Research shows the majority of women experience pain the first time they have sex after childbirth, regardless of whether they had a vaginal or a c-section birth.
A study, from the Murdoch Children’s Research Institute, Australia, showed women who had given birth via c-section were twice as likely to experience painful sex 18 months after birth, compared with women who had spontaneous vaginal births.
Ongoing painful sex after c-section is something most women don’t expect.
So what causes it, and how can it be treated?
When Should I Have Sex After A C-section?
Most healthcare experts recommend waiting 6 weeks after birth before having sex. This applies to women who have vaginal and c-section births.
Most c-sections are performed after labour has begun (emergency c-section), which means your body has undergone at least some of the physical changes of a normal labour and birth.
It takes around 6 weeks for the cervix to close completely, and for any post partum bleeding to stop. It also gives your body time to recover from surgery. Your incision needs time to heal, and there is likely to be bruising and tenderness around the site for some time.
Some women will wait longer than 6 weeks before having sex again after a c-section, depending on how they feel, both physically and emotionally.
Read more about when to have sex after c-section and tips to help reduce discomfort.
Why Is Sex Painful After C-Section?
Even if they have waited 6 weeks after birth before having sex again, some women experience pain during intercourse, which can be distressing.
The pain can range from a burning sensation, to a feeling of painful internal pressure.
Here are the main causes of painful sex after c-section:
Low Estrogen Levels
The hormone estrogen helps maintain the tissues in the vagina, keeping them supple and well lubricated. Breastfeeding can keep estrogen levels low, which means during sex, women can feel a lot of discomfort or pain, due to dryness and friction.
Using lube before sexual penetration sometimes helps – but not always. Some women are prescribed estrogen cream for vaginal dryness. This often resolves the problem within a few weeks.
Usually, estrogen levels will increase, and return to normal levels, when your menstrual cycle returns.
Pain Around Incision/Scar
The most common incision used for a c-section today is the ‘bikini’, or horizontal incision. The incision is made through the lower abdomen, just above the pubic hairline.
When the incision heals, the scarring isn’t just on the skin surface. There is also scarring to the tissue underneath the incision, and to the uterus. These scar areas have restricted blood flow, and can be very sensitive to touch.
During sex, women often prefer that their surface incision scar isn’t touched. They might be surprised to find they also experience pain internally, even when their incision has long healed.
The scarring caused by the c-section incision can cause the muscles nearby to refer pain to areas such as the clitoris. The ligaments running from the uterus to the labia can be caught in scar tissue, and certain movements can cause significant labial pain.
Fortunately, scarring can be improved, or even corrected, by making the scar tissue more flexible. This is done with scar tissue release therapy. The scar tissue is massaged and manipulated to become softer, which reduces tightness. It also breaks up any adhesions, where the scar tissue has attached to ligaments, or to the uterine wall.
Pelvic Floor Dysfunction
Pregnancy is the biggest culprit, as the muscles and tissues connected to the front and back of the pelvis are often stretched and even injured.
This can lead to tight muscles in the pelvic floor. These muscles spasm and become very tense, leading to painful sex. Women feel generalised pain in the vagina, or in a specific place, such as a point just above the cervix. Anxiety about painful sex can cause more tension, which leads to further pain experienced during intercourse.
You can seek help from a qualified women’s health physiotherapist, to re-train your pelvic floor. Therapies include pelvic floor relaxation, diaphragmatic breathing, vaginal dilators, and sometimes muscle relaxants.
Painful sex isn’t normal, but it’s a topic women are often reluctant to discuss with their care providers, or to seek help about. Some women might decide their general practitioner isn’t the right person to help them discover what is causing painful sex.
It’s important to give your body time to recover from your c-section. Ask your partner to be patient and gentle, as you reestablish your sexual relationship. If pain continues, don’t hesitate to ask your doctor for a referral to a women’s health specialist who can help you find out the cause and the best treatment.
Recommended Reading: Prolapse After Childbirth – 6 Things That Increase The Risk.