Postpartum Dyspareunia

Postpartum dyspareunia is the term used when someone is experiencing painful intercourse and/or postpartum dyspareuniasexual activity in the postpartum period. This is a common issue seen in the postpartum population with 62% of women experiencing dyspareunia in the first 3 months after delivery.

Causes

The causes of postpartum dyspareunia may often be a combination of several different factors. It is important to determine which variables are contributing the most  in order to treat the patient’s symptoms effectively.

  • Hormonal – when a woman is breastfeeding, her estrogen levels are decreased. Breastfeeding has been compared to being in a temporary state of menopause. One of the results of low estrogen is vaginal dryness and decreased tissue integrity.
  • Scar tissue restriction – perineal/labial tearing and episiotomies are common with vaginal deliveries. Scar tissue can often have decreased mobility and increased sensitivity. This may result in pain when there is pressure/stretch applied to the tissue.
  • Pelvic floor muscle tension – over recruitment of the pelvic floor muscles after delivery is one of the most common factors contributing to painful intercourse postpartum. When the body goes through a vaginal delivery or cesarean, there is often pain associated with the recovery. The pelvic floor muscles will often go into a state of self protection and guarding by developing tension.

 

Treatment

  • Lubricant/moisturizers – using a lubricant is a strategy that most women postpartum would benefit from. Trying a basic water-based option is a good starting place. If you’re finding that it dries out quickly, a silicon-based option may give you better results. If no matter how much lubricant you apply, you are still having pain related to vaginal dryness/irritation, the next step would be to try a vaginal moisturizer. These are vaginal suppositories you insert into the vaginal to create long lasting moisture. If lubricant and vaginal moisturizer aren’t enough for your tissues, your doctor may suggest using estrogen in the form of a vaginal tablet or topical cream.
  • Scar tissue mobilizations – if it has been identified that you have restricted scar tissue mobility (whether it be perineal or cesarean), your pelvic physiotherapist will likely mobilize these tissues with different connective tissue techniques. The goal is to slowly desensitize the tissues and increase the flexibility of the tissues thus minimize postpartum dyspareunia. In addition, your therapist will teach how to mobilize these tissues at home.
  • Pelvic floor muscle relaxation/release – many people assume that after a vaginal delivery, the muscles become stretched, open and relaxed. However, in the immediate postpartum period it is often the opposite. During an internal exam, your physiotherapist will assess your muscle tone by gently pressing on your pelvic floor muscles. There is often tension associated with an aching sensation indicating over recruitment of the muscles. Your therapist will provide feedback and allow you to connect to the areas of tension. Subsequently, this will help a patient learn how to lengthen and let go of tension. Diaphragmatic breathing is one of the most helpful strategies you will learn. In some cases, your therapist may suggest the use of dilators to slowly teach the muscles how to relax in order to accommodate insertion, as well as gently stretch the tissues.

If you are struggling with postpartum dyspareunia, connect with one of our pelvic physiotherapists today and get back to a positive, pleasurable and pain-free sex life.

 

Resources:

GUNTER, J. (2019). VAGINA BIBLE. TORONTO: MCCLELLAND & STEWART.

Stewart, E. G., & Spencer, P. (2002). The V book: A doctor’s guide to complete vulvovaginal health. New York: Bantam Books.

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