Painful sex after birth is common, but that doesn’t mean you have to wait for it to get better on its own. Here’s why it happens, what your pelvic floor may have to do with it, and what can actually help.
If sex hurts after having a baby, there is usually a reason. Vaginal dryness, scar tissue from tearing or a C-section, and a pelvic floor that is holding too much tension can all make sex painful postpartum, even when you have been told that everything has healed.
And this is where “cleared at six weeks” can get confusing. Being medically healed does not necessarily mean sex will feel comfortable again, and if it burns, feels tight, hurts at your scar or simply does not feel right, waiting longer is not your only option.
We hear some version of this at Oona all the time, often from someone who has been dealing with it quietly for months because they assumed it was simply another part of postpartum recovery.
The short answer
Painful sex after having a baby is common, but common does not mean you have to keep living with it. Hormonal changes and vaginal dryness, scar tissue after tearing, an episiotomy or a C-section, and pelvic floor muscles that may be having difficulty relaxing can all contribute. Often, more than one thing is happening at the same time.
And if you are wondering just how common this really is, the numbers are pretty striking. Research looking at more than 11,000 people found that about 43% were still experiencing painful sex between two and six months postpartum. Even between six and twelve months, it was still affecting about 1 in 5. So if sex still hurts months after having a baby, you are far from the only one, but that does not mean you have to keep waiting for it to get better.
If sex keeps hurting, you are avoiding it because you already know it is going to hurt, or you are months or even years postpartum and wondering whether anything can still change, it is worth finding out why.
Pelvic floor physiotherapy at Oona is one place to start.
Is it normal for sex to hurt after having a baby?
Painful sex after birth is somewhat common, but that certainly doesn’t mean that it’s something you should simply accept as your new normal.
After your body has been through pregnancy and birth, your hormones are changing rapidly, tissue may still be healing and, depending on how you gave birth, you may also be dealing with a perineal or Caesarean scar. Some discomfort may be present when you first return to sex after having a baby. What matters is what happens next.
If things are gradually becoming more comfortable, that’s great! If sex hurts every time, you are months postpartum with no real improvement, penetration feels impossible, or you have started avoiding intimacy because you are anticipating discomfort, we would absolutely not tell you to simply keep waiting.
There may be a very specific reason it hurts, and having an expert help you understand why is much more useful than guessing.
What causes painful sex postpartum?
There are a few reasons sex can hurt after having a baby, and these reasons often overlap. Your hormones may be affecting how dry or sensitive the vaginal tissue feels at the same time that a perineal or Caesarean scar is still tender or restricted. Your pelvic floor can be part of the picture too, particularly if those muscles have been holding tension through pregnancy, birth and recovery or have started bracing because something has hurt before. This is why an accurate diagnosis is important, because the reason sex hurts for you may be very different from the reason it hurts for someone else.
Sometimes, advice that works beautifully for one person can do almost nothing for another. More lubricant can be incredibly helpful if dryness is driving the discomfort, but it cannot change a sensitive scar or teach a pelvic floor that is holding tension how to relax.
The first job is understanding what is actually causing your pain.
Where does it hurt? The location can give us some clues
One of the first things a pelvic floor physiotherapist will ask is where you feel the pain because that can help narrow down what may be contributing to it.
Burning or pain at the vaginal opening
If the pain is right at the entrance and feels like burning, stinging, tightness or tearing, dryness may be contributing. Scar tissue after a perineal tear or episiotomy and tension in the more superficial pelvic floor muscles can also make penetration uncomfortable. Any compromised skin around the vulva can cause pain – even if it’s not an actual skin tear, even just a bit of a graze on that skin can be painful or feel somewhat raw.
Deep pain during sex
Pain that feels deeper in the pelvis, particularly with deeper penetration or in certain positions, may involve the deeper pelvic floor muscles or other structures around the pelvis and hips.
Deep pelvic pain can also have causes unrelated to pregnancy or birth. If something in your history or assessment suggests that another pelvic or gynaecological concern may be involved, that deserves its own medical assessment.
Pain after sex
Sometimes sex itself feels reasonably comfortable but aching, burning or pelvic discomfort shows up afterward and lasts for hours.
That can be another clue that the pelvic floor was working overtime throughout the experience, even if you did not notice it at the time.
Can breastfeeding cause painful sex?
Breastfeeding can contribute to painful sex, particularly when vaginal dryness is involved, but it is not the only reason painful sex happens postpartum.
During lactation, higher prolactin levels are associated with lower estrogen levels. That hormonal environment can affect vaginal tissue and natural lubrication, and research has found vaginal dryness to be very common among people who are breastfeeding postpartum.
For some people it feels obviously dry. For others, it feels more like burning, rawness, sensitivity or tightness with penetration.
Lubricant can make a very real difference here. A non-hormonal vaginal moisturiser may also be useful when dryness is happening outside of sex rather than only during penetration.
If dryness is significant or persistent, talk with your physician or nurse practitioner. There are medical treatment options that may be appropriate for some people, but that decision should be made individually, particularly while breastfeeding.
And if you are not breastfeeding, you can still experience postpartum dryness. Hormones do not immediately return to their pre-pregnancy state after birth.
Why does sex hurt after a tear, episiotomy or stitches?
A scar can look beautifully healed and still not move or feel like the tissue that was there before.
After a perineal tear or episiotomy, scar tissue may feel sensitive to touch or stretch, less mobile than the surrounding tissue, or as though it is pulling when penetration happens.
This is one of those things that is difficult to diagnose by looking in a mirror. A pelvic floor physiotherapist can assess the scar itself as well as the muscles around it and determine whether scar sensitivity, tissue mobility or pelvic floor tension may be contributing.
When appropriate, treatment can include scar mobilisation, desensitisation and exercises or techniques you can continue at home.
Why does sex hurt after a C-section?
If you had a C-section, painful sex can feel especially confusing. There was no vaginal birth, so why would it hurt? Here’s the thing: a C-section doesn’t remove your pelvic floor, or the rest of your postpartum recovery, from the equation.
Your pelvic floor still had to change to accommodate the weight of a uterus, fluid, placenta and a baby throughout pregnancy, your hormones still change after birth, and if you are breastfeeding, those hormonal changes can make vaginal tissue feel much drier and more sensitive. You are also healing from abdominal surgery, and the scar and surrounding tissues can sometimes remain sensitive or restricted after the incision itself has healed. There can be several reasons sex feels different or painful after a C-section, and none of them requires you to have given birth vaginally.
At Oona, pelvic floor physiotherapy can include assessment and treatment of Caesarean scars when that is relevant to what you are experiencing.
We also offer Dolphin Neurostim scar treatment in Toronto and Newmarket for people whose C-section scar remains painful, numb, tight, itchy or restricted.
If your scar is still bothering you months or years later, it is not automatically too late to work on it. Our C-section scar treatment guide explains what healing can look like well beyond the first six weeks.
Can a tight pelvic floor cause painful sex?
Yes, and this is probably one of the most important things to understand before you start doing Kegels because somebody told you that everyone should do them after having a baby.
Your pelvic floor does not simply need to be “strong.”
Those muscles need to contract when you need them, relax when you need them and coordinate with your breathing, abdomen, hips and the rest of your body.
If your pelvic floor is already holding too much tension, repeatedly asking it to contract more may not be what it needs, and in fact you might not be able to access it when you need to because it’s already too tight. Think of it this way: if your bicep muscle is always maximally contracted, if you ask it to contract a little bit more to help you carry a heavy bag of groceries home, it will have nowhere to go. Your pelvic floor is exactly the same.
Pain itself can also create tension. If penetration has hurt several times, your body can begin preparing for that pain before it happens. The pelvic floor tightens, penetration becomes more uncomfortable, and the next time your body has even more reason to brace.
That does not mean every person with painful sex has a tight pelvic floor, and it does not mean strengthening is never appropriate. It means you cannot know what your pelvic floor needs from a generic postpartum exercise list.
That is exactly what an individual pelvic floor physiotherapy assessment is for.
A useful rule: if sex keeps hurting, you do not need to keep testing it to see whether next time will be different.
What can help painful sex after birth?
The best treatment depends on why sex is hurting in the first place, but there are a few things you can try while you are figuring that out.
Use lubricant generously
If dryness seems to be part of the problem, use lubricant generously and reapply when you need it. If the tissue is already sensitive, a simple water-based or silicone-based product without warming ingredients, fragrance or other additives may be more comfortable. It’s worth finding a lubricant that maintains the normal pH of the vagina, as well.
Give yourself more time
Give yourself more time for arousal than you think you should need. Your body has changed enormously and it may not respond on the same timeline it did before pregnancy. Arousal increases blood flow and natural lubrication, so this is not an optional warm-up you need to rush through.
Choose positions where you control the depth and pace
Positions where you control the depth and pace of penetration can make a difference, particularly if deeper penetration is uncomfortable.
Do not keep pushing through pain
You do not need to keep pushing through pain to see whether eventually your body gets used to it.
If it hurts, stop, change what you are doing or take penetration off the table for now. Repeated painful experiences can reinforce the very guarding response you are trying to settle.
And if you have tried lubricant, more time, different positions and waiting, and it still hurts, you have not failed at fixing this yourself. You have simply reached the point where more information would probably be useful.
What does pelvic floor physiotherapy for painful sex actually involve?
A lot of people hesitate to book because they assume pelvic floor physiotherapy means an internal examination the moment they walk through the door. It does not.
Your first appointment starts with talking about what has actually been happening. Your physiotherapist will want to know about your pregnancy and birth, where the pain is, when it happens, what it feels like, what you have tried and what you want to be able to do comfortably again.
They may also assess things such as your breathing, abdomen, hips, pelvis and movement because the pelvic floor does not work separately from the rest of your body.
An internal pelvic floor assessment may be offered if it would provide useful information about muscle tone, coordination, tenderness or scar tissue. It is always your choice. You can start externally, ask as many questions as you need to and decide what you are comfortable with as you go.
Treatment is equally individual. Depending on what your physiotherapist finds, care might involve helping overactive muscles relax, working with scar tissue, breathing and coordination exercises, gradually returning to comfortable penetration, or strengthening when strength is actually what you need.
There is no standard set of postpartum Kegels waiting for you at the end.
How long after birth should sex stop hurting?
There is no magic point in postpartum when sex is suddenly supposed to feel the way it did before you had a baby. For some people it feels comfortable again fairly quickly, and for others it takes much longer. In fact, research found that about 43% of people were still experiencing painful sex between two and six months postpartum, and about 1 in 5 were still dealing with it between six and twelve months. So while it is very common for sex to still hurt months after having a baby, that does not mean you need to keep waiting and hoping it eventually sorts itself out.
They do not tell us that you should wait a year before asking for help.
If pain is recurring, not improving, stopping you from having the kind of intimacy you want, or simply bothering you enough that you keep wondering about it, that is reason enough to bring it up.
Can sex still hurt years after having a baby?
Absolutely.
We see people at Oona whose babies stopped being babies a very long time ago.
A scar can remain sensitive or restricted. A pelvic floor can continue to hold tension. Pelvic pain that started around pregnancy or birth can become persistent, and once the body has spent years adapting around discomfort, the picture may be more complicated than it was at six months postpartum.
More complicated does not mean there is nothing to do.
If pelvic pain has become part of everyday life rather than something that happens only during sex, our guide to chronic pelvic pain looks more closely at the different pieces that may be involved.
When does painful sex after birth need a closer medical look?
Not every cause of painful sex postpartum is something pelvic floor physiotherapy should treat.
Talk with your physician, midwife or other appropriate medical provider if you have bleeding after sex that concerns you, fever, unusual discharge, worsening pain, a repair site that does not seem to be healing or an area of tissue that looks or feels unusual.
Granulation tissue, retained sutures, infection and some gynaecological conditions need medical assessment and may require treatment outside physiotherapy.
It is also worth investigating pain that existed before pregnancy and has returned or worsened, particularly if it is associated with bowel concerns, significant bladder concerns or other persistent pelvic pain.
The right practitioner should be just as comfortable telling you when something is outside their scope as they are telling you how they can help.
Pelvic floor physiotherapy for painful sex in Toronto and Newmarket
Pain during or after sex is one of the concerns our pelvic floor physiotherapists see at Oona.
Our pelvic health physiotherapists work with people during pregnancy, after vaginal and Caesarean births, and years into postpartum life. They assess the whole picture rather than assuming every postpartum pelvic floor needs the same treatment.
That might mean working on pelvic floor tension, a perineal or Caesarean scar, strength and coordination, or a combination of several things.
Because Oona is multidisciplinary, your physiotherapist can also connect your care with another practitioner when there is a reason to. If you are carrying a lot of tension elsewhere in your body, registered massage therapy may be useful alongside your pelvic floor care. If pain, birth or intimacy has become emotionally difficult, mental health support is available too.
Connected care does not mean seeing every practitioner at Oona. It means that if another piece of the picture needs attention, the right person is here.
No referral is needed to book pelvic floor physiotherapy, and new patients are welcome at both locations.
Ready to have someone take a proper look?
Book pelvic floor physiotherapy directly at the Oona location that works for you.
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Not sure pelvic floor physiotherapy is where you should start?
You do not need to figure that out before you contact us. Our free 20-minute Care Navigator call is there for exactly that reason. Tell us what has been going on and we will help you understand where it makes sense to start.
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Frequently asked questions about painful sex postpartum
Is painful sex after birth caused by a weak pelvic floor?
Not necessarily. Painful sex can happen alongside weakness, but pelvic floor tension, guarding or difficulty relaxing can also contribute. This is why Kegels are not automatically the right exercise for painful sex postpartum. A pelvic floor physiotherapist can assess how your muscles are actually functioning before recommending treatment.
Why does sex hurt after a C-section if I did not tear?
Because tearing is only one possible reason for painful sex after birth. Postpartum hormonal changes can contribute to vaginal dryness regardless of how you gave birth, your pelvic floor still supported your pregnancy, and your Caesarean scar and abdominal recovery can affect the way your core and pelvis function together.
Does breastfeeding cause painful sex?
Breastfeeding can contribute to vaginal dryness because of the hormonal changes associated with lactation, and dryness can make penetration painful. It is not the only possible cause of postpartum painful sex, however. Scar tissue, pelvic floor tension and other factors may also be involved.
Do I need an internal exam for pelvic floor physiotherapy?
No. An internal assessment can provide useful information about pelvic floor muscle tone, tenderness, coordination and scar tissue, but it is optional. Your physiotherapist can begin with your history and an external assessment, explain why an internal assessment might be useful and let you decide whether you want one.
Does pelvic floor physiotherapy for painful sex hurt?
The goal is not to make you tolerate more pain. Your physiotherapist should work within what feels comfortable for you and adjust the assessment or treatment based on what you are feeling. When pain and guarding are part of the problem, repeatedly provoking that pain is not the goal.
Can I bring my baby to pelvic floor physiotherapy at Oona?
Absolutely. Babies are part of life at Oona, and they are always welcome at your appointment. Feed them, hold them, bring the stroller, take a break if you need to. We will work around both of you so you can get the care you need without worrying about how perfectly the appointment goes.
You are allowed to ask about this
Painful sex can be one of those postpartum concerns that gets pushed further and further down the list because there is always something more immediate happening.
The baby needs something. You are tired. You were told you healed. Maybe sex is not exactly at the top of your priority list anyway, so you wait.
But if you want sex to feel comfortable again and it does not, that matters.
You do not need to come to Oona already knowing whether the pain is coming from your hormones, your scar, your pelvic floor or a combination of things. Whether you are a few months postpartum or it has been years since you had your baby, we can start with what you are experiencing now, figure out what may be contributing to it and make sure you are getting the kind of care that actually makes sense for you.
