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Intimacy Postpartum Doesn’t Have to Hurt

post baby sexIn complete irony the same activity that gave you your little bundle of joy can be painful, daunting, and scary postpartum. I’ve reached the age where the majority of my friends have one or more babies and our group text is rife with complaints about the post baby “bounce back”. If 100% of my girlfriends have complained of pain or aversion to sex post baby I assumed that most women have some concerns about it.

Why Postpartum Pain during Intimacy Occurs

Well, there’s the obvious:  you just pushed a human out of a place that is normally a whole heck of a lot smaller than a baby. If you had a C-section, your doctor had to surgically create an opening to deliver your baby.  If you had an episiotomy or perineal tearing, residual scar tissue can restrict your abdomen and pelvis making intercourse feel painful. In addition, your life just got a whole lot more complicated. You’re now the caretaker for a little miracle and your mind may be on your fragile new baby instead of getting it on with your hubby. Thoughts and distractions can be a powerful libido killer. Lastly, your body is just not the same as it was pre-baby hormone wise. While breastfeeding, your estrogen plummets, and the hormone level in the vagina may be lowered while your whole body focuses on making enough milk for your baby.

post baby massageHow to Overcome Postpartum Pain during Intimacy

  • Firstly, if you had a c-section or episiotomy, self-massage of the vaginal area can be a helpful tool for breaking up scar tissue that may be causing pain. Tips: be gentle with yourself! Don’t rub over the scar but simply hold pressure on the area of discomfort for 5 seconds and then try to move the skin around the incision. Don’t be shy! You can even have your partner gently massage where the perineal or episotomy scar is located if you’re working on an episiotomy scar.
  • Next , when attempting intercourse, use lubrication. Low estrogen levels lead to a lower libido, which means less arousal and less lubrication in the vaginal tissue, and even thinner, more brittle tissue. If you’re into the natural stuff even coconut oil will do. Otherwise try any over the counter kind you like. Your MD may even prescribe a topical cream with some estrogen to help the vaginal tissue bounce back.
  • So you’re lubed up and ready to go…what next? Try different sexual positions, such as being on top of your partner, so you are better to control the depth and speed of penetration. Remember: everyone heals differently. There’s no rush, and you need to communicate with your partner what feels good and what doesn’t.
  • Last tip: don’t forget that you can still get pregnant during postpartum healing.

If you feel like working through the suggestions in this blog on your own is too daunting or you feel like you need professional help, let your MD or physical therapist know. At EMH physical therapy we can help. We specialize in women’s health including any issues that occur post-partum. You deserve to feel like “you” again, so you can be the best mom for that new baby!

Painfree sexual intercourse during Menopause: Helpful tips by a Pelvic Floor PT

Physical therapists have helped women in menopause return to painfree, satisfying sexual intercourse. These women could experience pain with intercourse, even after rehydrating their vaginal tissues under the guidance of their GYN, due to pelvic floor muscle tension.   The pelvic floor is a group of muscles located at the bottom of the pelvis  surrounding the vaginal canal.  Intercourse requires that the muscles be flexible to be able to receive the penis and strong enough to contract to provide more intense orgasms.    All healthy muscles have a normal length during rest.  Unhealthy muscles have knots/fascial restrictions so they are stuck in tight position during rest.  So with a tight pelvic floor, the penis cannot enter and women can experience pain.

How to gain a healthy pelvic floor?  Treatment by a physical therapist trained in pelvic floor dysfunctions is optimum as we provide you with tailored manual expertise and guidance to heal.  Here are some helpful tips:

1)      STRETCH HIP/GLUTEAL MUSCLES Stretch the large muscles of your hip, and buttock region as they can actively refer pain into the pelvis and cause the pelvic floor muscles to overwork or be strained.  By actively stretching the hip flexors, hip external rotators, inner thigh (adductors), groin and hamstrings,  the pelvic floor is released and can function optimally.  Hold each static stretch for 30 seconds, done twice,  2x’s times a day.

2)      VISUALIZE A RELAXED PELVIC FLOOR   Chronically tight pelvic floor muscles need many reminders to relax throughout the day.   Every time you look at the watch or your mobile phone, ask yourself, “Where is my pelvic floor?”   Think about the area softening, melting, widening. Use any visualization that is calming to you, send a healing color to your pelvis to bring awareness and “let go”.

3)      BREATHE  Diaphagramatic breathing helps to relax the abdominal and pelvic regions.   Lie on your back, pillow under your knees. Place your hands on your stomach, bent elbows resting by your sides.  Inhale slowly through your nose for a count of 5 seconds.  During your inhalation, allow your stomach expand into your hands. Visualize your pelvic floor muscles widening as well.   With each inhalation,  imagine or visualize the pelvic floor muscles expanding in all directions, front, back , left , right.  Slowly exhale for 5 seconds. Repeat 5 times. Do once in morning and at night.

4)      NEUTRAL PELVIS Set up your computer/reading/art work space to fit your body versus your body having to adjust to the environment.  The chair should be at a comfortable height so your feet are supported either on the floor or a raised footrest.  “Good posture” is when a neutral spine in maintained.  When sitting, your weight should be on center of your pelvic bowl, your lower back resting against a lumbar cushion. The lumbar cushion gently pushes your lower back forward to maintain it’s natural curve.  You should not slump back to sit on your coccyx bone, nor too far forward on your pubic bone and no sitting on one side/hip for hours at a time.      Here is where a PT can really help you gain knowledge and best position of your body.

5)      SELF STRETCHING INTRAVAGINALLY  This is a technique where you can stretch the intravaginal tissues by inserting a clean left thumb intravaginally up to the level of the first thumb joint. Gently press or sweep your thumb along the right vaginal walls providing a deep stretch.  Do a few sweeps from the midline towards bottom of the right vaginal wall.  You can hold a few areas that feel tight or uncomfortable.   Then insert the right thumb intravaginally and sweep or apply pressure points along the left side of the vaginal wall.  Repeat a few times each side. Do once a day.

6)      DILATORS Dilators are also used to help women prepare for intercourse and to apply pressure to tight spots within the vaginal walls to stretch. Your PT can guide you on how to use them.

7)      PELVIC FLOOR STRENGTH   Once your pelvic floor muscles are lengthened, a basic pelvic floor strengthening program can begin. Your physical therapist can teach you how to best recruit these muscles without co contraction of the hip adductors, hip extensors, and breath holding.  A basic pelvic floor strength exercise can be done by holding a contraction for 10 full seconds, resting/relaxing for 20 seconds. Repeat this 10x’s.   Then do 10 quick contractions and quick relaxations, repeated 10x’s to stimulate the fast twitch fibers of the pelvic floor which are innervated during orgasm

8)      SQUAT Squatting exercise helps to lengthen the pelvic floor and increases the strength of your hip and buttocks muscles.  When performing either a quarter, half or full squat in good alignment, this provides great balance of the pelvis and pelvic floor muscle function.

9)      AN ORGASM A DAY… Yes, an orgasm a day keeps all the pelvic muscles happy and healthy