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Unfiltered, educational, shameless talk about vaginas and it’s bffs with Dr. Ashley

  • Writer's pictureDr. Ashley Hocutt

Navigating Painful Sex Postpartum: A powerful perspective

Let's have a candid chat about something many new moms shy away from discussing openly: painful sex postpartum. As a pelvic floor physical therapist, I've walked alongside countless women on their journey to reclaiming pleasure and intimacy after giving birth, and I want to share some insights with you.

Historically, postpartum pain with sex has been deemed insignificant or a normal thing to "just deal with" and despite those horrible suggestions, you still have interest in seeking pleasure. And that's because you're more intelligent than the people that said "drink some wine" or "just wait" it will get better on its own.

Experiencing discomfort during sex after having a baby is incredibly common, but it's not something you have to resign yourself to or simply endure.

Here's why it might be happening:

1. Scar Tissue: Whether you had a perineal tear or a cesarean section, the healing process can leave behind scar tissue that affects the elasticity and mobility of the pelvic floor muscles, leading to pain during intercourse.

2. Pelvic Alignment: Pregnancy and childbirth can cause significant changes in pelvic alignment, leading to muscle imbalances and tightness that can contribute to discomfort during sex. Restoring proper alignment is crucial for optimal pelvic floor function.

3. Lifestyle Changes: Let's face it, life with a new baby is hectic. Sleepless nights, baby feeding, and constantly being on the go can leave you feeling exhausted and disconnected from your body, making it difficult to relax and enjoy intimacy with your partner.

4. Hormonal Changes: The hormonal fluctuations that occur during pregnancy and postpartum can affect vaginal lubrication and tissue elasticity, making sex uncomfortable or even painful. When estrogen plummets postpartum, the vulvar tissue may feel raw, burning or like sandpaper.

Now, let's talk about how we can address these issues and work towards making sex enjoyable again.

As a pelvic floor physical therapist, I take a holistic, mind-body approach to treatment. This means addressing not only the physical aspects of pelvic floor dysfunction but also the emotional and mental factors that may be contributing to your discomfort.

The pelvic floor does not function in isolation, it functions in collaboration with the mind.

These muscles have both voluntary and involuntary control. Just as I can actively make a fist, lick my lips or bend my knee, I can actively use my pelvic floor muscles for stopping the flow of urine or holding in a fart. This type of voluntary movement is controlled by our somatic nervous system.

Interestingly, the pelvic floor also functions under the autonomic nervous system in various ways. These muscles are involved with respiration, voice, activation of other muscles and respond to emotions. During respiration, as the diaphragm moves up and down, the pelvic floor moves. It also responds to pressures in the abdomen with coughs, sneezes, laughing and various exercise. Your vocal cords and the pelvic floor operate cohesively, releasing and contracting together when making sounds. These connections can be altered with injury, habits, childbirth and stress.

The muscles may also respond to emotions. They tense up as a protective response like my shoulder shrugging toward my neck when I watch a thriller. Actually, I don't watch thrillers, but if I did, you bet my shoulders would be protecting my neck. We are designed with an intricate neuromuscular network and that means the mind (nervous system) must be harmonized with the body when working to get sex to feel good.

Thankfully, the pelvic floor is complex in its connection to the rest of the body and mind.

Imagine a grandfather clock with lots of tiny gears that affect each other, a small shift to any gear will completely change the function of the clock. And so, a small adjustment to the pelvic floor directly OR indirectly through its connections to mind na body will create massive healing impact on the pelvic floor.

Seeking professional help from a pelvic floor physical therapist provides you with personalized care and support to address the root causes of your discomfort and reclaim your sexual health and wellbeing.

If you can't get to a professional yet, check out my favorite at home tools you can use to ease painful sex.

Favorite things to use at home to ease painful sex:

(P.S. The lubes and vaginal moisturizers link to Amazon and the others go directly to the company websites)

  1. Lube: This isn't the full answer, but decreasing friction is a must, my top 2 choices are Slippery Stuff, a water based lube at a super affordable price and Uberlube, a silicone based lube that is uber long lasting.

  2. Vaginal moisturizer: Unlike lube, this is for everyday use. I prefer to use it at night before bed. Remember postpartum, the tissues are typically less hydrated due to the reduction in estrogen, moisturizers can help. My top 2 favorites are Mama Medicine's balm and Momotaro's salve. I personally use both, they are very clean and use organic ingredients.

  3. Dilators: Progressive in diameter and length, dilators help relieve tightness or restrictions to the vaginal opening and musculature. My go to for dilator sets is Intimate Rose.

  4. Entry depth buffer: A stackable set of depth-limiting rings helps moms feel comfortable knowing the depth is controlled by this external device, Oh Nut.

  5. Vibrator: For entry pain, this device can help ease tension AND stimulate pleasure externally. Honestly, any vibrator will do, but this one is innovative, cute and designed specifically for easing entry pain, it's called the Kiwi.

Beyond this, specific hands on manual therapy techniques to improve mobility and alignment of the pelvic joints after birth, mind/body relaxation practices and stretches are helpful for relieving tension in the abdomen, pelvic floor, hips and neck.

When navigating painful sex postpartum, it's valuable to move towards pleasure. Go on a pleasure hunt to places beyond your vagina! Find where touch feels good and explore intimacy in satisfying, enjoyable, stress free ways.

A scalp massage can be calming and sensual. A foot massage may be nice at the end of the day. A simple snuggle without devices in hand and syncing with each other's breath may be the thing that you need right now.

With love and support,

Dr. Ashley


1. Sampselle, Carolyn M., et al. "Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial." Obstetrics & Gynecology 111.3 (2008): 631-638.

2. Bo, Kari, and Bjørg Hildegunn Berghmans. "Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction." World Journal of Urology 30.4 (2012): 437-443.

3. Reissing, Elke D., et al. "Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents." The Journal of Sexual Medicine 9.11 (2012): 2796-2807.

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