Why pain after childbirth is so common
After birth many things change at once: tissues heal, hormones shift, sleep is lacking and daily life is tightly scheduled. Sexuality in this phase often does not return automatically but needs to be re-established.
Pain is not just 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 precisely why a systematic look is useful instead of simply persisting through it.
Dryness and breastfeeding: the most common cause
Many people experience dryness, burning or rubbing after birth that they did not have before. Breastfeeding can make this worse because oestrogen levels are often lower while breastfeeding. This is a normal hormonal state that often changes again over time.
Dryness often feels like superficial pain at the entrance or as an irritation that stings for longer 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
- Allow more time for arousal, because increased blood flow is the best natural lubrication
- Use plenty of lubricant and start early, not only once it already hurts
- If irritated, take a break rather than continuing
- If condoms cause burning, check for additives and consider switching
Scar sensitivity and wound healing: perineal tears, episiotomy, caesarean
Scars can pull, burn or feel hard. After a perineal tear or episiotomy the tissue at the entrance can be sensitive. After a caesarean the scar on the abdomen may seem far away, but it can affect tension in the whole system, especially if you are still protecting the area unconsciously.
Many people underestimate how long nerves and connective tissue need before touch feels normal again. RCOG describes typical healing patterns and why problems after perineal injuries should be taken seriously. RCOG: Perineal tears during childbirth
Typical scar signals
- Sharp pain at a specific spot
- Burning when stretched, even with lubricant
- Sensation 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 about weakness. In practice an overactive pelvic floor is common: muscles hold tightly without intention because the body wants to protect. This can lead to dyspareunia, that is pain during sex, even when everything appears to have healed externally.
A clue is when insertion hurts from the start or when the pain feels more like pressure and tightness. Then it is often not about more training but about relaxation, coordination and graded loading. A short explanation of pelvic floor exercises and the basic principle of tension and release is available from the NHS. NHS: Pelvic floor exercises
What often relieves
- Slow, 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 recurring pain
Infections, irritations and contraception as hidden causes
Sometimes the explanation is not the birth but an irritation or infection that happens to coincide with the same period. Burning, odour, unusual discharge or pain on passing urine are more typical for those causes than pure scar pulling.
Contraception can also play a role, for example if a new preparation makes the mucosa drier or if condoms and lubricants are incompatible. If symptoms are new or increase quickly, a check is advisable.
A realistic restart: how to rebuild confidence
A restart is less a date and more a process. The aim is not to immediately return to everything as before but to gradually rebuild positive experiences.
A simple sequence that often works
- Allow pain-free closeness and touch without expectation of sex
- Treat dryness seriously and make lubricant the default
- Choose positions that give control and reduce downward pressure
- If the body is blocked, identify causes rather than working against them
If you wonder what is typical for body and sexuality in the postnatal period and afterwards, the NHS page on sex after birth offers good orientation. NHS: Sex and contraception after birth
When physiotherapy is useful
Physiotherapy is not only for severe cases. It is often the quickest route when you do not know whether dryness, scar or pelvic floor dysfunction is the main issue. Good therapy assesses coordination, tissue, breathing, scars and everyday tension and gives you concrete steps.
Good reasons for pelvic floor physio
- Pain persists over weeks or gets worse
- Insertion is difficult or feels blocked
- You also have a feeling of pressure, incontinence or strong tension
- You avoid sex out of fear of pain
Warning signs: when to seek timely assessment
Pain is common, but not everything should be simply endured. Assessment is particularly sensible if the pain is severe or if additional symptoms appear that point more to infection or a relevant healing problem.
Seek timely assessment if
- Fever, marked redness or increasing swelling occur
- A strong, unusual odour or abnormal discharge appears
- Bleeding increases or there is repeated heavy bleeding after sex
- The pain remains a sharp point and touch is not tolerated
- You find yourself trapped in a spiral of fear and avoidance
Conclusion
Pain during sex after childbirth is common and usually has several causes. Dryness, scar sensitivity and a pelvic floor that holds too tightly are the classics. With a slow restart, good lubricant and graded activity that ends positively, many people improve. If pain persists, is very severe or is combined with warning signs, early assessment and often specialist physiotherapy are worthwhile.
