Several months ago I asked a friend of mine how she was doing after delivering a gorgeous baby girl eight weeks prior to our meeting. “Everything has been ok with the baby, lack of sleep aside, but we haven’t had sex since I delivered. I think they might have stitched me too tight. I mean, is that even possible?” As a physical therapist specializing in this type of women’s healthcare, a number of thoughts were immediately racing through my mind, but I simply replied, “Unfortunately yes, it is very possible.”
Allow me to take a quick break from her story to share some background on childbirth. As one can imagine, the vagina changes when a woman becomes pregnant and delivers a baby. During vaginal delivery, more than 80% of women experience skin and/or muscle tearing in the pelvic floor. This tearing often requires stitches to the perineum to promote proper, faster healing of the skin and underlying muscle. And here is where my unsurprised response to my friend comes in; “the husband’s knot” was designed as a solution to the problem of the “changed vagina.” “The husband’s knot” is strategically placed additional stitch (one that is not medically necessary) at the introitus, or vaginal opening, to ensure fuller closure and a tighter fit when the penis later enters the vaginal canal.
Returning to my dear friend’s inquiry, I willingly provided some self-help tips but otherwise didn’t go further, keeping our conversation more friend-to-friend talk than clinical. However, we encountered each other again when she was 12 weeks postpartum and we picked right up where we left off, this time during cocktail hour at a mutual friend’s wedding. After reiterating her difficulties with perineal pain (medically speaking: pain at the perineum, the area between the vagina and rectum), my friend says she got an intriguing suggestion from the woman who runs her mother’s group: “Just inebriate then lubricate, that should help.”
That got me thinking… Was this advice warranted? Is getting drunk (alas promoting muscle relaxation and decreased inhibitions) and using lube the answer for us? Where are women getting their information (and may I ask, why I and other knowledgeable providers are NOT the source)? What other suggestions are new mothers being given? How does my work as a women’s health and pelvic floor physical therapist color my perceptions of and advice about resuming sex after baby?
I believe that most mothers will go for advice to their friends or the childbirth provider(s) involved in their care. Additionally, for somewhat taboo topics such as this, it is not uncommon to go to the web. Therefore, I put myself into the mindset we all go into for a quick web search and Googled “painful sex after childbirth.” The first “hit” I got was a WebMD.com link, which detailed a recent and informative study on the prevalence of dyspareunia (painful intercourse) postpartum. Subsequent hits were similar in nature warranting looking further into some statistics from medically recognized research journals regarding dyspareunia from childbirth. In one study published in 2008, it is cited that 41.3% of women experienced perineal pain with sexual activity in the 60-180 days post vaginal delivery. Pretty high, huh? That was surprising even to me, and this is what I do for a living.
After years in graduate training and working with this female population, what continues to shock me on a weekly, and sometimes daily, basis is how little women know about what happens to them during pregnancy and in the time following childbirth. The postpartum mother is one of the most underserved patient populations in the United States. Shouldn’t we be forewarned of the potential complications after delivery, even if the chances are slim? In addition to pain with sexual activity, new mothers experience a range of symptoms including chronic constipation, urinary leakage, and pelvic organ prolapse (pelvic organs such as the bladder and rectum falling into the vagina), to name a few.
Of all the links that came up from my Google search only one, (ONE!) offered treatment suggestions other than medication or lubrication. I would love to shout it from the rooftops so that the entire medical world would know; “physical therapy is a treatment option for your postpartum patient”! The French know this (see articles from a journalist’s perspective and from a physical therapist’s perspective) and that’s why they offer (even require) a series of pelvic floor physical therapy visits following childbirth regardless of symptom presentation. It’s 2013, where you at America? Isn’t it time that we put aside the “go on vacation, have a glass of wine” mentality of experiencing pain during sex, and actually do something about it?
Laura Robbins, DPT, is a physical therapist specializing in obstetrics and female and male pelvic health. She practices at Marathon Physical Therapy in Newton and Dedham, MA, blogs occasionally for Share MayFlowers, wears flowers regularly in support of Share MayFlowers, and chats folks up daily about the importance of improving education and access to care for new moms and for everyone with a pelvis.
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Solana-Arellano E, Villegas-Arrizon A, Legorreta-Soberanis J, et al. Women’s dyspareunia after childbirth: a case study in a hospital in Acapulco, Mexico. Rev Panam Salud Publica. Jan 2008; 23 (1)44-51.