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:

• # 1 what is good postnatal sex anyway & what if things are really not right
• #2  what to do when postnatal sex is painful
• # 3  what to do when postnatal sex is just a bit flat

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:

• # 1 what is good postnatal sex anyway & what if things are really not right
• #2  what to do when postnatal sex is painful
• # 3  what to do when postnatal sex is just a bit flat

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