woman in bed sex is flat

#3 When postnatal sex is just a bit flat

Getting your Mojo back: #3 When postnatal sex is just a bit flat

What if you are having sex, confident there’s no medical issue, but its just not really ‘doing’ it for you?  I’ve heard mums say postnatal sex is flat,  “a bit boring really”, or  “sore and uncomfortable”, or “not very satisfying”.

I have 3 suggestions to help you shift from here back to a place of “OK! I’m back! & I can get more sexy and heat up a bit from here by myself”

1. Are you flexible enough?

Pelvic Health physiotherapists assess and treat antenatal and postnatal pelvic girdle pain (PGP) and back problems.  You need flexibility in the spine, pelvis, and hips for  comfortable  sex.  I’m convinced that it is no coincidence that the Karma Sutra looks like advanced yoga!

The problem is that you can go stiff in your back and hip joints quietly, with no pain at all, no apparent loss of ability to walk, sit, and carry.  However, we are not at our optimum function anymore.  With our bodies it is easy  not  to notice what you are missing.  Stiffness often doesn’t hurt.

In everyday life, clues that your back/hips might be stiff:

  • you wake in the morning feeling morelike a granny than a gazelle and have to physically ‘get going’ for a few minutes or half an hour before you feel like yourself!
  • after you have been sitting for a while your first few steps are painful or difficult
  • you seem to be living with constant back ache
  • when you try to pick up your pace to run or walk fast or do your sport, you get backache or a proper pain
  • and/or your legs feel really heavy, like you are walking through thick treacle
  • you realise that don’t really properly stand up straight anymore

With sex this manifests as:

  • a sense that you can’t let go and fully relax,
  • you can’t take your partners weight onto you,
  • you can’t get comfortable or
  • your can’t get close enough (which then means you are not getting enough external stimulation of the clitoris, making reaching an orgasm dependent on penetration alone – not enough for most women)

If you think this might be a problem for you try this:

  • spend a week or two focusing on stretches for your lower back, inner thighs & hips
  • if you had PGP during pregnancy and it is still niggling, go back to your physiotherapy team and ask for a postnatal review and assessment of your spine
  • if you think that your delivery might have triggered a back or hip problem ask your GP to refer you for a physiotherapy assessment.   We tend to focus on trauma to perineum (the soft area) but did you have to to get into some awkward positions? Did you have to put your legs into stirrups at some point? Did you struggle to walk properly for a few days? Even with a caesarean there can be hidden trauma, possibly from being unable to feel your lower half properly yet trying to move about, let alone sleeping on a hospital bed for a night or two!

2.  Do your pelvic floor muscles need some attention?

Women don’t have that many nerve endings inside the vagina.  Inside, we feel ‘pressure’ and ‘deep touch’ more than light sensations.  The sexual pleasure we feel comes from the rubbing and build up of friction against the vaginal walls.  The vaginal walls at the base and the sides are layered with the pelvic floor muscles.

Clues that lack of pelvic floor tone might be a problem for you are:

  • it just feels a bit dull and boring inside during sex
  • you want to try to grip your partner but nothing happens
  • you feel there is too much room inside (you might also notice this when using tampons)

If you think WEAK pelvic floor muscles might be a problem for you:

standing pelvic floor exercises
  • make pelvic floor muscle training a focus for few weeks trying to make some impact on your muscle tone. 
  • concentrate on good technique, especially making a difference between tensing AND releasing the muscles.  In the Pelvic Floor School there are some videos showing the muscles on my plastic mode.  Having a good visual picture of where they are really helps if their sensation is not great.
  • You can  download a free pelvic floor muscle exercise booklet here which covers the basics.  If you are ready to move on to challenge the muscles to grow further try My favorite standing Pelvic Floor exercise.  It’s  a great brain/muscle teaser to do little and often through the day and really practical to fit in to a busy life.
  • do ENOUGH exercises to make the muscle change and grow. Try our Pilates for your Pelvic Floor video for inspiration and to keep you focused.  
  • consider using a muscle stimulation or biofeedback device, or vaginal weighted cones to enhance your standard pelvic floor exercises.

If you think TIGHT pelvic floor muscles might be a problem for you: see #2 What to do when sex is painful


3.  Can you tap back into your emotions or do you need some help?

 Be open and honest with your partner, and with yourself.  You may be loving being a mother but have you have lost your love of being a woman and a sexual partner?

If you’ve tried all the obvious things like making time (!), wining and dining each other and your usual pre-baby get in the mood tricks but you know it’s still not working for you – don’t forget that YOU could be the one (of many) experiencing a genuine, real, postnatal depression, anxiety or PTSD (post-traumatic stress disorder).

Childbirth is often considered to be a painful but yet exceptionally happy and wonderful moment of a woman’s life. But postnatal depression is a very real thing and affects too many mums mildly or severely. Isobel Harper, my friend and local Cambridge counsellor, reminded me that any difficult birth, or even a birth that is just not as expected, can leave a woman with a sense of failure. This can show up as not feeling bonded to your baby, but also in other ways such as not enjoying times with friends, losing your sense of self, or lack of libido. She describes 10 overlooked symptoms of depression and more about postnatal PTSD (post-traumatic stress disorder) on her website. 

Isobel recommends seeking help from a therapist with perinatal experience

  • some hospitals have perinatal mental health teams
  • some hospitals have midwives who offer a chance to talk through your birth in more detail. At the Rosie Maternity in Cambridge this service is called “Birth Afterthoughts”
  • Petals is a national charity which supports parents who affected by trauma & loss.
  • The Birth Trauma Association, The MASIC Foundation (supporting mothers with anal sphincter injuries) and Tommy’s are all wonderful charities with extensive information on their websites.

Please seek help from your GP or local physiotherapy team.  We are all here to help you.


 Blog Series: Getting your Mojo back:

Please do ask questions or share your story here. Your experience will help others too. #NoMoreMiserableMums

woman painful

#2 What to do when postnatal sex is painful

Getting your Mojo back: #2 When POSTNATAL sex is PAINFUL

If postnatal sex is painful, it’s not your fault. And it can be sorted.

The problem is that a pain-avoidance cycle can develop quickly.  If you experience pain when you have sex, your body recoils from the idea of sex again.    Your partner doesn’t want to hurt you either.  Before you know it there is an elephant in the room, the PJ’s are looking defensive and you’re both studiously looking tired or more interested in a book.   

But feelings of rejection, disappointment, fear and anxiety only add to the vicious cycle.

Here are some of the most likely issues:

1. Do you have enough lubrication?

Painful sex can be caused by a lack of vaginal lubrication.  The hormone changes of pregnancy, delivery and breastfeeding can change our natural production of essential body fluids in the vagina area.  Couple this with lower libido and rushed foreplay and then sex feels sore as body parts struggle to slide and glide past each other.

personal lubricant is helpful for painful sex

Forget KY Jelly.  There are now some beautifully packaged, organic, pH balanced personal lubricants which can enhance your love life and help keep you moisturised and comfortable.  At Supported Mums we think the inventors of personal lubricant should win Nobel prizes – read more about their magic properties and especially the difference between water-based and oil-based lubricants here. 


2. Are the pelvic floor muscles too tight?

Many women do not realise that pain can also arise during sex because the pelvic floor muscles both at the vaginal entrance and deeper inside the vagina have become tight or tense.  Like any muscle in the body there can have been strains and sprains which have healed tighter than the original tissues, or your body might be subconciously  guarding the area since your delivery. Or you may even know that you had a scar that was slow to heal? Or a scar that is still uncomfortable and you are still fearful of stretching it?

Clues that too much pelvic floor tension might be a problem for you are:

  • penetration is difficult, feeling painful and/or blocked
  • you feel yourself tensing up down below (or notice that you are gripping your teeth or clenching your body)
  • or you notice that you sit with your buttocks clenched, often tense around the pelvis
  • tampons won’t go in
  • you feel achy, painful or heavy in the vulva and vaginal area

Try this:

  • explore the outside (vulva) and inside (vagina) with your fingers.  In the bath is nice as you are naked anyway and it is warm, clean and private.  Can you feel any areas that want to be stretched or massaged?  Are there some focused tension spots?  Amy Stein, a US based physiotherapist has a good guide to perineal massage.
  • Use my BEAM Stretch & Relax sequence to bring your tension levels down in advance of attempting sex.
  • take time with proper foreplay to relax your whole body  as well as time spent enjoying sensations outside and inside the vagina area 
  • ask your GP to refer you to see a specialist pelvic health physiotherapist.  We can examine your pelvic floor muscles and explore with you how to get them working better using natural approaches like exercise (for weak muscles) and manual therapy release (for tight, overworking or scarred muscles).

 Blog Series: Getting your Mojo back:

Please do ask questions or share your story here. Your experience will help others too. #NoMoreMiserableMums

couple in bed what is good postnatal sex

#1 What is GOOD postnatal sex anyway?

GOOD postnatal sex?  Can you remember sex at all??

 We women can adapt quickly to things not being ‘right’. Patiently accepting a less than good experience as our new normal.   When your body changes slowly, with a process that evolves like pregnancy, childbirth and motherhood, it can be disorientating. Don’t be surprised if you can’t even remember what you felt like before!

Through my work as a specialist pelvic floor physiotherapist,  I have had lots of conversations with women about their bodies and how they find sex after childbirth.  Please be reassured that there are LOTS of women struggling ‘to get their mojo back’ and we will talk about some of the problems in this series:

 Blog Series: Getting your Mojo back:

It’s not all bad – and it will be good again

 I want to reassure you that I do know many women who have found that childbirth improves their experience.  Once the vaginal canal has been stretched sex can be physically more comfortable.  Others enjoy having a more filled out body or seeing  themselves and their partner in their new roles as parents.

Though many women struggle initially,  I have also seen many many mums regain their self-confidence and sexual relationships, by focusing on identifying their specific problems and looking at the solutions. These can be surprising, such as needing to work on pelvic alignment and general pelvic stretching, as well as their pelvic floor strength.

What is good postnatal sex anyway?? 

Let’s explore for a moment what might classify as “good” sex?  (With my convent education and professional physio background, let’s leave ‘hot’ sex to other websites).

  • First you should definitely be able to actually have sex.  All the parts should be able to fit together successfully without feeling there is a block.
  • Sex should be without pain. 
  • And most importantly sex should bring pleasure for you.    

I think of “good sex” as the type of sex that keeps your relationship with your partner connected, bonded and fun.  It keeps you feeling like a woman and lover, not purely a mother.  It keeps you feeling valued and loved and allows you the choice to value and love in return. 

When things are really not right

If you are not having sex because there is a deeper problem with your’s or your partner’s libido, or physically something is stopping you even trying (this could be a physical block, some bad healing, an infection, discharge, scarring) then if you are ready to have sex and you feel you just can’t then now is the time to take action. 

You need to book to see your GP for a proper examination, discussion of the issues and investigation of the situation, possibly including referral on to the gynaecology team or to a psychosexual counsellor. 

Many maternity departments have a dedicated clinic for reviewing what will be clinically termed “perineal trauma”. There is also the wonderful MASIC charity with good information about management and recovery of obstetric tears.

Even a while after delivery

Some trauma is missed or masked during delivery.  When the area is swollen, bruised and tender it is not always easy to determine what will heal well in the ‘natural’ way and what will actually cause ongoing problems.   Later or delayed identification of a problem with the perineal area is medically termed ‘occult’ trauma – and by it’s definition may not become apparent until some time after the delivery. So please don’t be embarrassed to speak up about any problems even if you struggle to understand how they have come about or why they didn’t seem to be there at the beginning.

These issues should be getting better:

Common postnatal problems which should be getting better with both time and pelvic floor exercises are:

  • pain in the vaginal or anal area,
  • painful or dissatisfying sex,
  • pelvic organ prolapse (feeling of bulging, gaping or discomfort below)
  • urinary stress incontinence (leaks with cough, sneeze, laugh, run),
  • urgency (struggling to get to the toilet on time),
  • nocturia (needing more than 2 wees in the night) or
  • bowel leakage or constipation

Fortunately, a large percentage of women will find that their post-baby symptoms improve with DIY pelvic floor exercises to improve the strength, endurance and reaction time of the muscles which support the organs and help with continence function. 

When to ask for help?

BUT if after 8-12 weeks of regularly practicing standard pelvic floor exercises,  you find that are still having one or more of these problems it is definitely time to seek further help from your GP and ideally, a specialist pelvic floor physiotherapist.

How to find specialist help

Please don’t delay.  If the exercises you have tried are not helping your symptoms we don’t want you to struggle along alone.

There are several reasons why pelvic floor exercises might not be working  not least because we know that 50% of people find it difficult to do them right by themselves.  But also because there could be problems with scarring, the nerve supply or other things like hormonal imbalances,  an infection , or something completely new, not even necessarily connected with your delivery, like a fibroid, polyp or cyst.

The next step is to get professional assessment of the whole situation, help with the next more advanced stages of muscle training (or perhaps releasing the muscles if they are too tight) and access to further investigations and treatments if needed.

In many areas of the country you can self-refer back to your NHS women’s health physiotherapy team where you gave birth.  Have a look through the booklets and information you were given when you left hospital to see if the pathway is clear.   If it is not clear how to access a specialist physiotherapist or you feel that you need a review at the postnatal clinic,  speak to your GP for guidance.  And if the first GP is not helpful…..book in with another one.  Persistence is sometimes needed.

 Blog Series: Getting your Mojo back:

Please do ask questions or share your story here. Your experience will help others too. #NoMoreMiserableMums

postnatal sex pain

Postnatal sex giving you Valentine’s blues?

When you are busy with a newborn baby, sex can drop quite low on your ‘to do’ list.  If it isn’t even comfortable when you do find the moment, it is all too easy to lose the intimacy in your adult relationship.  There are some simple but effective things you can do yourself, straight away, to improve your comfort and enjoyment.

 Blog Series: Getting your Mojo back:

Two quick tips:

#1 . Pelvic floor exercises improve sexual health too

Commit to a couple of weeks of daily pelvic floor exercises to bring about proper change in these muscles.  The pelvic floor muscles play an important role in giving you a sense of closure around your partner as well as support and friction to create your own pleasurable sensations. 

Taking time out to deliberately exercise the pelvic floor muscles will bring blood flow to the area, tone and tighten the muscles and improve your ability to feel the walls of the vagina during sex.  Many women report they are able to reach orgasm more easily, and that their orgasms are more powerful, after focusing on pelvic floor muscle exercises


POGP how to do pelvic floor exercises
POGP: excellent guide to PFM exercises
 Download a free pdf booklet here.

And clear video instructions in our Pelvic Floor School


#2 Keep a personal lubricant in your bedside table drawer 

The hormone changes of pregnancy and breastfeeding can leave your body surprisingly dry at the vaginal opening and deeper inside.  When you are trying to grab a quick sexy moment, with maybe less time than usual to get in the mood, your body may not produce enough natural lubrication.  This can make penetration painful or  the movement of your partner inside you can feel like a friction burn.  

Using a personal lubricant during your foreplay (it works best if you put it on both of you) can make a magical transformation to your comfort and enjoyment.

If you are still experiencing discomfort after boosting your pelvic floor muscles, trying a personal lubricant and the other tips in this series, then don’t hesitate to talk to your GP. 

They will be sympathetic and impressed that you have already tried these first steps.  Your GP  can organise referral to a specialist physiotherapist to give you personal 1:1 assessment and guidance,  and they will be able to move on to other investigations of the possible causes of your pain.

You can and will enjoy comfortable sex again – but you must be brave to let them know that you are suffering.   

 Blog Series: Getting your Mojo back:

Please do ask questions or share your story here. Your experience will help others too. #NoMoreMiserableMums

 

personal lubricant is helpful for painful sex

Nobel prizes for the inventors of personal lubricants?

Truly, the inventors of personal lubricants should be honoured for services to postnatal women and their intimate relationships.

Painful sex?  Might it be because of lack of lubrication?   Don’t be embarrassed.  We’ve all been there.  You might even actually want this to be the problem because it is the easiest problem in the world to fix!

WHEN YOU HAVE A BABY YOUR BODY CHANGES IN WAYS YOU NEVER EVEN THOUGHT OF 

With all the hormonal changes of pregnancy, delivery and breastfeeding, you may be surprised to find that your body may no longer make enough natural lubricating secretions for the vagina opening and the  vaginal tube.  Sex without enough lubrication in this area can distort and drag against your delicate female skin creating a friction burn, pain and discomfort.

You can battle through, women are so good like that, but it will be ‘grin and bear it’ kind of sex.  Not much fun for you.  And over time this can escalate into a bigger problem of avoiding sex because it hurts.

THANK GOODNESS FOR SCIENTISTS!

We are so lucky to live in an age where people in laboratories spend hours developing products to improve and enhance the natural functions of the body.    Even better, with trends in the cosmetic and food industries to keep products natural, organic and good for us there has been a growth in the development of products which should not be harmful to the body and even put good stuff in.

NOT ALL Personal LUBRICANTS ARE THE SAME

Not all lubricants are the same.  You may be alarmed to read the ingredients in some and it is important to ensure that they are pH balanced to the normal vaginal pH of between 3.8pH and 4.5pH.  Lubricants with a higher pH are too alkaline and can lead to UTIs, Thrush and Bacterial Vaginosis  Further, they can be water-based or oil-based. If you are not sure which is best for you do read the related post about the difference between them.

I think packaging is important too.  Who wants a big tube of ‘lube’ on their beside table?  Try explaining that to your 5 year old…?    It is so pleasing to see the brands taking women’s sensitivities into account and producing thoughtfully packaged products that look like quality cosmetics.  Thank you from all of us!

Below are links to the UK brands my clients have found helpful.   They have informative websites and offer free samples too.   

As usual you get what you pay for.   You only need a little bit each time and your intimate relationships are invaluable.  Treat yourself to something made for the purpose, in nice packaging and never run out!   

Please do let our Supported Mums readers know your preferences below and share any advice?  If you have come across a product that you think I should include in this list please let me know your recommendations?

YES®  www.yesyesyes.org

SYLK   www.sylk.co.uk

Boots own brand lubricating jelly    www.boots.com   

showing the difference between personal lubricants

What is the difference between water-based & oil-based lubricants?

If sex is painful, personal lubricant could be life-changing.  It is useful to understand the difference between water-based lubricants and oil-based lubricants.

If you have you have never tried a personal lubricant you might not realise what you have been missing. Those inventors should get Nobel Prizes!  Forget teen movie references to ‘lube and gloves.   And pity our poor grandmothers with probably only vaseline as an option.  Personal lubricants have come an enormously long way in their formulation, effectiveness and packaging.  I hope for the sake of these unsung heroes of our intimate lives that they get a better reputation soon.

IF SEX IS PAINFUL BOTH WATER-BASED Lubricants AND OIL-BASED PERSONAL LUBRICANTS ARE WONDERFUL!

There are some reasons why you might need to use one type over another, such as if you want to use condoms (the lubricant needs to be safe with latex), or you want to use an electricity based pelvic floor gadget (which need a water-based product).  But if you are just experimenting to improve your comfort I would recommend getting some samples of both types from several manufacturers and seeing what suits you and your partner best.

Below I have explained the key differences between water-based and oil-based and there are links to the websites of some of the brands my physiotherapy clients have liked.   

WATER-BASED LUBRICANTS

  • You will probably have come across the water-based lubricants in your ‘medical’ journey.  These are used in gynaecology clinics and smear tests.
  • If you want to use one of the pelvic floor enhancing gadgets (see Gadget Girl!) then you will need to use a water-based lubricant to create a connection between the pelvic floor and the gadget.     Think of how they smeared your belly with gel to do your ultrasounds during your pregnancy. The equipment will need the same kind of contact.
  • A water-based lubricant also works well to help insert a tampon, without interfering with its absorbency.
  • You can use water-based lubricants with condoms and sex toys
  • Many people feel that water-based lubricants feel more natural, “wet”, with a realistic texture and they have no smell or taste.  They leave skin clean and residue free.
  • You can use them for instant topical relief of a dry and itchy feeling vagina and perineal area.  I have known clients keep theirs in the fridge for extra-soothingness!
  • Water-based lubricants can be effective in reducing vaginal dryness over the longer term by rehydrating the tissues (just like a facial moisturiser would do).

THINGS TO CONSIDER?

  • The most well known is the brand KY Jelly but it contains parabens and research1 has shown that the formulation of KY can irritate the sensitive vaginal tissue It can also feel sticky due to the high glycerine content.  Most chemists offer an own-brand version.  These might be well suited to a short examination procedure, or  to use with a pelvic floor exercising gadget, however for intimacy you might find that with the lower quality products can turn a bit ‘sticky’ and you should check the list of ingredients carefully avoiding glycerine, propylene glycol and parabens. 
  • They can be a bit of a devil to get from the tube to the needed body part without dripping. Related post (?!)  “applying personal lubricants without losing your momentum/dignity/sense of humour!

OIL-BASED LUBRICANTS

  • Oil-based lubricants should be formulated with natural plant-oil
  • Products made from mineral oil which is a petroleum bi-product are not suitable for vaginal use
  • Natural plant-oil based lubricants are longer lasting and can nourish dry tissue and make sex much more comfortable
  • They can be used as all-over massage oils as well as personal lubricants so their application to yours, and your partners, important bits can feel more like a natural and enjoyable part of foreplay.
  • Like the cosmetic equivalent face oils, they can protect and feed dry, intimate tissues but they cannot be re-hydrating as they do not contain water.  They can be just as soothing as water-based products and may be more comfortable if you suffer with vulvodynia or other vulval conditions

THINGS TO CONSIDER?

  • All oil based products including Vaseline, Baby Oil and Mineral Oil can affect latex and are not safe to use with condoms
  • They are not the right product to use with pelvic floor gadgets such as stimulation and biofeedback machines (these need a water-based lubricant to conduct electricity between you and the gadget).  When you are using a ‘gadget’ for exercise rather than ‘pleasure’ you may find a cheaper chemist own-brand water-based lubricant perfectly satisfactory for the purpose depending on your personal position about ingredients.
  • Water and oil-based lubricants are suitable for use with silicone toys
  • Silicone is a synthetic product which can offer longer lasting lubrication but doesn’t feel natural and cannot easily be removed with water. Silicone lubricants cannot be used with silicone sex toys but are safe to use with condoms.  They are usually well-tolerated but some people prefer to source a completely non-synthetic product, like the ones made with plant oils.
  • When trying a new lubricant it is always wise to do a patch test on the inside of your arm or wrist.

NOT ALL LUBRICANTS ARE THE SAME

As usual you get what you pay for.   The more expensive products have given attention to the quality of the ingredients and spared a thought for the packaging.  You only need a little bit each time and your intimate relationships are invaluable.  Treat yourself to something made for the purpose, in nice packaging and never run out!   

Please do let our Supported Mums readers know your preferences below and share any advice?  If you have come across a product that you think I should include in this list please let me know your recommendations?

YES®  www.yesyesyes.org

SYLK   www.sylk.co.uk

Boots own brand lubricating jelly    www.boots.com   

References:

11D. Edwards & N. Panay (2015): Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric, DOI: 10.3109/13697137.2015.1124259

2World Health Organization. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360 advisory note 2012 [7 July 2015]. Available from: http://apps.who.int/iris/bitstream/10665/76580/1/WHO_RHR_12.33_eng.pdf