"I don't have a sex drive since having a baby."
"I'm too tired to have sex."
"Sex doesn't feel good since having a baby, I'm too dry."
...
Sex after having a baby can be emotionally and physically hard. Our bodies change, our hormones change, our priorities change...We change. It’s hard and it’s also important to know you are not alone as 58% of women report having pain with sex within the first three months of having a baby. That number decreases to 26% at six months but that is still ¼ of all mamas that are having pain with sex.
Why do I hurt "down there" when I have sex? What can I do to make sex after a baby more comfortable?
Muscles, Ligaments or Nerve Changes...oh my!
Pelvic floor dysfunction is pretty common for anyone who has carried a child, whether they delivered vaginally or via cesarean. While pain at one month postpartum is associated with vaginal birth, there is not a change in pain with sex between vaginal or cesarean births in that group of mamas that have pain at six months postpartum. Childbirth can change how things feel and work down there. Our muscles could be stretched and need a little more strengthening. Or our muscles could be in spasm and need relaxing. Or we could have nerve damage that is altering how we feel and sense things...or it could be a combination of it all.
When our muscles are tight we oftentimes are not getting enough blood flow to the area. This can be seen when we experience constipation, increased urgency or frequency with urination or even hesitancy (start/stop or difficulty starting to pee). When we don’t have blood flow to tissues, we also don’t have oxygen which our tissues need and love for healing.
Solution: Pelvic floor PT can assess your ability to relax, your pelvic floor strength and even how your coordination is to determine what you need most. Some mamas need kegels, some need to learn how to relax their pelvic floor and others need to work on coordination. Sometimes it’s also something as simple as changing positions to make sex more enjoyable so don’t hesitate to move around and see if one position is more comfortable than another.
Sex vs Stress vs Sleep
Honestly, the newborn days are hard. Lack of sleep, physical and emotional exhaustion, a never-ending load of laundry on the top of your to-do list right after making sure the baby is cared for. It's a lot. Throw in the fact that stress and fatigue are related to increased pain with sex, those early days can be even more brutal. Nicole Jardim, author of “Fix Your Period” often highlights how stress (cortisol) can affect your menstrual cycle, but here’s the thing, it’s not just your cycle, it’s all of your hormones. When our cortisol levels are high it can actually decrease our production of estrogen, testosterone and progesterone as well as lower TSH and create hypothyroidism. Symptoms of hypothyroidism include fatigue, dry skin, and constipation...all things that tend to be less than sexy.
Speaking of sexy, testosterone is also important to female sexual health because it is what helps with sexual desire/libido and helps with erections (yes, females have erections too), ejaculates and ease of obtaining an orgasm. Testosterone also helps with lubrication.
Solution: When we are constantly stressed and/or not sleeping well, it can lead to a decrease in testosterone and estrogen and a decrease in sex drive.I’m not going to tell you to get more sleep and decrease your stress because honestly, that feels like a slap in the face to most new moms, myself included. The only thing I’m going to ask is that you try to find support however you feel comfortable. Support can come in many forms- finding someone to watch your child so you can nap, having someone help you clean or fold laundry, asking for meals to be delivered so you don’t have to make them yourself, seeing a chiropractor or acupuncturist, or even finding a counselor/ CBT provider/ sex therapist to help you navigate the changes in sexual desire. Having a solid support team can help decrease stress and improve your ability to go to sleep and stay asleep.
If you have pain at the vaginal opening or with initial penetration, then it may be caused by inflammation or hormonal changes. If you are finding pain with all intercourse and gentle touch along the vagina, working with a functional medicine doctor can help you determine the root cause of your pain and ideally get you personalized care to help ease the pain. If your pain is with deep penetration, then it is more likely to be caused by overactive/tight pelvic floor muscles and finding a pelvic floor therapist near you can help you determine how to navigate that pain.
Decreased Estrogen Postpartum & Increased Vaginal Dryness
When we are pregnant we have a huge increase in estrogen...so much that we produce more estrogen during pregnancy than we will in a lifetime of not being pregnant. During pregnancy estrogen helps increase blood flow and lubrication everywhere from the nose to the pelvic floor. Postpartum those hormones drop drastically and can stay low as long as you are breastfeeding but usually regulate around six months postpartum. When breastfeeding our bodies make increased prolactin which helps with milk supply but prolactin blocks estrogen. This makes the body's ability to naturally lubricate a little harder and leaves mamas with dry vaginal tissue that is easily irritated during sex.
Solution: Use a high quality lubricant to help keep everything moisturized. Some quality lubricants include Pjur (safe with condom), Sliquid silver, Good Clean Love, Uber Lube, or good ole coconut oil (do not use oil-based lubricants with condoms if you are trying to avoid conception as the oil can weaken the condom). If you continue to experience dryness, some moms have felt relief with Vitamin E suppository which helps increase lubrication down there.
Another way to increase lubrication is through foreplay, clitoral stimulation and orgasm. If you feel comfortable, a website like OMGYes can help you navigate the clitoris and find ways to improve blood flow to the area which in turn can increase lubrication. “OMGyes has a range of strategies that can make clitoral pleasure better and also helps you find ways to give and read a partner’s feedback.” This is helpful for a lot of mamas who are hesitant to communicate with their partner as OMGyes allows you to work through it with them rather than on your own.
Nourishing your Tissues Through Nutrition
Did you catch the constipation in the last section? Constipation is pretty common postpartum due to the decrease in hormones which affect intestinal movement. You’ve probably heard the statement, “you are what you eat” but let’s take it one step further. Our digestive system is where all of those foods we eat are broken down so the nutrients can be absorbed. If we are constipated we tend to absorb more than we want...if we are constantly running to the bathroom with diarrhea then we probably aren’t absorbing enough.
Solution: Eat a diet rich in colorful, anti-inflammatory foods to help with inflammation and pain while also focusing on foods that help balance blood glucose levels. Healthy fats, protein, and foods rich in vitamins and minerals are all beneficial.
First, slow down and see how many times you actually chew your food. I’m mildly embarrassed to say that one time I caught myself chewing a total of three times. When we don’t chew, our bodies have to work that much harder to break everything down so we can absorb and utilize it. You can help this by taking 10 breaths before you eat or focusing on chewing your food at least twenty times.
Next, look at the food you are eating. Foods like bone broth, grass-fed meat, wild fish, organ meat and healthy fats (hello avocado and coconut oil) help keep blood glucose levels stable. Foods like ginger and garlic, berries, cruciferous vegetables (broccoli, bok choy, kale, Brussels sprouts, collard greens) and fermented foods can also help nourish and heal the body from the inside out.
The book “Nutrition for Relieving Pelvic Pain: Fueling the Patient/Practitioner Healing Partnership” by Jessica Drummond is a great resource for anyone looking to navigate their pain through nutrition. For more personalized care, a functional medicine provider can help you figure out your specific nutritional needs and oftentimes can help you heal faster by making sure you are getting the nutrients you truly need.
Sources: