Let's Talk About Sex, Baby: Sex & Pain Postpartum
By: Nataliya Zlotnikov, MSc, HBSc
By: Nataliya Zlotnikov, MSc, HBSc
Estimated reading time: 4 minutes
What's normal for postpartum sex?
It's common for many people to experience dramatic changes in their desire or frequency postpartum.
Some new parents may get completely side-swiped by the unexpected stresses of parenthood, others may use sex as a means to manage depression, while others yet may find that the added strain of becoming parents has brought them closer together and has resulted in improved sex life (PostpartumSex, 2018).
"It's all completely understandable. We are human, after all" (PostpartumSex, 2018).
Factors impacting postpartum sex
Many factors can impact sex postpartum, some of these include:
- Feeling touched out: due to breast/chestfeeding, night feedings, co-sleeping, or constantly holding a fussy baby.
- Constantly giving: feeling as if one is constantly giving to everyone; women who have birthed often report this.
- New body: navigating a completely new body.
- Relationship dynamics: change in relationship dynamics, be it for better or worse.
- Sexual and personal identity shifts: e.g. now that I'm a mom I don't feel like I can wear sexy clothes
- Mental health/mood disorders: e.g. postpartum depression
- Refusing to give up on sex!
- Improvement in sex life
- Deeper, more intimate bond with partner outside or within sex life
Causes of painful sex postpartum
One of the factors that can impact postpartum sex is pain. Pain with sex can have a domino effect on a person’s quality of life, especially during the unique stresses of the postpartum period.
There are a number of reasons why sex can hurt postpartum and unfortunately, many women suffer in silence when there are a number of treatment options available.
Here are a few causes of painful postpartum sex:
- Vaginal dryness
- Perineal scar from tearing or episiotomy
- Pelvic floor/deep core "dysfunction"
- Decreased drive
Science of desire: little or lots of libido
Having touched on painful sex postpartum, now let's take a look at desire.
A lot of folks think that we either have a lot of libido, or we just don't. But that is not how desire works. Our drives have more to do with our nervous systems.
Sexual drive and arousal are products of the interplay between the sympathetic (fight and flight) and parasympathetic (rest and digest) nervous systems. When our sympathetic nervous system turns on to fight—something that can happen a lot postpartum—it can be quite difficult to be turned on at that moment.
Furthermore, some people might experience fewer barriers or "brakes" to being turned on while others might experience more.
This blog is based on the online course on Embodia, Sex & Pain Postpartum for Physiotherapists, with Tynan Rhea, Sexual Health Professional. Take a look at this video from the course to learn about the libido myth and the dual control model of desire.
The libido myth & the dual control model of desire
Accelerators & brakes
Below are some postpartum-specific "brakes" and "accelerators" that can impact sexual desire.
Two of the biggest brakes when it comes to pain and sex are focusing on the painful sex as well as avoiding talking about sex.
As healthcare practitioners, we can explain the basics of accelerators and brakes to our patients and even do a brainstorming session with them so that they may become more cognizant of their own accelerators and brakes.
Expand the definition of sex
In addition, the focus on our reproductive organs as our only erogenous areas can also be part of the problem.
Far too often when we think about sex we only think about penis and vagina. Only penis and vagina sex is real sex. Or, that it is the kind of sex one must have in order to keep their relationship together. However, and especially postpartum, discussing sexual fantasies and exploring intimacy and sexuality outside of our reproductive organs can help partners remain intimate and sexually connected.
Oftentimes, many patients may improve their postpartum sex life simply by expanding their definition of sex.
Here are some excellent ideas that Tynan shares in their course; of course, this list is non-exhaustive.
More for clinicians
The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005.
The 2021 paper below provides a consensus‐based Terminology Report for the assessment of PFM function and dysfunction to aid clinical practice.
If you are a physiotherapist and would like to learn more about sex and pain postpartum, take a look at our online healthcare course from the energetic and passionate sexual health counsellor and educator, Tynan Rhea. Tynan developed and teaches the Sex & Birth course for Doula Training Canada and is the founder of PostpartumSex.com.
In this online physiotherapy course, you’ll learn:
- How to apply Tynan's sexual self-model in practical ways
- How to incorporate basic sex education into your practice
- How to screen for compounding sexual health factors
- How to make educated referrals and provide up-to-date resources
Date written: 28 Jan 2022
Last update: 17 July 2023
Pelvic Health Solutions (PHS) is an evidence-based teaching company that aims to educate and empower physiotherapists, healthcare professionals, and everyday people about pelvic health.
PHS was founded in 2010 out of the need to develop pelvic health resources in Ontario at a time when it was an under-serviced health concern. PHS provides continuing education courses, mentoring, and clinical resources for a variety of practitioners with the goal of equipping them to deliver evidence-based, biopsychosocial assessment and treatment of pelvic health problems in our province and abroad.
Our company also exists as a way to connect people experiencing pelvic health concerns to pelvic health physiotherapists in their area. PHS has ultimately blossomed into a community of curious people who are committed to providing hope and healing to those who suffer from pelvic health issues.
Sexual Health Professional
PT DPT, BKin, FCAMPT; Registered Pelvic Health Physiotherapist/Clinic Owner
Beth is a Registered Physiotherapist, having achieved her Doctorate in Physical Therapy at Franklin Pierce University in New Hampshire and her Kinesiology degree from McMaster University. Beth focuses her practice on pelvic floor and orthopedic physiotherapy with an interest in post partum rehab in elite athletes as well as weekend warriors and fitness enthusiasts.
Beth practices in the Kitchener-Waterloo area. She is the owner and founder of KW Pelvic Health which is a full service physiotherapy clinic that has a mission to help women and men maintain their active lifestyles while finding solutions to their pelvic health challenges.
A lifetime endurance athlete and yoga instructor, Beth enjoys many sports. A former captain of the McMaster University women’s swimming team, she remains an avid swimmer. She also enjoys running and cycling. She currently competes in long-distance triathlons and running, having qualified for the Boston marathon 3x (2015, 2016, 2019) and the Ironman 70.3 World Championships (2014, 2018, 2020). She has also completed multiple Ironmans with a personal best 3rd place finish at Ironman Mont Tremblant in 2019. Beth loves being active and is the proud mother to a young daughter and son.