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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 Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

Read more: Testimonial by Ann V.

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.

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