Why pain after childbirth is so common
After childbirth many things change at the same time: tissues are healing, hormones shift, sleep is lacking and the daily routine is tightly scheduled. Sexuality in this phase is often not automatic but needs to find a new rhythm.
Pain is not only a signal from the vagina. It can come from scars, muscles, mucous membranes, nerves, the pelvic floor or from fear and pressure of expectation. For that reason a systematic view is more useful than simply trying to endure it.
Dryness and breastfeeding: the most common reason
Many people experience dryness, burning or a rubbing sensation after childbirth that did not exist before. Breastfeeding can increase this because oestrogen levels are often lower while breastfeeding. This is a normal hormonal state that changes again for many over time.
Dryness often feels like superficial pain at the entrance or like an irritation that burns for a while after sex. A good overview of why sex can feel 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 blood flow is the best natural lubrication
- Use plenty of lubricant early, not only once it already hurts
- If there is irritation, take a break rather than continuing
- If condoms sting, check for additives and consider switching
Scar sensitivity and wound healing: perineal tear, 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 abdominal scar may seem far away, but it can influence tension throughout the system, especially if you are still protecting yourself unconsciously.
Many people underestimate how long nerves and connective tissue need before touch feels normal again. RCOG describes typical healing courses and why symptoms after perineal injuries should be taken seriously. RCOG: Perineal tears during childbirth
Typical scar signals
- Sharp pain exactly at one spot
- Burning during stretching, even with lubricant
- Sensation of tightness or pulling at the entrance
- Pain that occurs especially in certain positions
Pelvic floor too tight rather than too weak
After childbirth many people think only 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, that is pain during sex, even though everything looks healed on the outside.
A clue is when insertion hurts right at the start or when the pain feels more like pressure and tightness. In those cases the focus is often not on more strengthening but on relaxation, coordination and graded loading. A short explanation on pelvic floor exercises and the basic principle of tension and release is available from the NHS. NHS: Pelvic floor exercises
What often provides relief
- Slow, controlled exhalation and reducing speed
- Choose positions where you have control over depth and angle
- Short, positive sessions rather than long attempts that go wrong
- Targeted physiotherapy for the pelvic floor if pain recurs
Infections, irritations and contraception as hidden causes
Sometimes the explanation is not childbirth but an irritation or infection that happens to occur at the same time. Burning, odour, unusual discharge or pain when passing urine point more to that than to simple scar pulling.
Contraception can also play a role, for example if a new preparation 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 get back to exactly how things were immediately, but to gradually accumulate good experiences.
A simple sequence that often works
- Allow pain-free closeness and touch without expectation of sex
- Take dryness seriously and use lubricant as standard
- Choose positions that give control and reduce downward pressure
- If the body is blocked, clarify the causes instead of working against them
If you wonder what is typical for the peripartum period and later regarding body and sexuality, the NHS page on the time 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 fastest route if you are not sure 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 stays the same 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 because of fear of pain
Warning signs: when you should have prompt assessment
Pain is common, but not everything should simply be waited out. Assessment is particularly sensible when the pain is severe or when additional symptoms occur that point more to an infection or a significant healing disorder.
Seek prompt assessment if
- Fever, marked redness or increasing swelling occur
- Strong, unusual odour or conspicuous discharge appears
- Bleeding increases or is repeatedly heavy after sex
- The pain remains a sharp spot and does not tolerate touch
- You find yourself emotionally stuck in a spiral of fear and avoidance
Conclusion
Pain during sex after childbirth is common and usually has multiple causes. Dryness, scar sensitivity and a pelvic floor that holds too tightly are the classics. With a gradual restart, good lubricant and graded activity that ends positively, many people improve. If the pain persists, is very severe or is combined with warning signs, early assessment and often specialised physiotherapy are advisable.
