Understanding Postpartum Dyspareunia: Causes, Symptoms, and Treatment Options

Navigating and Overcoming Painful Sex After Childbirth

Congratulations! You navigated the incredible journey of pregnancy, embraced the challenges of childbirth, and conquered the early months of postpartum life. Sleepless nights, learning a big new job (parenting!), and riding the waves of hormonal shifts —these milestones are behind you. Now, after all that, you’re ready to return to the sex life you had before. But there’s just one problem: sex has become painful. Does this sound like your story? If so, you might be experiencing postpartum dyspareunia.

What is postpartum dyspareunia?

Dyspareunia is the medical term for painful sex, and postpartum dyspareunia is the term used to describe painful sex after childbirth. Postpartum dyspareunia is very common, with studies showing that it is present in over 50% of women 6-12 weeks after delivery and up to 32% of women at 12-18 months after delivery.^1,2 Learn more about the signs and symptoms of dyspareunia.

Why does postpartum dyspareunia happen?

Pregnancy and childbirth are a big deal! Your body undergoes many changes, and it takes time to recover from these changes. There isn’t one single cause of postpartum dyspareunia. Some of the associated causes and risk factors³ are:

• Breastfeeding: Breastfeeding has many benefits but suppresses your body’s estrogen release. This can cause vaginal dryness or thinning of the vaginal tissue, both of which can contribute to painful sex.³
• Vaginal tearing or injury during childbirth: The process of delivering a baby can injure tissues in and around the vagina. As your body heals, it may form scar tissue, which can make penetrative intercourse uncomfortable or difficult.⁴
• Pelvic floor changes: Your “pelvic floor” is the group of muscles that support your pelvic organs, including your uterus, bladder, and vagina. The process of growing and carrying a baby puts a lot of strain on these muscles, while the process of delivering a baby can cause excessive stretching or tearing of these muscles. As a result, it’s common for women to experience pain related to pelvic muscles being too tight or too weak after childbirth (including those who deliver by Cesarean).
• Fatigue and stress: Caring for a newborn is exhausting, and most new parents get less sleep than usual and feel stressed about their new role as caregivers. Fatigue and stress are both risk factors for painful sex.
• Hormonal changes and other psychological factors: Depression, fatigue, social support, and stress all seem to contribute to the development of postpartum.
• Even after a C-section, postpartum dyspareunia can occur.

Is vaginismus connected with postpartum dyspareunia?

Vaginismus is a condition where you experience pain with vaginal penetration, thought to be caused by involuntary contraction of the pelvic floor muscles. People with vaginismus feel pain, discomfort, and distress when trying to insert anything into the vagina. Often, there is not one specific cause for vaginismus, but we do know that it can be associated with injury during childbirth. So, vaginismus is associated with postpartum dyspareunia. You can read more about vaginismus here if you relate to these symptoms.

How long does postpartum dyspareunia last?

One study² found 31% of women experienced dyspareunia at 3 months after delivery, and 12% experienced it at 2 years.

Are there treatments for postpartum dyspareunia?

Yes! The good news is that dyspareunia that begins postpartum² is usually easier to address than dyspareunia unrelated to childbirth. Here are some of the treatment options:

• Lubrication or Topical Estrogen: Using lubrication or topical hormones (like estrogen, estrogen-like medications, or DHEA) inside your vagina can help address pain related to vaginal dryness. You’ll need a prescription from your doctor for topical estrogen.
• Pelvic Floor Physical Therapy: If some of your pain is due to weakness/tightness of your pelvic floor, you can work with an experienced Pelvic Floor Physical Therapist. They will teach you exercises to strengthen or stretch your pelvic muscles and diminish pain.
• Vaginal Dilators: Vaginal dilators are a way to stretch and recondition the muscles in order to gently reintroduce penetration as a pleasurable– rather than painful– part of intercourse⁵. This can be especially helpful for those having symptoms of vaginismus.
• Talk with a Therapist: If you think fatigue and stress are contributing to your postpartum dyspareunia, consider talking with a professional therapist (there are even therapists who specialize in postpartum therapy!).
• Check in with your Healthcare Provider: Although postpartum dyspareunia is very common, it’s also a medical condition that your healthcare provider can help you address. They’ll be able to discuss treatment options, prescribe physical therapy or estrogen cream, and make sure that there aren’t other medical conditions contributing to your pain.

Research Studies about postpartum dyspareunia

• Overview of past and current reviews
• Current or recent cohort studies

1. Lagaert L, Weyers S, Van Kerrebroeck H, Elaut E. Postpartum dyspareunia and sexual functioning: a prospective cohort study. Eur J Contracept Reprod Health Care Off J Eur Soc Contracept. 2017;22(3):200-206. doi:10.1080/13625187.2017.1315938
2. Rosen NO, Dawson SJ, Binik YM, et al. Trajectories of Dyspareunia From Pregnancy to 24 Months Postpartum. Obstet Gynecol. 2022;139(3):391-399. doi:10.1097/AOG.0000000000004662
3. Alligood-Percoco NR, Kjerulff KH, Repke JT. Risk Factors for Dyspareunia After First Childbirth. Obstet Gynecol. 2016;128(3):512-518. doi:10.1097/AOG.0000000000001590
4. Gommesen D, Nøhr E, Qvist N, Rasch V. Obstetric perineal tears, sexual function and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study. BMJ Open. 2019;9(12):e032368. doi:10.1136/bmjopen-2019-032368
5. Macey K, Gregory A, Nunns D, das Nair R. Women’s experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study. BMC Womens Health. 2015;15(1):49. doi:10.1186/s12905-015-0201-6

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