51. Dyspareunia or painful sex postpartum
Listen & Subscribe on: Apple Podcasts Google Podcasts Spotify
Let’s talk about sex, baby! Or in this case, dyspareunia or painful sex. We go over:
Find out what dyspareuia is and the different types and categories (superficial vs deep, primary vs secondary)
How common is dyspareunia and how many people are impacted by painful intercourse postpartum
How dyspareunia impacts mental, physical and sexual health
Learn why you do not need to rush to have sex at 6 weeks postpartum
How postpartum sexual health declines across all domains
Why painful sex is not just the responsibility of the woman or vulva-owner
Purchase the replay for my Reclaim your Pleasure workshop to help you release tension, pain and welcome in more pleasure (even if you deal with painful intercourse!)
Links & Resources:
Reclaim your Pleasure workshop replay: https://www.thepassionatephysio.ca/reclaim-your-pleasure-workshop
Need help managing pelvic floor symptoms? Book your virtual consultation: https://www.thepassionatephysio.ca/book-with-surabhi
Connect with Surabhi:
Website: https://www.thepassionatephysio.ca
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Dyspareunia, pain and postpartum sex
[00:00:00] Episode & music
Surabhi: [00:01:08] Hey friends, and welcome back to another episode of Mom Strength. I am your host Surabhi Veitch, and we're gonna get into Dyspareunia. So dispo, what? That's a long word. In essence, what Dyspareunia is pain with sex, pain with intercourse, especially for those, or it is referring to those people with a vulva, right?
So this can be pain on the outside. It can be pain deep inside. It can be pain before, during, after. You know, some of the symptoms might be sharp pain. It can be, uh, throbbing pain. It can be, it can feel kind of stingy or burn. It can be crampy. It can feel like muscle tension. . Um, and there's different types.
So I'm gonna describe the different types. There's superficial dyspareunia, which is more on the outside and or the vaginal entrance. And then I'm actually gonna show you this on my model of the vagina. So this is the vulva. If you open up the inner labia, I see the vaginal opening there.
those of you who are listening or like, what the [00:02:08] heck is she actually showing her vulva? No, I'm not. I'm showing a model. Relax. Um, so, but picture your vaginal opening if you have pain right around there. It's called superficial dyspareunia. Why is this as important to classify? Mainly because how you treat it is gonna depend on where the symptoms are and when it occurs.
If you have pain deeper inside, um, you know, with deep penetration it's called deep dyspareunia. So that's some of the, one of the ways we can distinguish it. And then there's primary, and then there's secondary. Primary's initiating sex. You have pain right at the beginning. Secondary is, you know, it's good for some time, and then pain starts.
And so some of these questions, uh, are, we're gonna ask you as a pelvic health physical therapist, you know, you're gonna be asked these questions like, when does it occur? How often does it occur? Does it occur every single time? And why I'm talking about this is. Everybody and their dog seems to know what erectile dysfunction is, right?
We all know the term erectile dysfunction ED. We all know about Viagra. How many people [00:03:08] actually know the term dyspareunia and forget the term, how many people even know how common it is for people with vulvas to have pain with sex or intercourse? Um, you know, it can affect 10 to 28% of the female population over a lifetime.
You know, in their literature. But then, but then it also depends on where you live, right? Which country you are from, which culture you're from, how taboo a topic sex is. Because if you can't even talk about it in your culture, many people may be dealing with these, this pain and the shame and the issues around that without any support, right?
I want you to know that if you have dyspareunia, if you have pain, , whether it's for a couple days, couple years, all your life you've had pain, you, you know, or maybe you've never had sex because you're, it just hurts and you're, um, scared to, and it just doesn't feel good. If it doesn't feel good, why the heck would you wanna have it?
Right? It makes total sense. You're not wrong if you don't have the desire to, uh, or if you're avoiding sex because it hurts. But [00:04:08] if you have the desire to and you wanna get help, just know that there is help for you. You can see a pelvic floor physical therapist or pelvic health professional to help you with exercises and strategies.
And some may, some strategies may involve using a dilator, but it may not. You may also need mental health support. Seek, uh, support from a sex therapist to help you just work through this, cuz it affects every aspect of your life. I'm gonna pull up some research here.
[00:04:33] How dyspareunia impacts mental and physical health
Surabhi: Dyspareunia can impact physical, mental health and your sexual relationships.
We, we know that, but it can lead to depression, anxiety, hyper vigilance to pain, negative body image, and low self-esteem. And this is in research and I know that sometimes we rely heavily on research and other times we just like talk out of our ass, right? So I wanna make sure. When I'm sharing these stats with you, it actually shown in the literature, and I don't know how, I don't know how representative it is of the world's population.
A lot of this research is coming out of the United States or Canada, um, or the UK. So we [00:05:08] can't always generalize these stats for worldwide, but what we do know is that these issues are common and we need to talk about it, and we need to talk about, um, the impact it has, not just physically and on your sex life, but on your emotional wellbeing and your mental health and your, overall wellbeing as well.
You know, we can't separate mental and physical health or mental and physical and sexual health. it all. It ties in together and it all encompasses you as a human being. So it's important that if you're having pain, discomfort or if it doesn't feel good that you seek support and that you know that it doesn't matter how long you've had it, you can still seek support.
You can still improve, right? Uh, I reiterate that because I will get DMs to be like, oh, you know, this has been going on for 10 years and people almost lose hope, and I don't blame you. You know, it can be really hard when you. You know, find the courage to tell your doctor or find the courage to talk to a public health professional and find the courage to tell some another specialist, and then nobody seems to be able to help you.
Right? [00:06:08] And it can take a while to find the person or the people, the team that's going to be on your side to support you, but. This conversation is with the hope that you understand what dyspareunia is, how prevalent, how common it is, what the symptoms are like, so that you can realize that if you have any type of pain or discomfort with intercourse, that that's not normal.
Um, even if it's your first time. Right. Do you know how much, do you know how long it took me to realize that that's not normal, that we, that even our first time should not be painful? I think I found out only in the past few years. Right. And I. Think that these narratives get told as if they're fact like, oh yeah, it's just gonna hurt the first few times.
Or, oh, if, if sex hurts, just keep doing it, it'll get better. What do you think happens if you have a cut and it's almost fully healed and then you cut it again, almost fully healed and you cut it again? You keep itching at it, you keep scratching at it. Does it get better or does it just get more and more irritated and more sensitive?
Right, so it's not that you just [00:07:08] ignore it and like hope it goes away, or that you just suffer with it for the rest of your life. Let's make sure that you're actually able to seek support for it because you deserve support and you deserve pleasure, and you deserve pain-free sex pain, PainFREE intercourse.
While we're on the topic of that, you can still do a lot of, many people may not have pain with arousal, for example, so they might get aroused and you know, no pain, but it's the actual intercourse part that hurts. So if arousal is pain free, if. You know, stimulation of your clearance is pain free. You can still have sex.
Sex isn't defined by only something in your vagina, right? And that opens up or takes the pressure off, first of all, and it opens up a lot more possibility for you in feeling like you can reclaim that sexual energy. Right? And the reason I'm talking about this is also gonna lead to my workshop next month.
This month, February 23rd, and my [00:08:08] workshop is going to be about. reclaiming your sensual self. We're gonna breathe. We're gonna release some tension. We're gonna move our bodies and our booties, and we're gonna practice feeling more present and feeling open to receiving pleasure in our bodies.
This is for anyone who is stressed out mom, who feels like you're constantly thinking about your to-do lists. , and this is for anyone who's had any pain down there, or trauma or history of trauma or, um, people who are chronically stressed, um, anxious. Maybe you're dealing with some mental health issues, um, for people who just wanna step back into their bodies and take ownership over it.
Or people just are like, Hey, I'm here for the pleasure. I am here for the pleasure, so I hope you'll join me. I'll share the link in my show notes and you can go to my website, www.thepassionatephysio.ca, and it's right on my website. There's a link at the top to save your spot for my workshop. It's 60 minutes, it's on Thursday, February 23rd at 8:30 PM [00:09:08] Eastern Time.
And yes, there is a recording that gets sent out afterwards, so if you miss the live, or if you wanna re-watch it, you will have access to.
Okay, now let's go back and talk about, the fact that 17 to 36% of women have dyspareunia at six months postpartum. So that's a big range, but that's also a big number and that, that not six weeks, that's six months.
So when your doctor tells you that gives you the go ahead at six weeks postpartum, go for it. You can go and have all the sex you want and you assume that it, that means that you've. Adequately. That means that it should be pain free and then it's that hurts. Then what do you do? Right? A lot of people don't even know that they can go tell their doctors that, that actually this hurts.
And if you have a doctor who's like, haha, just drink a glass of wine and relax, it'll get better. Go find a new doctor because that's highly disrespectful. And that would be ne, that advice would never be given to a man [00:10:08] with any type of health. , right? So we need to stop allowing our health issues to be dismissed.
And I know that that's not a privilege everybody has, depending on where you live, how much access to medical care you have are good medical care. But the other thing is reach out to a pelvic health physio. I work virtually. There are many of us who work virtually. I have in my um, Instagram, Link in Bio and through my website, I have a melanated pelvic physical therapy directory linked.
It was started by Dr. Janelle Howell, who's a pelvic physical therapist based out of Chicago, and both of us actually work fully, virtually now because it's very effective and we find it actually more effective in many ways than in-person care. And for some people, they do need in-person support. So you can combine virtual and in person, or you can just see someone in person or just see someone virtually.
It really depends on your preferences, your comfort level, and what works and what fits in your lifestyle. Right. Okay. Let's go back to Dyspareunia. Let's talk about postpartum. Postpartum, there's a worsening of all sexual domains. [00:11:08] So that's dyspareunia, lack of vaginal lubrication, especially more common if you're breastfeeding, difficulty to reach orgasm, vaginal bleeding or irritation after sex.
And this can be even more common in people who've had any type of deep or superficial scarring, tearing, but it can still be, if you haven't had any tears, there's so many reasons. The tissues are a little bit more sensitive. Um, if you have inadequate lubrication, another thing that happens postpartum is loss of sexual desire.
And now anyone who has had a kid is like, well, that's obvious. You know? And there's, there are many reasons to this, and. One of the things that I do wanna say is it's not common for everybody, right? There are some people whose desires are just as good, if not better, but there are many people who have worse desire.
Like mine was a lot worse, pretty much non-existent. And one of the big reasons, or there are many reasons for that, and you know, it could be fatigue, it could be sleep deprivation. If you're not sleeping, like if you're exhausted, you need [00:12:08] to have rest in order to. Feeling pleasure, right? Like you can't feel joy and pleasure fully if you're just chronically exhausted and sleep deprived.
And that also ties into with mental health, depression, anxiety, chronic stress, unmanaged stress, all of those things can diminish your libido, um, changes in your body. , right? So your muscles are looser or tighter or weaker, or your body shape has changed, size has changed. How you feel about your body has changed.
Maybe you have scars that you're, you know, not learning to get familiar with again. So while you're processing all that, which can take time, by the way, it's not like you process that in six weeks as you're processing that, your libido might be impaired, right? And another huge issue is just your, depending on the baby you have, was your baby in the NICU?
Is your baby having feeding issues? Is your baby struggling to breathe? There's so many things that can impact your [00:13:08] mental health, which then affects your desire and your arousal and your libido. And some many people just don't talk about this cuz they just say six weeks, oh, what's your birth control gonna be?
And go ahead and have sex. And many of my clients I will say, um, don't feel ready at six weeks. And that's okay. And again, we just talked about how sex is like a continuum. It's not one thing. So you can still participate in cuddling or hugs or kissing or oral or manual stimulation or you know, playing with toys or vibrators without feeling like it has to be intercourse.
And it's just a very hetero normative approach to only consider sex to be intercourse or penis in vagina intercourse. Right. Okay. So let's go back to some stats. a study with 580, 82. First time moms showed that 31 and 0.4% have Dyspareunia at three months postpartum. That's like one in three ish, right?
That's a lot. And [00:14:08] 11.9% still had it at two years, 24 months postpartum. So think about how many mums you know in your life. Can you think of 10? One of them at least, will have pain at two years postpartum, and it doesn't, and this is not just vaginal births, by the way. This is people who've had vaginal or cesarean births or, you know, abdominal births.
People with cesarean births are often surprised if they have pain with sex because they are like, but I thought I saved my pelvic floor by not having a vaginal birth. But it's the pregnancy itself and everything else, like the dehydration from not drinking enough water, the lack of lubrication for breastfeeding and being postpartum and sleep deprived and everything that affects you know you is gonna affect you regardless of which type of birth that you have.
The only exception is of course, With a vaginal birth, you might be, you might have more tearing or stitches or localized scar tissue, which you may not have with a cesarean birth. But, you know, just being mindful that this can impact anyone regardless of [00:15:08] type of birth you have had, and also if you've never had a child at all.
Right, because what, what were the overall stats? It was like 10 to 28% of people. Female population over lifetime, and that was the research. When I say female, I assume that they are talking about people who are assigned female at birth. Um, and this is the cool part with postpartum dyspareunia.
Um, the things that contributed to the likelihood of dyspareunia postpartum were more fatigue or depression during pregnancy and higher fatigue or pain focus at three months postpartum. So I'm thinking of myself in my first pregnancy. I was very exhausted and looking back on it, I was depressed and anxious mostly.
and at three months postpartum, I don't think I'd have pain focused, but I was highly symptom focused. So I was really, um, focused heavily on my prolapse and on my leaks, and I was exhausted, right? [00:16:08] So I would've been one of those people who were maybe more likely to have more severe symptoms of, um, dyspareunia or pain with sex.
But here's the catch, here's some of the things that did not contribute to more severe symptoms. So you might still have symptoms, but they won't be as severe just because of these issues, right? So if you've had chronic pain before or prior pain with sex, it doesn't mean that you're gonna, it's gonna be worse now.
if you had an epidural or if you had an induction or a episiotomy or perineal tears, doesn't mean it's gonna be worse if you, regardless of mode of delivery. We talked about that c-section, vaginal birth does not mean it's gonna be worse with one or the other. If you're breastfeeding, doesn't mean it's gonna be worse.
breastfeeding. While it does impact your estrogen levels, um, and can affect your lubrication, it doesn't necessarily mean that that's gonna guarantee pain because with adequate arousal and lubrication, like external lubrication, that should quote unquote, um, solve that [00:17:08] problem. Right. And then the other thing that didn't impact whether or not somebody had, um, postpartum, a pain with sex postpartum is whether they had a new pregnancy during that postpartum period.
So if you had another pregnancy in that first 24 months postpartum, it doesn't mean that you're more likely to have pain either. Right? So those are some things that are good to know because some people will say, oh, just have a c-section and that will prevent the pain, right? Or, get this or get that.
And it. Actually the research anyways right now that the research, um, is not showing that that's true despite the significant impact, right? On a mom's a person's life, women's sexual function is rarely discussed postpartum besides the like all clear at six weeks, and that's why I wanted to have this conversation today.
When we don't even talk about or ask questions, sometimes people don't even [00:18:08] know that they're allowed to talk about it. And so here's, here's an example. In my intake form for my one-on-one, one-to-one clients, I ask, how's your mental health? And it opens up the door for more conversation during our initial assessment.
Not because I'm a mental health practitioner, mind you, but because I can make the referral and because also the person is like, oh. I wonder why this person's asking me about my mental health, and they start to clue in themselves. Guess what this might relate versus if you never asked about your mental health or your sexual health.
I've actually added that question in as well. I didn't have that before, but it just allows people to, um, tell you about what is going on. And sometimes you have to actually explicitly ask those questions.
[00:18:55] You don't have to have sex at 6 weeks postpartum
Surabhi: The next thing that I wanna talk about is the fact that if you're not ready at six weeks postpartum, you do not have to have sex.
You do not have to do anything when you're not ready. Communication with your partner or partners is very important. When [00:19:08] we talk about sex, it's a relationship between you and yourself, and there's a sexual relationship between you and yourself. There's a sexual relationship between you and your partner partners, and anytime there's a relationship, it's not just for you to do your exercises before sex or it's for you to do all the work because you are the postpartum person.
Guess what? The person who hasn't had the baby, who isn't postpartum, is just as much. Their work because they are now having a relationship with a different body, physically and a different body, mentally, a different body emotionally. So you have to get to know each other again, and this is something that I feel like.
you know, postpartum. We didn't put any effort into that. You know, we're so busy taking care of our kids and time just ticks by and you don't really invest in that, like, that open communication about your needs and your desires and your wants. And that's something that, you know, for those of you who are earlier postpartum, learn from my mistakes.
Um, and just have those open conversations. Right. [00:20:08]
in a study of 421 postpartum folks, 31.6% returned to sex at six weeks after childbirth. And this was a study in Ethiopia, so maybe there's more sex positive community there. Um, I don't know. . You know, like I said, all these studies, we can't always extrapolate the data and the stats worldwide.
So depending on where you're listening from, you might say, oh, that's a low number. Or I actually read that and I said, wow, that's actually a higher number than I thought. Like one in three-ish, right? People. But then what about the other two-thirds, right? So if you are not in the one in three, and you are the majority of the population who doesn't return at six weeks, don't feel bad.
And don't feel bad if you do return either. Don't feel like, oh my gosh, I'm some like sex addict. You're not. You're just a normal human being and each person has their own innate level of desires and, um, arousal levels and and whatnot and needs right. But [00:21:08] I find that a lot of people have hold shame for not getting back to it.
And so even when I ask the question like, how does sex feel? Have you returned to return to any kind of sexual activity? People will sometimes be embarrassed and be like, no. And I'm like, don't be embarrassed. Like it takes a while. Give it six months. Give it, give it however long it needs.
Right? 89% of women resume sexual activity within six months of giving birth. That's a different study, right? So 89%, so give it the six months. Chances are by then and still there's 11% that don't. So, You know, don't feel like you have to do anything any one way. It's all about you, your individual body, and what is going to work best for you.
It's not a race, , uh, and you're not wrong. You're not right. You're not weird, you're not abnormal. You know, there is a lot of sleep deprivation, exhaustion, feeling touched out, relationship dynamic changes. Um, you know, if you have multiple children, . Even [00:22:08] just the actual fact that you might have a child in your bed, sleeping in your bed, co-sleeping, like maybe you just don't have any space or feel like you don't have any privacy or time.
Um, and then you're also learning a lot of new stuff. You're learning about a new human, you're caring for. Um, if you have a live child and you are also learning about your own body and your own body's changes, you may be navigating a loss. There's a lot of things, right? So don't feel like wow. life is the same as before.
So you know, sex should be the same as before. It will change. Most of the time. It will change, and it might change for many. For many people, actually changes for the better because it forces them to deal with some of the nagging issues that they may have had before. Like, oh, I had minor pain, but it wasn't that bad, so I never got help.
But now maybe it's a bigger deal. So you're actually getting the help that you need for your pelvic floor and for your core and your glutes and everything else around it.
So here's this other thing on top of all that [00:23:08] sexual dysfunction prevalence. So this is not specifically pain with sex, but just sexual dysfunction.
Prevalence rates vary from 41 to 83% at two to three months postpartum, like that is a very high number. That's almost half to three quarters or more, right? And that's a two to three months postpartum. So if you are a professional working with folks, um, whether you're a fitness pro, Medical doctor, a physio, pelvic physio, um, mental health professional, like ask these questions, not because you're necessarily gonna treat it yourself, but so you can make that referral and help that person feel like, wow, this is, I'm not alone, right?
I'm not alone in this. Cuz there's nothing worse than feeling like you are the only one dealing with these issues and get this, at six months postpartum. The prevalence can be 64%, so it's still really, really high. The pre-pregnancy levels of sexual dysfunction were 38%. So even at [00:24:08] six months postpartum, 64% on average can have sexual dysfunction.
[00:24:15] Take home message
Surabhi: So take home message. You do not have to have sex at six weeks Postpartum. Sex does not have to be defined by intercourse. Um, if you have pain with sex, you do not have to deal with it for the rest of your life. You can get help, even if it's been a long time, even if you've seen a bunch of professionals. Please don't lose hope.
Um, no matter where or when or how long you've had it, it's not something you have to put up with. And you deserve pleasure. You deserve pleasure, and the best person to give you pleasure is yourself. And the next solo episode. I'm gonna do, I'm gonna be gonna be talking about some of the aspects that help you maximize your pleasure and your orgasms, and so stay tuned.
But I hope that this helped, this episode on [00:25:08] dyspareunia and Pain with Sex just helped you discover a little bit more about it and, uh, feel not so alone in wherever you are in your postpartum journey. and know that it can always get better and that you can talk about it. Talk to your doctor. If your doctor feels awkward about it.
That's because they also maybe, you know, listen to my previous episode if you haven't yet. I talked about sexual shame and like I, someone like me, I'm a physiotherapist. I work in pelvic health and I still have sexual shame to unpack. So your medical doctor might be the same. they might have grown up in a household where they also have a lot of sexual shame to un unpack.
So don't feel like, oh my, but, but my doctor should just be, you know, ready to talk about these things. They may not be, and that might be because they're a human being. So give yourself compassion. Give them compassion. Ask for the referral. That's what I want you to do. I want you to advocate for yourself because unfortunately, female sexuality, women's [00:26:08] sexuality, postpartum sexuality, these are rarely discussed topics.
Es. Especially, especially for anyone who is Black, Indigenous, a person of color, anyone who's disabled, who is fat, who is transgender, non-binary, who doesn't fit essentially, that, you know, narrow, st narrow literally. Um, and figuratively that narrow path of like white thin, young, female... or male, right?
Cisgender female or male in heteronormative, heterosexual relationships. So if you don't fit in that category, you might find yourself even less represented. And that's especially who I'm talking to in this episode. I'm talking to everybody, but especially you, if you are like me, if you are, you know, grew up being really stigmatized, not just for speaking about sex, but also culturally you didn't see people like you represented in the sexual health world or talking about sex openly. Just want you to know that not [00:27:08] talking about it doesn't make the problem go away. So we need to be a bit more courageous in having these discussions and having these conversations and opening, opening discussions up with your friends, your family, your cousins, whoever is in your circle, and talking to your kids about it as well.
I took a recent, um, workshop on parenting without sexual shame with Erica Smith. She's on Instagram and it was great. Right? It's like, my kids are young. I wanna start now making sure that they don't grow up with the same shame that I grew up with, right? Or that they don't grow up with the same shame that my partner grew up with.
Because guess what, if most of the people who are listening to this are probably, uh, identify as women or non-binary, but if you are identify as male and you're listening to this, you probably also have shame, right? So it's not just, it's not something that only impacts women. Right. Um, okay. I'm gonna sign off but before I do that...
[00:27:59] Reclaim your Pleasure workshop
Surabhi: please come join me at my workshop, reclaim your pleasure. On February 23rd, we're gonna spend an hour from eight 30 to nine 30 Eastern standard [00:28:08] time. And we are going to, you're gonna get a replay, by the way, if you can't show up live. Um, and we're gonna practice moving and shaking our bodies and getting present.
We're gonna do a wonderful mindfulness visualization strategy. And I can't wait. I am doing this for me, I'm doing this for you, doing this for all of the people who feel either repressed or shameful, or they're unpacking that and they're like, yeah, I'm ready for this. So come join me live or catch the replay.
I will share the website where you can purchase from, which is my website, www.thepassionatephysio.ca. Go sign up now and I will see you there. Lots of love to you, lots of pleasure to you.
