Sex can be painful for weeks after giving birth. Why don’t more people talk about it?

The first time Hannah Levine (who did not want to use her real name) tried having sex after giving birth, “the pain was immediate,” she says. Levine was taken by surprise. “No one warned me,” she says.

Levine is not alone. Joselyn Rodriguez says she felt like she “waited forever” to have sex after giving birth because “things felt so different.” Rodriguez says that no one told her that sex might be painful after giving birth and that she “didn’t know what to do” to get help. Gennifer Rose, a motherhood blogger, says that she waited three months to have sex after giving birth because she was so concerned about having a painful experience.

What causes painful sex after giving birth?

What these women experienced is incredibly common, say experts. According to Dr. Victoria Scott, a urogynecologist and co-author of "A Woman's Guide to Her Pelvic Floor: What the F*@# is Going On Down There, “At least 50% of women have reported painful sex at six weeks after delivery, and up to 40% have persistent pain at six months.”

Dr. Deepali Kothary, an ob-gyn at Kaiser Permanente, explains that “discomfort can occur before, during or after sex and may manifest as a burning, aching or uncomfortable sensation in the genital area,” she says.

The cause of painful sex after childbirth varies. Reasons include the physical recovery from childbirth itself, hormonal changes, exhaustion, and tears in and trauma to the vaginal area, Kothary explains. “In particular, the hormonal shifts that occur after giving birth can lead to genital tenderness and decreased vaginal lubrication,” she says.

Women who are breastfeeding are especially susceptible to hormonal shifts, “which can lead to vaginal dryness that often leads to painful or uncomfortable intercourse,” she says.

Even though Rose’s doctor gave her the “all clear” to have sex after six weeks after giving birth, she “didn't even want to attempt intercourse” until she was confident sex would not hurt. By waiting, Rose was able to avoid severe pain, but she still experienced discomfort. However, that “doesn't mean that it wasn't enjoyable,” she says.

Why don’t women talk more about painful sex after giving birth?

There is a “stigma around discussing intimate topics, especially those
related to women's health and sexual experiences,” Kothary says. She adds that many women feel embarrassed or uncomfortable discussing such a personal topic with their health care provider and even friends.

Levine says that after giving birth she tried to seek help from doctors but found them unwilling to discuss why sex might be painful for her, even months afters he had her baby. She says that while her health care providers were understanding, their general attitude was that “every woman goes through this and so will you.”

When Levine couldn’t get support from doctors, she tried to reach out to other new moms. She couldn’t find any willing to discuss painful sex with her. “I remember asking two mom friends how long it took them to ‘get back on that horse,’ but it wasn't an in-depth conversation,” she says. “I think it's just an assumed thing that sex would hurt after but of course, it's not something you talk about.”

Like Levine's, Rose’s doctors were also reluctant to discuss sex with her. “They seemed to shy away from intimacy conversations,” she says. Rose’s friends weren’t much help either. “I was one of the first women in my group of friends to have a baby, so I had to learn everything as I went along,” she says. “Pretty much everything came as a surprise with my first baby,” including what sex would be like after giving birth.

Why does it take 6 weeks or more before you're ready to have sex again?

According to Scott, most women are physically ready to have sex after six weeks if they had an uncomplicated delivery.

However, recovering from childbirth “is different for each woman,” Kothary says. Even after six weeks, some women are not fully healed and others may not feel ready for a range of reasons. Some factors that prevent a woman from feeling “in the mood” for sex include fatigue, postpartum depression and decreased libido, Scott says.

Rose shares that after giving birth, she was focused on the baby and was “so tired and sleep deprived that sex isn’t something very top of mind” for months after delivery. She adds that even after the stitches she needed after giving birth healed, she had a “mental block” that made her fear they could “pop out” and cause another tear.

What can women do to make sex more comfortable after childbirth?

Women can take several steps to help make sex more comfortable after giving birth. Kothary first recommends that women talk to their ob-gyns to determine the source of their pain and find the best solution.

To address vaginal dryness, Kothary suggests using water-based vaginal lubricants, increasing foreplay and trying sexual play without penetration at first. Some women will also benefit from vaginal estrogen, which comes in the form of a cream, suppository and ring, and can be used safely while breastfeeding, she says.

Time can also help. “After all the changes you experienced, your body needs to heal from your birth. Give yourself time to recover,” Kothary says. Scott emphasizes that “good communication” with your partner is also vital.

One thing that doesn’t work is having sex if you’re not ready or comfortable and hoping for the best. “Some people think having more penetrative sex will help loosen the vaginal tissue,” Kothary says. “That will just cause more pain and create an unhealthy cycle that doesn’t allow for the vaginal tissue to heal.”

Rose says that she used boric acid and vaginal suppositories to facilitate her healing. “When you're itchy and inflamed down there, sex is definitely off the table,” she says.

Levine, who is still experiencing painful sex, does relaxation exercises and experiments with different positions. “If I can get the right position and I'm not feeling too tense, it can be pleasant,” she says.

Two of Levine’s close friends are pregnant, and because of her own experience, she wants to help break the silence around painful sex. “I want to be the one that can help them because I didn't really have anyone to talk to,” she says.