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Photo by Kelly Sikkema on Unsplash
Photo by Kelly Sikkema on Unsplash

Many women experience lower libido, vaginal dryness, sore muscles, and tender skin in the genital area after childbirth.

These issues can make sex uncomfortable, or even unappealing.

Many women are not comfortable bringing up their sex lives to their doctors and midwives, thinking that it “will get better with time.” However, if you find your sexual health impacted for more than a few months after childbirth, you might start to wonder when you’ll be feeling back to normal.

Hormones Can Cause Vaginal Dryness

After delivery, estrogen levels drop and progesterone levels stay high, especially if you’re breastfeeding. This shift in hormones causes dryness of the vaginal tissues. If dryness if your main problem, try a water based lubricant and make sure you’re drinking enough water.

Genital Skin and Muscle Pain

Muscle and skin pain is common postpartum, especially if there was tearing during the delivery. If you are feeling muscle and skin pain, try placing an ice pack to the perineum (the area between your vaginal opening and your anus). Performing Kegel exercises will also promote healing by increasing local circulation. Keeping the area clean with the use of a perineal irrigation bottle and sitz baths will reduce infection and further assist in the healing process. Use of a doughnut cushion provides relief for perineal wound pain in some patients. Finally, keeping bowel movements soft will minimize stress on any sutured and healing sites, thereby minimizing pain.

Vaginal Scar Pain

Scars from episiotomy or natural tearing can cause pain with tampon insertion or pain with intercourse. An easy self treatment is doing perineal massage over the scar, with a finger/thumb or a small vibrator.

Orthopedic Issues

Other women may experience central pubic pain during their vaginal delivery. This could be due to a sprain or separation of the pubic symphysis joint. This will lead to pain over this area, sacroiliac joints, buttocks or thighs. You may feel pain with turning in bed, transitioning from a seated to standing position, getting in and out of a car, or with weight-bearing activities. The pain might be so severe that you are not even thinking about sex.

If this is the case, consider contacting a pelvic floor therapist to receive advanced manual techniques to restore alignment, reduce muscle spasm, and to receive guidance with stabilization exercises that will strengthen the area without making pain worse.

What is Post-Partum Pelvic Floor Therapy Look Like?

Treatment will consist of:

  • Myofascial/connective tissue release
  • Postural training
  • Gait and body mechanic training
  • Ergonomics (i.e. workstation, office desk set-up)
  • Activity modifications to assist with pain provoking tasks and to prevent injury or repetitive stress on muscles and joints
  • Strengthening and stabilization training (this would be tailored to the individual and based upon what stage of gestation you are)
  • Stretches to address myofascial restrictions due to bodily changes during pregnancy
  • Abdominal strengthening and neuro-muscular awareness of pelvic bracing during functional activities
  • Pelvic floor muscle awareness and training to help stabilize pelvis and support
  • Pelvic floor downtraining to help with pelvic pain, hip pain, constipation, and pain with sex

Check out these articles on the Femina PT website about pregnancy


References:

ACOG, 2005. Your pregnancy and birth. Washington, DC: Meredith Books.

Al Hakim M,. Katirji B. 1994. Femoral mononeuropathy induced by the lithotomy position: a report of five cases with a review of literature. Muscle Nerve 17:4 466.

Babayev M., Bodack M.P., Creatura C. 1998. Common peroneal neuropathy secondary to squatting during childbirth. Obstet Gynecol 91:5 830-832.

Haslam, J., Laycock, J. Therapeutic management of Incontinence and Pelvic Pain.
Therapeutic Management of Incontinence and Pelvic Pain. 2nd edition. Halsam and Laycock.

Ley L., Ikhouane M., et al. 2007. Neurological complication after the “tailor posture” during labour with epidural analgesia. J Gynecol Obstet Biol Reprod 36:5 496-499.

Massey E.W., Cefalo R.C. 1979. Neuropathies of Pregnancy. Obstet Gynecol Surv. 34:7 489-492.

Ronchetti I., Vleeming A., et al. 2008. Physical characteristics of women with severe pelvic girdle pain after pregnancy: a descriptive cohort study. Spine 33:5 145-151.

Snow R.E., Neubert A.G. 1997. Peripartum pubic symphysis separation: a case series and review of the literature. Obstet Gynecol Surv 52:7 438-443.

Stephenson, R., O’Connor, L. 2000. Obstetric and Gynecologic Care in Physical Therapy. New Jersey: Slack, Inc.

Tetzschner T., Sorensen M., et al. 1995. Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth. Acta Obstet Gynecol Scand 74:6 434-440.

Tetzschner T., Sorensen M., et al. 1997. Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 76:4 324-331.

Wong C.A., Scavone B.M., et al. 2003. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 101:2 279-288.

What Our Patients Have to Say

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Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by M.M.

My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

Read more: Testimonial by M.M.

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

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