Why pain after childbirth is so common
After childbirth many things change at once: tissues are healing, hormones shift, sleep is lacking, and daily life is tightly scheduled. Sexuality in this phase is often not automatic but needs to be re-established.
Pain is not only a signal from the vagina. It can come from scars, muscles, mucosa, nerves, the pelvic floor, or from anxiety and pressure of expectation. That is exactly why a systematic look is worthwhile instead of just powering through.
Dryness and breastfeeding: the most common reason
Many experience dryness, burning, or chafing after childbirth that they did not have before. Breastfeeding can make this worse because lower oestrogen levels are common during lactation. This is a normal hormonal state that often changes over time.
Dryness often feels like superficial pain at the entrance or like an irritation that continues to burn after sex. A good overview of why sex can be different after childbirth and what is normal can be found at ACOG. ACOG: Postpartum, pain and management
What usually helps with dryness
- More time for arousal, because increased blood flow is the best natural lubrication
- Use lubricant generously and early, not only once it already hurts
- When irritated, take a break rather than continuing
- If condoms sting, check for additives and consider switching
Scar sensations and wound healing: perineal tears, episiotomy, cesarean
Scars can pull, burn or feel hard. After a perineal tear or episiotomy the tissue at the entrance can be sensitive. After a cesarean the abdominal scar may seem far away, but it can affect tension throughout the system, especially if you are still unconsciously protecting yourself.
Many underestimate how long nerves and connective tissue need before touch feels normal again. RCOG describes typical healing courses and why problems after perineal injuries should be taken seriously. RCOG: Perineal tears during childbirth
Typical scar signals
- Sharp pain at a single spot
- Burning with stretching, even with lubricant
- A feeling of pulling or tightness at the entrance
- Pain that occurs especially in certain positions
Pelvic floor too tight rather than too weak
After childbirth many people only think of weakness. In practice, an overactive pelvic floor is common: muscles hold on unconsciously because the body wants to protect itself. This can lead to dyspareunia, meaning pain during sex, even though everything may look healed externally.
A clue is when insertion already hurts at the start or when the pain feels more like pressure and tightness. Then it is often not about more strengthening, but about relaxation, coordination and graded loading. A brief explanation of pelvic floor exercises and the basic principle of tension and release is available from the NHS. NHS: Pelvic floor exercises
What often provides relief
- Calm exhalation and slowing the pace
- Choose positions where you control depth and angle
- Short sessions that end positively, rather than long attempts that go wrong
- Targeted pelvic floor physiotherapy for recurrent pain
Infections, irritations and contraception as hidden causes
Sometimes the explanation is not childbirth but an irritation or infection that happens to coincide with the same phase. Burning, odour, unusual discharge or pain when urinating are more suggestive of this than pure scar pulling.
Contraception can also play a role, for example if a new method makes the mucosa drier or if condoms and lubricants are not compatible. If symptoms are new or increase quickly, a check is sensible.
Realistic restart: how to rebuild confidence
A restart is less a date and more a process. The goal is not to immediately return to how things were, but to gradually rebuild positive experiences.
A simple sequence that often works
- Allow pain-free closeness and touch without expecting sex
- Take dryness seriously and make lubricant your standard
- Choose positions that give control and reduce downward pressure
- If the body is blocked, clarify causes instead of working against them
If you wonder what is typical for the body and sexuality in the postpartum period and afterwards, the NHS page on the time after birth provides good orientation. NHS: Sex and contraception after birth
When physiotherapy is useful
Physiotherapy is not only for severe cases. It is often the fastest route when you do not know whether dryness, scar or pelvic floor is the main issue. Good therapy assesses coordination, tissue, breathing, scars and everyday tension and gives you concrete steps.
Good reasons for pelvic floor physiotherapy
- Pain persists for weeks or gets worse
- Insertion is difficult or feels blocked
- You have added pressure sensation, incontinence or marked tension
- You avoid sex because of fear of pain
Warning signs: when you should have it checked soon
Pain is common, but not everything should be endured. Assessment is especially sensible if the pain is severe or if additional symptoms appear that point more to an infection or an important healing problem.
Have it checked soon if
- Fever, marked redness or increasing swelling occur
- a strong, unusual odour or noticeable discharge appears
- bleeding increases or there are repeated heavy bleedings after sex
- the pain remains a sharp point and cannot tolerate touch
- you find yourself emotionally trapped in a cycle of fear and avoidance
Conclusion
Pain during sex after childbirth is common and usually has multiple causes. Dryness, scar sensations and a pelvic floor that holds too tightly are the classics. With a slow restart, good lubricant and graded loading that ends positively, many people improve. If pain persists, is very severe or is combined with warning signs, early assessment and often specialised physiotherapy are worthwhile.
