The baby is asleep in the other room and you and partner are both awake, feeling a little frisky but also a little nervous about “down there”. Maybe you’re abdominals are a little slack, maybe you have a heaviness or bulge in your vagina, maybe you’re just worried it’s not quite healed from the delivery. Should you wait? Or is it safe to go for it?
As a pelvic health physiotherapist, you’ll find most of my patients will attest, I am a big fan of penetrative intercourse. Sex is good for the pelvic floor, let’s all repeat together: sex is good for the pelvic floor. It can help restore tone to a floor that doesn’t have enough, help decrease tone in a floor that has too much, help get a prolapse back in, and even help regenerate the nerves that were squished during the delivery. Now before your significant other rejoices, I do have rules.
The general guideline is to wait 6 weeks before having intercourse. In a vaginal delivery, it is crucial that the stitches and perineum be healed. This will normally take about 4-6 weeks. Having sex at this point in the healing can actually help normalize the tissue (muscles, ligaments, nerves) benefitting the pelvic floor as mentioned above. In a c-section, the guideline is to protect the stitches and allow for healing from the surgery. However all this must be pain free, bringing me to the next rule.
Sex must be pain free. You will likely feel a little tightness especially if you haven’t done the perineal massaging yet, but it should not hurt. Different positions will affect the perineum differently (see below for details), so depending on where and to what degree you tore, you may find some positions more comfortable. Also keep in mind a pelvic organ prolapse can affect how sex feels, both emotionally and physically. BTW, pain during sex is called dyspareunia and can be treated with pelvic floor physiotherapy.
You must communicate with your partner. He has no clue. What was once your favorite position before baby may now be the most painful one and to get all the benefits mentioned above it has to be painfree.
You must be willing to try different positions. Here’s a little cheat sheet, but remember everybody is different and every pelvic floor and perineum heals at a different rate.
Missionary: you’re on the bottom, he’s on top.
Good- for a first degree or no tear, rectocele, uterine prolapse,
– pushes prolapse back in, will stretch post perineum
Problematic- c-section, disc herniations, 3-4 degree tear, clitoral tears, DRA
– the pelvic tilt may pull too much on the c-section adhesions or DRA, too much flexion in low back, weight from hubby may pull too much on the perineum or put too much pressure on clitoris
Side lying / spoons
Good – clitoral tears, cystocele, uterine prolapse, rectocele, DRA, discs
– you have more control of entry, no pressure on clitoris, penis pushes prolapse in, low load on lumbar discs, can be in lumbar extension, lower load on abdominal separation
Problematic – may pinch prolapse
Woman on top
Good -all prolapse, all tears, discs, DRA
– you get to control the entry speed and angle of penetration
Problematic – gravity pulls prolapse down, deep penetration can be painful
On all 4s (aka doggy style)
Good- prolapse, esp cystocele, disc, perineal tears
– gravity helps prolapse, angle away from perineum
Problematic – DRA, clitoral tears
– abdominal wall not strong enough, pressure can be too far forward
L- shape ( you are at right angles from each other, he’s on his side, you are on you back)
– you can control angle of entry and depth of penetration
No matter when you return to intercourse, the most important thing to remember is sex should not be painful. There is no predetermined time when you should have sex. There are a myriad of reasons couples chose to wait longer than 6 weeks. What’s important is that you maintain intimacy and open communication. Desire can take a long time to return. Talking to your doctor or a therapist can help with this. Seeing a pelvic floor physiotherapist to help reconnect you to your pelvic floor can be life changing. A strong, flexible pelvic floor accommodates penetration much better. Restoring normal tone (getting rid of trigger points, releasing myofascial adhesions) can increase pleasure. Overall the fear of what might be can be relieved.
What position did you find best and why?