Painful Sex

Stretching your pelvic floor out after birth- this seems counterintuitive, right? After all, your vagina was just stretched to its limit so you are probably wondering WHY in the world would you need to stretch it after giving birth?! NOTE:  If you have pain with sex and HAVEN’T given birth– we treat that too!  Scroll to the bottom of the page for help with painful sex that is unrelated to childbearing!

Generally speaking, this information typically applies to women who had more trauma to their pelvic muscles with birth.  You may need to do some intervention on your pelvic floor muscles if you experienced tearing and/or an episiotomy and particularly if a vacuum or forceps was needed to bring baby into the world.  Mamas who ended having an emergency c-section after pushing for some time— this applies to you too!! 

Other signs you may benefit from some work on your pelvic floor include:

  • pain with penetration, thrusting and/or tampon insertion

  • pelvic floor (clitoral, vaginal, perineal, anal) pain in general

  • liberally using personal lubrication does not seem to completely help.  Postpartum mamas and especially breast-feeding mamas have lower levels of estrogen— leading to vaginal dryness.  Using lubrication is often essential but often not the complete answer to postpartum sexual pain

Your pelvic floor gets stretched to its max during a vaginal birth and then typically responds by spasming in response to the pain. 

Instructions and tips for stretching your pelvic floor (vaginal) muscles after birth

You can start the following program around 12 weeks postpartum

  • USE YOUR FINGER.
    You can insert your pointer finger or thumbs into your vagina. Wash your hands before and make sure your fingernails are short so you don’t scratch anything. Lubricate the finger(s) you are going to use with a water based lube- my favorite is slippery stuff.
    Insert your finger 1-1.5 inches inside your vagina. Imagine your vagina as a clock (6 is down toward the anus and 12 is up tossed the clitoris). Slowly massage the lower half of the vagina using a U shaped motion. Press down toward 6 o’clock and back and forth from 3 to 9 o’clock until you feel a slight burning, stretching sensation. Do this for 2-3 minutes max. Focus on relaxing your muscles while you do this and practice using your diaphragmatic breathing. Repeat with your finger more deeply inserted. 

  • USE A VAGINAL DILATOR
    Just like with the finger, you can imagine your vagina as a clock. Push the dilator down towards six o’clock and work it from 3 to 9. Push and hold for a few seconds at 3, 6 and 9 o’clock.

  • ENLIST YOUR PARTNER TO HELP
    You can also have your partner help you with this! Have them use their index finger and follow the same instructions above, using their index finger and lubrication. Make sure you have good communication if you are going to do this and please let them know if it is causing you pain. Again, you should just feel a slight stretching/burning sensation but shouldn’t be painful.

  • WORK YOUR SCAR
    To perform scar tissue mobilization, pinch the surrounding skin near the scar in your fingers rolling it in different directions. Up/down. Left/right. Right diagonal/ left diagonal. You can also “twist” stubborn areas to get them moving. Use your three middle fingers and place them over the scar. Rotate them clockwise and counterclockwise. Look for which directions cause movement restrictions when areas are stubborn. Once you find the restriction, keep holding it and take three deep breaths. When you do this, see if the scar softens and try to move the scar further into the restriction. It is crazy how much more movement you can get!  

  • HAVE SEX
    While this doesn’t actually “stretch it out”, it really is an important part of the process of your pelvic floor healing. Delaying sexual intercourse indefinitely for fear of “injuring” yourself is not necessary for the vast majority of women. When you are physically able, it is great to be able to resume sex with your partner!  It may not feel quite the same at first, but should get rapidly better with subsequent sexual encounters.  Again, if it doesn’t, come in and talk to us!

For people with painful sex NOT  related to childbearing– we will help you out! The inability to tolerate penetration at all (vaginismus) is one of the reasons why pelvic floor therapy even exists!  There is a strong muscular component to most women who have this disorder and therefore there is so much help and room for improvement in the vast majority of cases with pelvic floor therapy!

What does that PT appointment look like?

We will have you tell your story and how things have been going for you.  If the goal is to resume sex, we’ll discuss a vaginal pelvic floor muscle exam and treatment.  If that feels like too much for the first visit– don’t worry!  We have so many ways of assessing and treating the pelvic floor that do not have to involve internal treatment, including external manual techniques as well as the use of pelvic floor biofeedback.

If we do go ahead with an internal pelvic floor muscle examination, this involves one gloved and lubricated finger in the vagina so we can pinpoint the problem areas and more specifically treat the cause of the problem! 

We also make sure to zoom-out and look at your whole body.  You are not just a floating pelvic floor, with issues there is nearly always some other musculoskeletal stuff going on that will help your well-being for us to discuss and treat out!  We truly hope to be your “one-stop shop” to get your physical body functioning efficiently again in your postpartum time!!

Krystle Howald