Painful sex after birth

A: Painful intercourse after having a baby is not uncommon and is called postpartum dyspareunia. Approximately 50 to 60 percent of women experience dyspareunia in the six to eight weeks after delivery, and a small percentage may continue with discomfort up to six months postpartum. However, the numbers are not exact as many women never bring it up with their care provider. It’s also worth noting that there does not seem to be a difference between women who delivered vaginally or via cesarean.

I assume you had a normal six-week postpartum exam with your practitioner. You did not mention whether you were breastfeeding, but if you are, this may be the cause of your discomfort. Similar to women who are postmenopausal, breastfeeding women have a decline in estrogen levels that may continue during the time they are nursing. As a result, after delivery women may experience vaginal atrophy, when the vagina receives less blood flow, and the tissue may thin and lose pliability, resulting in painful intercourse.

For some women, using a water-soluble lubricant or a vaginal moisturizer is a sufficient solution. If you continue feeling discomfort, follow up with your practitioner. She can rule out other possible sources such as infection or scar tissue. She may also consider other alternatives for treatment, such as a topical estrogen or pelvic floor physical therapy if she feels it is appropriate. Fortunately, the symptoms should improve over time, and the vaginal tissue will respond to normalization of hormone levels and recover.

—GABRIELA SIEGEL, MD, OB/GYN at Atlanta Women’s Obstetrics & Gynecology