When to resume sex after giving birth

Resuming sex after giving birth may seem like the last thing on a woman’s mind. New motherhood and postpartum recovery have a significant impact on a couple’s intimate life. Not only is it harder to find the moment, but also (in the woman’s case) there may be injuries in the vaginal area.

Both vaginal birth and cesarean section cause erosion and changes in the pelvic floor region. That’s why many women are afraid of having sex after pregnancy. So in this article I’m going to look at how and when to resume sex after giving birth.

What happens to the pelvic floor during birth?

If we picture the pelvic floor muscles as several layers surrounding the openings of the urethra, vagina and anus, we can see that in a vaginal birth they will undergo a great deal of stretching.

The second stage of labor, the pushing stage, is when the pelvic floor stretches (almost six times more) compared with its normal state. When the baby’s head passes through the birth canal, the vagina and muscles stretch and, together with the mother’s pushing, it’s a very critical moment with a high risk of injury. That’s why it’s so important to prepare the pelvic floor during pregnancy, strengthening it and making it more flexible, to prevent perineal tears and major trauma.

Why might a woman be afraid to resume sex after giving birth?

Perineal injuries, such as a vaginal cut, a perineal tear or bladder prolapse, can happen in any vaginal birth. After an episiotomy and/or perineal tear, the wound is stitched and a scar then forms.

Perineal scars significantly change the condition of the pelvic floor. They can cause pain if they are not very flexible, have a high amount of collagen or when fibrosis develops in the affected tissue. All these changes affect women’s sex lives and can make them afraid of resuming sex after giving birth.

How long should you wait to have sex again after a vaginal birth or cesarean?

If you had a vaginal birth, you need to wait at least four weeks until the puerperium is over. During the first weeks postpartum, the uterus contracts and expels blood, so the woman bleeds and may notice abdominal discomfort.

All women who have had a vaginal birth with an episiotomy or a perineal tear are advised to wait six weeks before resuming sex. Mothers who gave birth by cesarean should wait at least four weeks.

Before having sex after giving birth, a pelvic floor assessment is essential. The physiotherapist specializing in gynecology will examine the vaginal area and assess the perineal scar, muscle tone, the degree of stretching and the presence of genital prolapse. This gives us a lot of information about how to exercise the pelvic floor and how to avoid the discomfort that could appear during sex.

Is it normal for sex to hurt postpartum?

Sex should never be painful. If, after six weeks postpartum, you notice pain the first times you have sex, the best thing is to see a physiotherapist specializing in gynecology. The reasons for pain in the genital area can be:

• Vaginal hypersensitivity
• Very fibrous scars
• Pelvic floor hypertonia
• Muscle knots in the pelvic floor
• Keloids in the perineal scar

You need to have your pelvic floor checked as soon as you notice the first discomfort, without waiting. Otherwise, any dysfunction that becomes chronic will be harder to treat. Women who start postpartum rehabilitation and exercises in the first weeks after giving birth are more likely to make a full recovery.

What role does the pelvic floor play in sex after giving birth?

As we’ve seen, during a vaginal birth the pelvic floor is overstretched. In addition, the postpartum period brings many hormonal changes: more tiredness, little sleep, more awkward postures and potentially higher stress levels.

All of this affects the pelvic muscles and will have an impact when it comes to resuming and having sex after giving birth. It’s important that after the first postpartum physiotherapy assessment we start the right training. Above all, it’s important to look after your pelvic floor after a cesarean.

The exercises that will help make sex feel like it did before pregnancy are:

• Kegel exercises in different positions
• Hypopressive abdominal exercises
• Exercises to tone the transverse abdominis
• Training with Kegel balls or vaginal cones
• Functional training
• Exercises with vaginal trainers or vaginal electrical stimulation

Perineal care to have sex after giving birth

During the first months after birth, in the exclusive breastfeeding phase, estrogen levels drop sharply. This fall in the female sex hormone can cause vaginal dryness, vaginal hypersensitivity, atrophy, weakening of the pelvic floor muscles, etc.

In addition, a perineal scar can increase the feeling of discomfort, tension and sometimes tightness during the day. It’s important to use special postpartum lubricants often, especially before having sex.

Water-based lubricants with hyaluronic acid are the most recommended, as they restore the natural pH, reduce the risk of bacterial infections and help healing. They can be applied two or three times a week for two months.