Postpartum Pain During Intercourse: Causes and Solutions

Dyspareunia

Hello Doctor, I am 38 years old.
Four years ago, after my cesarean section, my vagina has not been as moist as before, and intercourse is painful.
I have seen three gynecologists, and they all suggested using lubricant.
I have applied it both inside and outside the vagina, and my husband also uses it.
We apply a lot of lubricant, but it still hurts; it feels like being stretched, and the outer vaginal opening sometimes gets raw and bleeds.
The doctor I am currently seeing has not been able to resolve my issue.
Because of the pain, along with my husband being tired from work and sharing a bed with our child, we rarely have intercourse.
When we do, I feel a lot of pain from being stretched, which I did not experience before giving birth.
This has also affected my desire for a second child.
What should I do about this issue? I sincerely ask for your advice.
Thank you.

Yun, 30~39 year old female. Ask Date: 2016/10/11

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, since a cesarean section causes less damage to the vagina, if using a lubricant does not improve the situation, it is recommended to try applying a female hormone cream.
Wishing you good health.

Reply Date: 2016/10/11

More Info

Postpartum pain during intercourse is a common issue that many women face after childbirth, particularly following a cesarean section. Your experience of vaginal dryness and pain during intercourse can be attributed to several factors, including hormonal changes, physical trauma from childbirth, and psychological aspects related to intimacy after having children.

Causes of Postpartum Pain During Intercourse
1. Hormonal Changes: After childbirth, especially if you are breastfeeding, your body experiences a significant drop in estrogen levels. Estrogen is crucial for maintaining vaginal lubrication and elasticity. Low estrogen can lead to vaginal dryness, making intercourse uncomfortable or painful.

2. Physical Trauma: Even though you had a cesarean section, the body undergoes significant changes during pregnancy and childbirth. The pelvic floor muscles may become weakened or damaged, leading to discomfort during intercourse. Additionally, scar tissue from the surgery can also contribute to pain.

3. Psychological Factors: The transition to motherhood can be overwhelming, and anxiety or stress about intimacy can exacerbate physical discomfort. Concerns about body image, fatigue from caring for a newborn, and the presence of children in the home can all affect your sexual relationship.

4. Infections or Other Medical Conditions: Sometimes, persistent pain can be a sign of an underlying condition such as vulvodynia, vaginismus, or pelvic floor dysfunction. These conditions can cause pain during intercourse and may require specific treatments.

Solutions and Recommendations
1. Consult a Specialist: Since you have already seen multiple gynecologists without satisfactory results, consider consulting a pelvic floor physical therapist or a specialist in sexual medicine. They can provide targeted exercises and therapies to strengthen pelvic floor muscles and improve sexual function.

2. Use of Lubricants: While you mentioned using lubricants, it may be beneficial to explore different types. Water-based lubricants are common, but silicone-based lubricants tend to last longer and may provide better relief from dryness. Additionally, consider using vaginal moisturizers regularly to help maintain moisture.

3. Hormonal Treatments: If hormonal changes are contributing to your symptoms, discuss the possibility of estrogen therapy with your healthcare provider. This can be in the form of vaginal estrogen creams, rings, or tablets that can help restore moisture and elasticity to the vaginal tissues.

4. Gradual Reintroduction to Intimacy: It may be helpful to gradually reintroduce intimacy with your partner. Focus on non-penetrative activities that can help you both reconnect without the pressure of intercourse. This can help alleviate anxiety and build comfort.

5. Communication with Your Partner: Open communication with your partner about your discomfort is crucial. Discussing your feelings and experiences can help both of you understand each other better and find ways to make intimacy more comfortable.

6. Consider Counseling: If psychological factors are contributing to your discomfort, consider speaking with a therapist who specializes in sexual health. They can help address any anxiety or stress related to intimacy and motherhood.

7. Follow-Up Care: Continue to follow up with your healthcare provider to monitor your symptoms. If your pain persists or worsens, further evaluation may be necessary to rule out any underlying conditions.

Conclusion
Postpartum pain during intercourse is a complex issue that can stem from various physical and psychological factors. It’s important to approach this problem holistically, considering both medical and emotional aspects. By seeking specialized care, exploring different treatment options, and maintaining open communication with your partner, you can work towards improving your sexual health and overall well-being. Remember, you are not alone in this experience, and there are effective solutions available to help you regain comfort and intimacy.

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