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Dr. Caroline Morgan, St. Luke's Hospital

Women don't have to live with painful intimacy after childbirth

Changes to expect during pregnancy fill the pages of every pregnancy book - from your growing belly and stretch marks to nausea and swelling feet. But you're not likely to find a chapter on the much-less-talked-about topic of painful sexual intercourse after childbirth. Many women are hesitant to bring this up even with their doctors, and it often goes undiagnosed.

Six weeks of pelvic rest is recommended after childbirth. During pregnancy, and especially a vaginal birth, the pelvic floor muscles get stretched out. This group of muscles connects to the vagina and serves as a hammock to support pelvic organs like the uterus and bladder. After childbirth, it takes about six weeks for them to contract back to their normal, pre-pregnancy position.

Since most women have a six-week postpartum visit with their doctor, it's a good time to bring up the subject of painful intercourse. It may be caused by a number of things, and your doctor can usually diagnose the problem by asking you a few questions and performing a pelvic exam.

During the exam, your doctor will make sure an episiotomy (an incision made to assist in vaginal birth) or tear has healed properly and that there is no infection. Normal scar tissue that forms may cause some discomfort. While it typically improves over time on its own, massaging estrogen cream onto the area can help. If vaginal dryness is making intimacy painful, try using over-the-counter lubricants.

The most common cause of painful intercourse after childbirth is myofascial pain or pelvic floor dysfunction caused by stretching of the pelvic floor muscles that become very tender to the touch and create trigger points of pain. If pain or problems persist beyond the six-week rest period, pelvic physical therapy can be very effective. A specially-trained therapist can provide treatments and exercises to help strengthen and tone the pelvic muscles. Some women may also experience some degree of incontinence. This, too, may resolve on its own as the muscles heal, or it can be helped by pelvic therapy. If it continues, tell your doctor.

If you experience painful intercourse months after childbirth, don't be embarrassed to talk with your doctor. It may be easily treated or signal a more serious problem.

Dr. Caroline Morgan is a board-certified OB/GYN at St. Luke's Hospital. Call 314-576-0930 or visit her Physician Referral page.

This article was published in the St. Louis Post-Dispatch on March 10, 2011.

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