Painful Sex After Birth

After birth, pain during sex may be felt at the vaginal opening, in the perineum or deeper in the pelvis. Sensitivity of a stitch or episiotomy scar, vaginal dryness and difficulty relaxing the pelvic floor muscles can all be linked to this pain. Hormonal changes during breastfeeding can also cause dryness. Because where the pain is, when it started and what makes it worse differ from person to person, the assessment begins by understanding these details. A physiotherapy assessment covers your birth history, how the perineal tissue has healed, and how well your pelvic floor muscles relax and coordinate. Based on the findings, the approach is built around relaxation, breathing, tissue mobility and a gradual return to your sex life.

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Painful Sex After Birth: Possible Causes and Physiotherapy Support

Where and How the Pain Appears

The pain may be felt at the vaginal opening, at the perineal scar or deeper inside, and may be described as burning, stinging, pulling or tightening. The physiotherapist tries to understand which touch, position or movement triggers the pain and what makes it better or worse. This information shapes the rehabilitation approach.

Pelvic Floor Muscle Relaxation and Coordination

During sex, it is important that the pelvic floor muscles can not only contract but also relax when needed. The assessment covers breathing, muscle awareness, the ability to relax and coordination with movement. If the muscles are tender or tense, strengthening exercises should not be the first step.

The Perineal Scar and Returning to Pain-Free Intimacy

If tenderness or tightness remains at the perineal scar after a birth tear or episiotomy, the mobility of this area is assessed once the wound has healed. Depending on your needs, scar tissue work, relaxation and gradual touch may be planned. The goal is not to keep having sex despite the pain, but to support your return to intimacy at a pace where you feel safe.

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Common and Treatable

A review of 22 studies reported pain during sex in about 43 out of every 100 women between 2 and 6 months after birth, and in 22 between 6 and 12 months.

"Since giving birth, I feel burning at the vaginal opening during sex."

"The area where my perineal stitches were hurts when touched."

"While breastfeeding, dryness and a feeling of friction have increased."

Banaei M, Kariman N, Ozgoli G, et al. Prevalence of postpartum dyspareunia: A systematic review and meta-analysis. International Journal of Gynecology & Obstetrics. 2021;153(1):14–24.

Painful Sex After Birth FAQ

Is it common to have pain during sex after giving birth?

Yes, pain can occur, especially in the first months after birth; but being common does not mean you should ignore it. If the pain persists, gets worse or makes intimacy difficult, you can talk to your doctor or a pelvic floor physiotherapist.

When can I start having sex again after birth?

There is no single date that applies to everyone. Healing of stitches, whether bleeding has stopped, your physical comfort and whether you feel ready are all considered together. If it hurts the first time, you do not have to continue; there are also ways to be intimate without penetration.

Should I do Kegel exercises if sex is painful?

Kegel exercises may not be suitable for every case of painful sex. If the pelvic floor muscles are already tense, focusing only on contracting them can make your symptoms worse. A physiotherapy assessment looks at both how the muscles contract and how they relax, and exercises are chosen accordingly.

Can vaginal dryness while breastfeeding cause pain during sex?

Vaginal dryness can cause friction and discomfort during sex; the NHS notes that pain after birth can sometimes be related to dryness. Water-based lubricants may make things more comfortable for some people. If dryness or pain continues, talk to your doctor.