Please welcome physiotherapist Tamara Gerdis, a women’s health specialist from PhysioActive.
Returning to sexual intercourse after giving birth can create anxiety for many women. Your baby is probably awake often during the night, meaning you are exhausted. Your body hasn’t returned to its pre-pregnancy state and you may have had some perineal stitches from a vaginal birth, or abdominal stitches from a Caesarean (C-section). It is completely normal to feel apprehensive about returning to sexual intercourse so here are a few pointers to help combat those nerves:
When is it ok for my partner and I to have sex?
You shouldn’t have sex until your bleeding stops. This is due to the risk of infection. I usually recommend my patients wait until their 6-week check-up, especially if they had a vaginal birth and have had some stitches. As long as there are no complications post-birth, I encourage my patients to try intercourse at least once after 3 months. This gives me a good indication if there are any concerns that need to be addressed.
I am nervous that sex will be painful, is there anything I can do to help minimise any discomfort?
One of the most important things to remember is lubrication. Women who are breastfeeding have low estrogen levels, which can lead to vaginal dryness. Vaginal dryness can result in painful intercourse. Please use a good quality lubricant (it shouldn’t sting).
Even if you aren’t breastfeeding and you have some vaginal dryness, don’t worry, just use some lubricant. Feeling stressed about having sex again can stop you from relaxing and feeling “in the mood”. If you are very nervous, start with other forms of foreplay rather than penetrative sex. Even just experimenting with different positions can help minimise discomfort.
My partner and I attempted sex the other night but it was really painful. Is this normal?
There is a difference between feeling nervous about having sex and actually experiencing pain with intercourse. It helps to try to distinguish between the two. Sometimes what started out as nervousness develops into a fear. The fear in itself can cause your pelvic floor muscles to tighten up so much prior to penetration, that pain is created. Sex should not be painful and if it is, you should follow up with an appropriate professional like a women’s health physiotherapist, gynecologist or your GP.
I had a vaginal delivery and now my vagina feels different. Is there anything I can do to help it go back to normal?
Your vagina has just had a big stretch from your baby’s birth and your pelvic floor muscles are often weak post-natally. Doing your pelvic floor exercises (see below) will help strengthen your pelvic floor muscles, thereby increasing vaginal sensation during sex. If you feel something coming down, or a bulge in your vagina you may have a pelvic organ prolapse, for which you should be assessed by a women’s health physiotherapist or gynaecologist.
How do I strengthen my pelvic floor?
Your pelvic floor is a group of muscles that lie at the bottom of your pelvis. They play an important role in supporting your organs, helping to control your bladder and bowel, and improving sensation during sexual intercourse. It is essential that a pelvic floor muscle contraction is done correctly as many women bear down (push down) when contracting their pelvic floor rather than lifting their pelvic floor up. Bearing down will actually do more harm than good. You can learn how to correctly contract your pelvic floor muscles here.
Once you are squeezing your pelvic floor correctly, try squeezing and holding your pelvic floor muscles for 10 seconds, repeating 10 times in a row. Follow this by 10 fast squeezes, where you just squeeze and let go. Aiming to do these exercises about 3 times a day is ideal but even once a day will help. Having your pelvic floor checked by a women’s health physiotherapist will allow you to check your technique and have a training program personalised for your current ability level.
Now that I’ve had my baby, I’m having difficulty getting to the toilet on time. Every time I cough or sneeze, I leak some urine. What can I do to help this?
One third of women who have a baby will experience urinary leaking at some point in their lives. If you are noticing that you are leaking some urine with coughing, sneezing, laughing, running or any other physical activity, you are most likely experiencing stress incontinence. Stress incontinence can usually be helped by strengthening your pelvic floor muscles, learning how to protect your pelvic floor from further damage and implementing good bladder and bowls habits.
If you are struggling to get to the toilet on time, or if certain triggers like putting the key in the door or hearing running water make you feel like you have to wee or cause you to leak, you may be experiencing urgency or urge incontinence. Urgency and urge incontinence can usually be conservatively managed similarly to stress incontinence but we incorporate bladder training as well.
I haven’t really felt like having sex. What can I do to increase my libido?
As a women’s health physiotherapist I always encourage my patients to be kind to themselves, as they are usually exhausted and are experiencing big changes to their bodies. It is also important to allow your partner to know how you are feeling. Getting back in control of your body with regards to your pelvic floor and appropriate exercise will help with your libido. Click here for some other great tips.
Above all else, remember to look after yourself, rest when you can and explain to your partner how you are feeling.