By Penny Hanlon, physiotherapist at The Sports Physio Clinic Narrabeen
Sex after having a baby is something a lot of women worry about. Women often wonder: Will it feel different? Will it be as satisfying? Will my partner think differently about it?
One thing women often don’t expect is that sexual intercourse can be painful. Pain can develop after a vaginal birth because of tearing, scar tissue, nerve damage or hormones. But what is really surprising for some women is that pain with sex is quite common after a caesarean!
The reasons are not completely understood, but research suggests several factors can contribute to painful post-c-section sex:-
In order to reach your baby, your obstetrician had to cut through 7 layers: skin, fat, fascia, abdominal muscles (not actually cut through but between), peritoneum, uterus and the amniotic sac. Whilst the external layers (e.g. your skin) may start to heal, the internal layers take longer to heal. A lot of women by, or shortly after, their 6 week check-up, will attempt intercourse and the pressures and movements involved can pull at this incision healing causing pain. This is where pain may be felt, or women will sometimes anticipate the pain and tighten their pelvic floor (which we discuss below).
After all 7 layers have healed, some people will feel a hard lump along their scar. This is scar tissue and if it is raised you’ll sometimes hear it referred to as keloid scarring. With intercourse the uterus usually adapts and moves with the rhythm of thrusting, however when scar tissue is present it is unable to do this effectively which can be painful. What a lot of women aren’t taught is scar tissue massage, which helps with keeping the tissues mobile and preventing stiffness occurring in an area such as the uterus. When scar tissue develops at the incision site the mobility of the uterus, and sometimes the bladder, is reduced which can cause pain.
Was your c-section planned or an emergency? Some research suggests that emergency c-sections have a higher rate of reported pain than planned c-sections. This would most likely be because a woman has gone into labour and may have even gone as far as to start pushing. The stretch on the pelvic floor, the hormones released and, in a lot of cases, the psychological effect on the mother can all have a carry-on effect.
Pelvic floor muscles, just like any muscle, can become too tight. Usually when a muscle is too tight you experience some pain when you try to stretch it or if someone was to rub it. The same applies to the pelvic floor. The reasons for this occurring after a c-section can be multi-factorial: psychological, secondary to any of the above, tension/fear response and others. But they all mean the same thing: that your pelvic floor isn’t relaxing so when you are having sex its like you are over-stretching a muscle before it’s ready. Continuing with sex isn’t ‘damaging’ but it can lead you to develop an automatic response to tighten your pelvic floor.
Like with a vaginal birth, your hormones after pregnancy and birth are all over the place and can take a while to settle. Oestrogen, in particular, is low post birth and is a big influencer on vaginal dryness. It is even more common for oestrogen to remain lower if you are breastfeeding.
The good news is that all of these can be treated! Pain is complex in nature so often there is a multifactorial approach to treatment. A women’s health physio can address pelvic floor overactivity, scar tissue and incisional pain issues, and refer you to the appropriate professional for management of the psychological or hormonal components.
The take home message is: seek treatment early! Don’t suffer in silence or think things will improve. It’s ok to put yourself first and get help.
Penny Hanlon is a physiotherapist with a special interest in women’s health working at The Sports Physio Clinic Narrabeen. If you have any questions feel free to contact Penny directly at firstname.lastname@example.org, or call the clinic on (02)9981 4099.