Article
“I had a C-section.
So why is sex painful for me now?”
Three things you need to know about postpartum sexual health & wellbeing.
Author
Gráinne Byrne
It’s no secret that childbirth causes physical trauma to the pelvic and abdominal regions.
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However, talking about the physical and emotional issues that can stem from this trauma is still very much taboo.
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Things like dyspareunia (painful penetrative sex), vaginal dryness and lack of arousal are just some of the common sexual health problems that postpartum people deal with behind closed doors.
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The MAMMI study is a longitudinal research project in Ireland that analyses the health problems associated with being pregnant and postpartum. A 2018 paper it published reported that, out of 832 first-time mothers at 6 months postpartum:
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Almost half reported a lack of interest in sexual activity.
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37% had dyspareunia.
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43% experienced a lack of vaginal lubrication.
Recently, a friend of mine — let’s call her Sophie — had messaged me about how she was experiencing the aforementioned symptoms.
Naturally, she was confused, feeling as though what was happening to her body would have made more sense if she’d had a vaginal birth.
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The online pre-natal course she’d attended didn’t cover anything about how her sexual health could be impacted postpartum, irrespective of the mode of delivery.
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This leads me to my first point about sexual well-being, beyond the bump:
Background photo by Tiego Bandeira via Unsplash
#1
Breastfeeding, on top of already extreme hormonal fluctuations, can result in vaginal dryness or tenderness.
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Having consistently breastfed her child since birth, Sophie was not aware that this could be indirectly linked to her experiencing dryness ‘down there’.
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She’d found that none of the resources she’d reviewed had given her the simple science behind what will happen to her body postpartum.
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So, here’s a mini-science lesson to boot:
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The hormone estrogen holds the key to vaginal lubrication, and it goes on a total rollercoaster ride 24 hours after the birth.
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During pregnancy, estrogen levels are sky-high due to the placenta supporting its production. When the placenta comes out, estrogen levels drastically drop overnight to peri-menopausal levels.
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On top of this significant hormonal change, the milk-production hormone prolactin kicks in. Prolactin then temporarily blocks estrogen production, keeping levels quite low in the body.
Youtuber Keelin Moncrieff has spoken openly about how her sexual well-being has been impacted post-partum.
#2
Undergoing a C-section doesn’t mean you are less likely to experience sexual difficulties postpartum.
Vulvovaginal pain expert and co-author of When Sex Hurts, Dr. Jill Krapf, has shed light on the fact that some people actually choose to have a C-section to avoid more physical trauma to the vulva and perineal area.
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However, a C-section is not a safeguarding measure against developing sexual health issues like postpartum dyspareunia (painful sex).
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In fact, the evidence shows that there is actually minimal difference between the rates of postpartum dyspareunia experienced by those who’d had an uncomplicated vaginal delivery (no tears or episiotomy), versus those who’d undergone a C-section.
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Referring to the stigma of C-sections as being ‘an easy way out’, Sophie had assumed that her problems were probably less valid or serious than others who’d gone through a non-medicated, low-intervention birth.
Photo by Malvestida via Unsplash
#3
Sexual health MUST be taken more seriously as a key factor in overall postpartum wellbeing.
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Unfortunately, people find it challenging to bring up sexual health issues with their clinicians.
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Another MAMMI study from 2022 found that a seriously low number (2.9–3.6%) of first-time mothers in Ireland consulted a GP about their sexual health issues postpartum.
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It highlighted that even when people did proactively consult their healthcare professionals, they were met with ‘unhelpful responses’.
Sadly, this meant that they had no other option than to go online for guidance or seek out advice from peer groups.
Photo by Domo via Unsplash
To Conclude..
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Although breastfeeding can indirectly lead to the temporary experience of vaginal dryness, stopping breastfeeding is not a logical or recommended solution. Treatments such as topical estrogen, lubricants or pelvic floor physiotherapy can prove beneficial during this period.
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Regardless of the way the baby is delivered, there is potential to develop postpartum sexual health issues. It’s clear that a knowledge gap exists and that people must be properly equipped to deal with changes to their sexual health and/or relationship after childbirth.
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We do not obtain a full picture of postpartum health unless sexual well-being is evaluated. More opportunities must be created both to talk openly about sexual health issues and to educate people on how they can support their sexual health in the postnatal period.
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Disclaimer: Please consult a medical professional if you are experiencing any of the aforementioned symptoms. The information provided in this article should not be taken as official medical advice.