The causes of painful postpartum sex

July 10, 12:21 AMSF Sexual Health ExaminerJennifer Gunter

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• Too little estrogen. Estrogen keeps the vaginal tissues healthy and lubricated. Estrogen levels are often low after a delivery, especially if a Mom is breastfeeding or using a progesterone-only type of contraception (like Depo Provera or the Mini-pill). Lack of estrogen can produce pain on insertion and with deep penetration. Using additional lubrication may help, but it won't take care of the problem.

• Problems with the scar from a tear or an episiotomy. This is only a concern for women who have delivered vaginally. The scar should be healed by six weeks. An improperly healed scar typically produces pain on insertion.

• Muscle spasm. The pelvic floor muscles wrap around the vagina. Sometimes these muscles may develop excessive spasm after a delivery (this can happen after both a vaginal delivery or a c-section). The trigger may be the rapid drop in hormones in the immediate postpartum period. Muscle spasm is associated with pain on deep penetration.

• Vulvodynia. This is a nerve pain condition where the skin on the vulva develops a heightened sensitivity to touch. Even the lightest touch can produce terrible burning pain; some women even find underwear uncomfortable. Vulvodynia typically produces pain with insertion.

If there is pain with sex despite adequate lubrication then a trip to the gynecologist is in order. Each one of these conditions has a specific therapy, and the sooner the right treatment is started, the faster parents can return to their sex life.