Childbirth & Sexual Dysfunction - Understanding and Preventing

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What Sexual Problems Can Occur After Childbirth?

Changes to the Vagina or Perineum. Perineal injuries can increase the risk of sexual pain after childbirth, and are sometimes preventable. Widening of the vaginal entrance, due to stretch and separation is actually a very common anatomic change after childbirth.  And for most women, it poses no problem. But for some, the vagina becomes extremely ‘loose’, and intercourse is simply not enjoyed in the same way for either partner. Many women who have noticed this problem are reluctant to tell their doctor, unaware that there are effective solutions.

Sexual Effects of Incontinence and Prolapse. Pelvic prolapse, urinary incontinence and anal incontinence can each have a negative impact on sexual identity and functioning."Coital Incontinence” refers to the actual leakage of either urine or stool during sexual intercourse, or even sometimes during orgasm. It is reported by up to 21% of women surveyed in a urogynecology practice, with 72% of these women reporting adverse effects on their sexual function.

Any Simple Tips for Restoring an Active Sex Life After Childbirth?
Countless psychological and emotional factors contribute to sexual function, and should all be considered if problems arise.  However, purely physical changes around the pelvic floor may also impact your sex life after childbirth, and should not be overlooked.

Healing of the Perineum & Vagina. The perineum is a key anatomic area when it comes to sexual function– and also one that is highly prone to obstetrical injury. For this reason, up to 20% of women take longer than six months to resume comfortable intercourse. Women experiencing perineal or anal sphincter injury, and those undergoing forceps or vacuum delivery, are at even higher risk of painful intercourse. For some women, ‘loosening’ of vaginal tone can have a negative impact on sexual pleasure, including a loss of sensation, or difficulty reaching orgasm during intercourse for women able to do so before. Whether you had an episiotomy or ‘spontaneous’ perineal injury, attention should be devoted to this area after childbirth, to ensure full healing.
o Avoid Swelling & Infection using ice packs as directed by your doctor or midwife, and proper hygiene to prevent infection and breakdown of your stitches as they heal.
o Vaginal dryness is especially common during breastfeeding due to a drop in hormones, and may lead to sexual discomfort or pain. Various lubricants – some containing estrogen – may often provide relief.
o Positions & Perineal Massage. The perineum may feel sensitive or less flexible as healing occurs; this does not necessarily indicate a problem. If tenderness persists internally or externally, despite simple remedies, occasionally other treatments may be warranted.
o Timing. Returning to sex may prove to be a slower process than you or your partner had expected. Some women feel ready and able soon after delivery; others remain uncomfortable or uninterested for quite some time. Six months after vaginal childbirth, up to one in four women still report decreased sensation, worsened sexual satisfaction, and reduced orgasm compared with before the birth.
Rehabilitating the Pelvic Floor. Weak pelvic floor muscles may decrease sexual satisfaction by making the vagina feel ‘too loose’.  In other cases, tenderness or ‘spasm’ of the levator muscles may lead to pain during penetration.  Kegel exercises can improve vaginal tone, awareness of pelvic floor muscles, and the ability to relax them during intercourse.  Biofeedback and/or pelvic floor physiotherapy may help to rejuvinate the pelvic floor muscles after childbirth, even if Kegel exercises failed.  Biofeedback sensors signal when you’re contracting the correct pelvic floor muscles, and improve your workouts.  Pelvic floor stimulation, using electrical or magnetic energy, is another means to rehabilitate the pelvic nerves and muscles.

Adapted From:  “Ever Since I Had My Baby: Understanding, Treating and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth”, by Roger P. Goldberg, MD MPH

(Crown Publishers, Random House, NY 2003)

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