), things will eventually go back to normal in that department. But what if, as the months pass, sex continues to be painful? Why can postpartum sex still hurt after a year (or sometimes even longer)?
First of all, if this is something you're experiencing, you should know that you're not alone. Even though it's not something people necessarily like to talk about, the truth is, quite a lot of women have long-standing sexual issues after having a baby. In fact, one Australian study found that not only do almost nine in 10 women feel pain the first time they have sex after childbirth, but nearly one-quarter still complained about painful sexual intercourse 18 months later, according to research published in BJOG: An International Journal of Obstetrics and Gynaecology. Those are some awfully high percentages, considering how little we hear about this subject.
“Some pain with intercourse right after having a baby is common and experienced by the majority of women. It is more concerning if this pain continues for months, or suddenly worsens. And pain lasting past one year is almost always abnormal," Dr. James Lozada, an anesthesiologist at the Northwestern University Feinberg School of Medicine, tells Romper.
"Anytime sex hurts it's something to be concerned about," Dr. Deitsch tells Romper. "Sex shouldn't hurt, so if it does, seek medical attention first to check for physical issues, then move on to psychological remedies if a medical doctor doesn't resolve it."
None of this is your fault, of course. Because emotions play such a large part in sexual function, everything from anxiety to depression to relationship issues (all things new moms often struggle with) can interfere in your level of arousal, which can result in discomfort or pain.
So what are some physical reasons that sex might still hurt even after you've celebrated your little one's first birthday? Most of the causes are common — and treatable, so don't lose hope!
1You Had A C-Section
Interestingly, while many women worry that a vaginal birth will increase the likelihood of painful sex later on, the same Australian study mentioned above found that women who have a cesarean section are no less likely to have sexual problems following childbirth; in fact, women in the study who had emergency cesarean sections, vacuum extractions, or elective C-sections had "double the risk of pain during or after sex at 18 months" postpartum, according to Parents. Another surprising discovery: Apparently, practically all women feel some degree of pain the first time they have sex after giving birth, whether they wait six weeks or even six months.
Everybody knows breastfeeding is a great for babies, but your sex life? Maybe not. Nursing mothers have lower levels of estrogen, as the International Society for Sexual Medicine explained on its website. Low estrogen levels can cause vaginal dryness, which naturally can result in some serious discomfort during sex.
Fortunately, there are some fairly easy fixes for this one; namely, lube (or, in some cases, a topical estrogen cream).
3You Had A Difficult Delivery
One potential downfall to having an unmedicated birth? As Dr. Lozada explains, the way pain is managed during delivery can have long term consequences for sexual function and health:
“Anesthesiologists play an important role during childbirth to help control pain, because when women experience uncontrolled pain during childbirth, they are more likely to have long-term pain," he says.
Interestingly, pain itself causes a number of changes in the body, Dr. Lozada says, including inflammation. So in some cases, the pain of childbirth can kick off a sort of vicious cycle, causing nerves to become more sensitive, and even making you feel pain more intensely.
"When the body is unable to quiet these effects, chronic pain can develop," Dr. Lozada says.
"If we prevent pain from occurring initially, we can often stop some of the effects that begin when our bodies feel pain," he continues, adding that "most women who have chronic pain will report long labor, that was painful, and deliveries that included forceps or vacuum."
4You Were Given A 'Husband Stitch'
You probably thought the "husband stitch," an extra stitch given while repairing episiotomies or tearing from childbirth for the purported benefit of a husband or male partner's sexual pleasure, was the stuff of urban legend (or at least something that hasn't happened since the 1950's). Not so, says Dr. Deitsch.
"Though less common, the 'husband stitch' is still utilized by some OB-GYNs," she says.
"This extra, unnecessary stitch is sometimes put in during an episiotomy in a misguided effort to create a smaller vaginal opening," she adds, and it can cause some women serious pain during sex for years to come. If this happened to you, talk to your doctor about options such as physical therapy.
5You Have An Infection
When you're an overextended (and probably overtired) new mom, it can be easy to let things like routine check-ups and other forms of self-care slide. But if you're still having pain months and months after giving birth, the reason why could be something your doctor should easily detect during an exam.
"First and foremost, rule out any infection, obstruction or scar tissue issues," says Dr. Deitsch.
"A year after childbirth if sex is still painful, something else is likely going on, but it's unwise not to do a routine exam first."
6Your Vagina Is Trying To Protect Itself
After the ordeal of childbirth, the vagina sometimes can get a little skittish and react by contracting as a defense mechanism when anything tries to get near it — even if that's not what you want it to do.
"There might be some involuntary muscle contractions happening which can make intercourse painful and difficult," Dr. Deitsch says of this process, also known as "guarding."
"It could be helpful to seek a therapist to rule out trauma or new issues that are completely unrelated to the new family addition."
Bottom line: While painful sex isn't uncommon, it shouldn't be something you have to deal with. So talk to your doctor!
Check out Romper's new video series, Bearing The Motherload, where disagreeing parents from different sides of an issue sit down with a mediator and talk about how to support (and not judge) each other’s parenting perspectives. New episodes air Mondays on Facebook.