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February 25, 2022

I Had a Cesarean… So Why Do I Have Pain with Intercourse?

A few things before we dive in: 

1. The pain you feel is valid; it is real and it is explainable.

2. You are not alone; pain with intercourse is a very common experience for women after a cesarean.

3. Postpartum care for sex is not just for women who delivered vaginally; there is treatment available and every person who has had a cesarean needs scar work and pelvic health PT.

Sadly, we see so many post-cesarean women struggling with confusion when intercourse is painful for them because they did not expect it or know that it is common. This is in large part due to the lack of education out there about the physical aspects that can be challenging after a cesarean. Our culture has done a good job bringing painful intercourse to light for postpartum women who had vaginal deliveries, but not as much for women who have had cesarean deliveries.

So today, we want to validate you in your pain and say “that makes sense, and here’s why.” Some contributing factors to painful intercourse after cesareans include:

Abdominal Scarring:

Your scar is more complicated than you think. When you have a cesarean, they have to cut through 6 layers of tissue, including skin, fascia, muscle, the uterus, etc. Thus, the scar can contribute to restrictions in any or all of these layers.

For example, restrictions in the abdominal fascia can lead to restrictions in your pelvic floor, all the way down to your labia. Fascia is a thin layer of tissue covering every organ, muscle, blood vessel, etc. in your body. (Think plastic wrap that is wrapped around your muscles and organs) So when fascia becomes bunched near an incision or even with pregnancy, it can limit a muscle’s ability to move or stretch with arousal or with penetration, which can cause pain with sex.

Labor Progression Prior to Cesarean: 

If you went through labor prior to your cesarean, then you could have some scarring or “skid-marks” on your pelvic floor muscles that are contributing to intercourse being uncomfortable or painful. Also, your pelvis likely expanded and shifted during labor and may still need some PT to help it align.

Pelvic Floor Muscle Guarding and Tension: 

Our pelvic floor can be very protective of us after having a baby whether via cesarean or vaginal. Our pelvic floor muscles tend to guard out of protection for the transition that our body just went through, which can cause pain at the opening or deeper in with penetration. 

Also, you did carry a baby for 9 months, which can lead to changes in your pelvic floor, such as muscle tension, which is the most common contributing factor to painful intercourse. 

Decreased Estrogen if you are Breastfeeding: 

A change in estrogen levels can lead to vaginal dryness, causing intercourse to feel very uncomfortable. Something we work on in PT is getting proper blood flow to the muscles, which can improve lubrication and the muscle’s ability to stretch. 

If you’ve had a cesarean, whether planned, or unplanned,  and you’re feeling like your pelvic floor issues were dismissed or weren’t justified, we’re here to tell you, you are NOT alone and we’re here for you. 

Pelvic floor physical therapy can be helpful for all of the above contributing factors to painful intercourse. PT can also be life-changing for cesarean scar care alone. Contact us if we can help you in any way!


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