Sexual Pain (Dyspareunia)

It is important to know that sex should not be painful. However, many women experience recurring pain during sexual intercourse after the birth of their baby. If you have never experienced this before it can be very distressing.

Some of the common reasons why you may be experiencing these new symptoms after having a baby could be (please note this is not an extensive list):

  • You had an episiotomy (a short cut at the entrance to the vagina) during the vaginal delivery. Scar tissue may form as a result of this incision or infection.
  • You had tearing of the perineum during the vaginal delivery. Scar tissue may form where the tearing occurred.
  • Breastfeeding can temporarily cause estrogen deficiency. This may result in dryness in the vagina or inadequate lubrication.
  • Fear or anxiety about resuming sexual intercourse may result in tensing or tightening of the pelvic floor muscles during attempted penetration. This may result in pain and may mean penetration is not possible. Pain then results in more bracing and then avoidance of the painful activity, intimacy and possibly even a decrease in sexual desire.
  • You may have a prolapse of one of the pelvic organs which is causing a lump or bulge in one of the vaginal walls. This may result in an obstruction that is painful.
No matter whether the sexual pain has only just started, or has been persisting for a while, a Physiotherapist with training in this area can help you. Firstly, we must determine the reason why you are experiencing sexual pain by conducting a thorough history and assessment. Then we can design a treatment plan individually tailored to you.

General Vulva Care

Clothing & Laundry
  • Wear all-cotton underwear or wear microfiber underwear with a cotton crotch. Underwear should never bind. Make sure you are wearing the right size. Avoid g-strings completely. Be aware of the pressure from elastic in panties.
  • Do not wear pantyhose. Wear thigh high or knee high hose instead.
  • Wear loose-fitting pants or skirts. Avoid jeans whose thick seams can irritate. Avoid tight lycra which hugs the vulva.
  • Take your underwear off when at home and go without underpants.
  • Do not wear underwear to bed. Avoid pajamas that ride up and bind. Wear nightgowns or oversized T-shirts.
  • Use detergents that are perfume and dye-free. Tide contains enzymes that bother some women. All Free and Clear detergent is generally safe. Detergents are not commonly related to vulvovaginal problems, but with persistent symptoms, all possible irritants must be considered.
  • Do not use bleach or fabric softener on undergarments. Use dryer balls to soften dried clothing.
  • Double-rinse underwear and any other clothing that comes into contact with the vulva if you are highly sensitive.
  • Use soft, white, unscented toilet paper.
  • Use lukewarm or cool salt baths or compresses to relieve burning or irritation. Follow the baths with patting dry and application of a small amount of Vaseline petroleum jelly. This is the treatment we call “soak and seal.”
  • If you are highly sensitive, avoid getting shampoo on the vulvar area.
  • Do not use bubble bath, feminine hygiene products, powder, cleansing wipes, or any perfumed creams or soaps. Two products that are recommended are Cetaphil gentle cleanser and Dove for Sensitive Skin soap.
  • Wash the vulva with cool to lukewarm water only, using your hand or a soft cloth. Do not scrub!
  • To remove stool, use plain mineral oil (or petroleum jelly) on soft toilet paper, rather than commercial wet wipes, even the ones made for babies.
  • Rinse the vulva with water after urinations if you wish. Blot to dry gently.
  • Use 100% cotton menstrual pads and tampons free of perfumes.
  • Avoid the use of daily panty liners. Change underwear as often as necessary to control wetness. Some menstrual pads with “wicking” material on the top surface can be irritating to the skin.
Sexual Intercourse
  • Use a lubricant, if necessary, but make sure it is water-soluble if condoms are being used (e.g. Astroglide-Free) or silicone-based (e.g. Pjur). Be aware that some lubricants contain propylene glycol (P.G.) which is irritating to some women. A dab of almond or olive oil is fine if no condoms are used. Oil-based products can break down rubber condoms. For women attempting pregnancy, Preseed is recommended.
  • Ask your GP for a prescription for a topical anesthetic e.g. lidocaine 5% ointment, which can be put into the vaginal opening for 10 – 15 mins, then wiped off prior to intercourse. Lidocaine may sting for a few moments after application, but then will numb the skin. Avoid the clitoris.
  • Apply crushed ice or frozen gel packs (lunch box sized) wrapped in one layer of a hand towel to relieve burning after intercourse. Frozen corn or peas in a small sealed plastic bag covered with a cloth fit comfortably to the vulvar anatomy.
  • Urinate (to prevent infection) and rinse the vulva with cool water after intercourse. To further protect against urinary tract infection, guide your partner’s penis or any sex toy into the vagina with your own hand to avoid contacting your anal area. Organisms normally harmless there may cause infection if introduced into your urethra on the way to the vagina.
Physical Exercise
  • Avoid exercises that put direct pressure on the vulva such as bicycle riding and horseback riding. Look online for special bicycle seats that can alleviate pressure against the vulva.
  • Limit intense exercises that create a lot of friction in the vulvar area; try low intensity exercises such as walking.
  • Enroll in a yoga class to learn stretching and relaxation exercises.
  • Do not swim in highly chlorinated pools. Salt water pools seem to cause fewer reactions.
  • Avoid the use of hot tubs.
Everyday Living
  • Use a foam rubber donut for long periods of sitting.
  • If you must sit at work, try to intersperse periods of standing; put on a timer that reminds you to get up and walk around. Think about using a computer on wheels that allows you to stand.
  • Learn some relaxation techniques to do during the day. The Relaxation and Stress Reduction Workbook by Davis, Eshelman and McKay; The Chronic Pain Control Workbook by Catalano and Hardin; Managing Pain Before It Manages You by Caudill.
  • Diet: Eating a health, well-rounded diet is important for good health and a sense of well-being in everyone. Other than that, diet is not thought to play a role in vulvovaginal disorders, even in the case of frequent yeast infections. Ingestion of probiotics may be helpful in cases of bacterial vaginosis (more studies are needed), but does not seem to play a role in the prevention or treatment of yeast infections. Obesity produces more skin folds that may accumulate moisture or cause increased friction, increasing discomfort.
  • Urinary incontinence: many women who have leakage of urine also have vulvar skin irritation. The use of daily panty liners or urine-catching panties encourages irritation and unwanted moisture. Try to minimize the wearing of these protective pads or panties. Use Vaseline as a barrier after using the bathroom, to protect the skin. See medical help if urinary leakage is a significant problem.