I think all mamas, regardless of whether you tore during childbirth should have a visit with a pelvic floor specialist. I’m not sure why it isn’t standard care, but we all know mothers tend to be the after thought when it comes to having babies in the US. I think it’s important though because all those muscles had to stretch and work over time to push baby out and into the world. Even if you don’t have any obvious issues, it’s always good to check. I definitely was peeing my pants for a little white after having Olive during random times like getting up from the couch. Haha. Seriously, so weird but it was happening!
I was able to have several appointments with Jessica Jenkins (coincidentally, I photographed her gorgeous self for an artful nude maternity session!) and she helped me tremendously with getting my pelvic floor back into a healthier state. She also showed me how to work on the scar tissue from tearing which ultimately made the biggest difference for me when it came to sex after baby. Highly recommend her! She was kind enough to write a blog post for me and YOU so here are her words:
So you just had a baby… and you may be wondering about how and when to return to having sex.
Your OBGYN or midwife will recommend that you abstain from intercourse for 6 weeks after having your baby. This is important to adhere to because your cervix is not closed and your uterus is still healing. Introducing anything into the vagina will put you at risk for dangerous infections. This does not mean you cannot have an orgasm, or be intimate with your partner in other ways, but nothing should be inserted into the vagina unless your doctor says otherwise.
Some women may find the idea of sex so soon after having a baby laughable. This is normal too. Certain hormones are still surging at this time which keep our desires for intimacy at bay and our attention mainly on our babies. But we also have hormones that are being produced at a much lower rate than normal, like estrogen. Estrogen is responsible for lubricating the vagina and also keeping our pelvic muscles and vulvar tissues plump and flexible. When you lack estrogen you may feel drier than normal and may be unable to produce much personal lubricant which can not only reduce desire, but also can make sex (or even the attempt at sex) painful.
There are multiple things you can do to help with painful intercourse. First, do not keep attempting to have sex if it is painful. Tell your doctor or midwife that you are having any pain no matter how big or small. Many times she or he can prescribe you topical or intravaginal estrogen. More recently, I have seen them prescribe it as just a pea-sized amount used every other day at the vaginal opening compared to the intravaginal use which is a tube of cream inserted twice a week. So likely you won’t have to worry about a goopy mess. This, surprisingly, can be all you need to feel a lot better. If this is not something you need, or it doesn’t seem to be doing the trick, ask to get a prescription for pelvic floor physical therapy.
In many countries, pelvic floor physical therapy is the standard of care for every woman who is postpartum. Pelvic floor therapists understand all the nuances that have happened to your body and can give you exercises, manual work, postural and ergonomic training, and pain management strategies to help. If you want to get back to sex, but are feeling pain or maybe even worried that things aren’t the same down there, a pelvic floor physical therapist can help. An internal exam can be performed. We do not use stirrups or speculums, just a single finger, and there are no requests to keep “scooting down” into a bright and hot spotlight. If you are not comfortable with an internal exam, that is always your choice and is never a must. There are lots of different tools that can be utilized to help relax your pelvic floor or strengthen it. Physical therapy treatments are very successful and have few to no side effects. I recommend physical therapy to all my fellow mothers that I encounter, but I might be biased since I am both a therapist and a mother.
Many insurances don’t require a referral to see a physical therapist, but usually your doctor or midwife will gladly give you one. It is never too late to help heal our bodies no matter how far postpartum you are. Please let me know if you have any questions or need to find a pelvic floor physical therapist near you. Jessica.Jenkins2@UHhospitals.org