How to Have Better Sex After Baby | Expert Advice from Dr. Brenda of Revitalize Physical Therapy

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This post is sponsored by Revitalize Physical Therapy, with offices in Wauwatosa and Hales Corners. We love sharing local resources our audience will find valuable and empowering. All opinions are our own.

Better sex after baby? Is it even possible? For many who have entered into that postpartum zone, the “6 week go-ahead” is somewhat of a daunting milestone. Will my body be ready? Will I even want to be intimate again? What if I look different….down there? Will my partner still find me attractive? Won’t it hurt? Will my body respond differently? There are SO. MANY. QUESTIONS. Plus, new parents are exhausted by lack of sleep, hormones in flux, and numerous other factors so sexual intimacy is often not at the top of the list.

But what happens when the six week mark turns into six months? Or six YEARS? Yes, it is possible to have the best sex of your life after having kids and we are thrilled to be partnering with Dr. Brenda Heinecke of Revitalize Physical Therapy to address some of the biggest issues that often stand in the way of patients having mind-blowing sex after baby.

So, let’s get down and dirty and talk about sex, baby.

Disclaimer: In the majority of this article, female pronouns and terms like “woman” and “women” are used. Pelvic floor therapy in the transgender community is a rapidly growing and evolving field and for the purposes of this conversation, we used female pronouns, however the information shared would absolutely apply to persons who identify as male or non-binary who have the genitalia discussed. Dr. Brenda recommends checking out the PT Clinic at the Aurora Women’s Pavilion where there is a physical therapist who frequently works with trans patients. If our audience knows of additional resources, we would LOVE to share them, so please don’t hesitate to let us know!

How to Have Better Sex After Baby (from Dr. Brenda)

As a pelvic floor physical therapist, I have heard it all. And I mean, ALL (so please don’t feel embarrassed!). I have been privy not only to the fine details of patients’ sex lives and the *weird* things that happen once in a while, but also to all of the outrageous advice women have been given. Advice like, “drink more wine” or “you just need to relax” or “it’s all in your head” or “give it more time.” All of which are terrible pieces of advice and usually not the solution. I hear women say over and over again that they thought these common issues were normal or part of having a baby.    

It is so frustrating to hear that women aren’t given any valuable advice to resolve their issues and that this is so commonplace now, but I am also heartbroken when I hear of women suffering for months, if not years, or are on the brink of divorce because of issues related to sex. Women rarely receive proper education and advice on these incredibly common sex issues. So I’m going to break down the 4 most common sexual health issues that women experience after having a baby and give you the information you need to resolve them.  

1. TIME

I’m going to get real with you right now. I just had my third baby in less than three years.  So I totally understand the struggle to find time (and energy) to make sex a priority.  Perhaps you find yourself in a similar situation and you long for the days of spontaneous sex. But your reality has changed, at least in this stage of motherhood.

While it might not be as romantic, scheduling sex with your partner is one way to get around this obstacle. It ensures that you make the time and effort to connect. Plus, it can also help “stoke the fire” beforehand when you are anticipating that standing appointment all day. Making a game plan with your partner will help you know that the kids will be taken care of, and you can get into the right mindset and enjoy your time together.

2. LIBIDO

Decreased libido is so common after baby and especially as we get older. When we welcome a new baby into our family, our mind and priorities shift and are focused on that baby and not on sex. However, our hormones play a big factor as well. During the postpartum period (and also during perimenopause), our estrogen levels tend to be low and this can cause decreased libido. Not only does a low libido kill the mood, but it also can lead to dryness issues. Believe it or not, diet can have a big impact on hormone regulation. Making sure you are getting an adequate amount of “good fat” is really important, especially postpartum. The fat molecules are required for your body to make hormones, especially estrogen and if you aren’t getting enough, your body will not make estrogen.  Consuming grass-fed, organic butter, avocado, nuts, olive oil, and salmon will help provide good quality fat for your body.

Another really common cause for decreased libido is impaired blood flow. If there isn’t enough blood flow coming to the pelvic area, it makes it much harder for the muscles to work properly and communicate well with the brain (which helps control libido). This is actually much more common than you may think! Common reasons for impaired blood flow include: Cesarean section scar tissue and adhesions, perineal tearing scar tissue, restrictions within the pelvic floor muscles (aka tightness and/or trigger points). The best thing you can do to help with this is manually releasing all of the restrictions with pelvic floor physical therapy (interested in getting your FREE Better Sex Blueprint? CLICK HERE!) to help restore good blood flow. After releasing these restrictions, we typically recommend using vibration in the area to also help bring in more blood flow. This can be done in a more “therapeutic” way if you are not comfortable utilizing a vibrator for more sexual reasons or situations.

3. PAIN

Guess what? Sex should NOT be painful or uncomfortable! Say it with me…sex should NOT be painful or uncomfortable. Over 50% of women have painful sex after baby. And actually, that statistic is likely higher because in my experience, women may not associate what they are feeling as “pain.” Instead, they may think it is just the position, dryness or not having enough foreplay. Or they are so used to having some discomfort that it’s all they know. Needless to say, this issue is so common…but it’s not normal. And it’s not something that you should suffer through, give more time in hopes that it just resolves, or dismiss it because you aren’t fully healed. Pain with sex is caused most commonly by scar tissue and overactive pelvic floor muscles. Watch this video to better understand the anatomy of the pelvic floor and the causes of painful sex:

Scar Tissue is a total mood-killer.

If you had an episiotomy or any tearing during childbirth, you will have scar tissue. Producing scar tissue is your body’s normal way of healing but it can be very painful and very limiting. This can feel like a sharp, stabbing pain, burning, pinpricks, or tugging. All of the connective tissue in the injured area gets “jumbled” up and is not aligned in a nice woven network like it should be. This is partially what scar tissue is and in order to resolve it, we work manually to realign the connective tissue and break up that scar tissue.

Too tight? That’s a thing?

What a lot of women don’t know is that the pelvic floor muscles may be overactive, or you can think of them as “too tight.” They will essentially get stuck in this contracted state and can’t relax well. Similar to your neck or shoulder muscles when you might be under a lot of stress. When this happens, it can cause pain. If the superficial pelvic floor muscles are overactive, there may be pain with penetration and pain located closer to the opening of the vagina. If the deep pelvic floor muscles are overactive, then pain will feel deeper and can be sharp stabbing or dull achy. What we do in pelvic floor physical therapy is assess all of the different muscles to determine which ones are causing pain and then determine where your scar tissue is (sometimes you may even have some from small tears that did not require stitches). Then we use a variety of manual treatment techniques with gentle pressure internally and externally to alleviate the pain.

Not all lubricants are created equal.

Oftentimes if you are experiencing pain, it can become a vicious cycle because you tend to tense up in anticipation of pain which only exacerbates the pain more. It also causes decreased libido and increased dryness because your body is anticipating pain. Using a good quality lubricant will ensure that dryness is not contributing to your pain. Check out our free lubricant guide for recommendations on good quality lubricants without all the harmful chemicals. And if you’re experiencing any of these sensations, please know that there is a real cause for it, that it’s not normal and it can be resolved quickly with the right treatment.

4. ORGASM

If you haven’t quite caught on to a theme yet, good blood flow is SO important for having better sex. It helps increase libido, minimize pain or discomfort and can also play a big role in your orgasm! Without proper blood flow, it is very difficult to achieve orgasm or your orgasm will be significantly diminished. As we discussed above, blood flow can be compromised due to tightness or restrictions within the muscles and/or connective tissue (ie: fascia) in and around the pelvis. Pelvic floor physical therapy is the best way to assess and resolve these issues since it is very difficult to do yourself. And these restrictions rarely resolve on their own or with more time.  

Having dysfunction of the pelvic floor muscles can also make it difficult to have an orgasm. During orgasm, these muscles will contract and relax, contributing to the sensations of orgasm. If the pelvic floor muscles can’t do that, reaching orgasm will be more difficult and if you do achieve orgasm, it will not be as strong. Now, before you just start doing kegels, please know that there is more to it than “just do kegels.” Yes, if the muscles are weak, strengthening them will help this and kegels can definitely do that. However, most women (80%, actually) do kegels incorrectly. And I have found that there are better exercises to strengthen the pelvic floor than plain ole’ kegels. As we talked about above, the pelvic floor muscles may also be overactive or “too tight.”  When this happens, the muscles will not be able to contract and relax properly, like what is needed for orgasm, but doing kegels will make the issue worse. Assessing the muscles to find out if they can contract and relax properly and why there are issues is imperative to know what to do to fix it.  

Could my medication be inhibiting my orgasm? Oh, come on!

Lastly, I want to mention that if you are taking a Selective Serotonin Reuptake Inhibitor (SSRI’s) medication for depression, this type of medication may inhibit the ability to orgasm no matter what you do with any of the above advice. They block the chemical pathway in the brain that is necessary for orgasm to occur so if you experience difficulty orgasming and are taking SSRI’s, this is why. This isn’t to tell you that SSRI’s are “bad” or to stop taking them, because mental health is imperative to your well-being. But it will help you understand why orgasm isn’t happening so you don’t feel as if your body is broken. You can still have intimacy and connection (and fun!) without having an orgasm.

Bring on the Better Sex

On a positive note, pelvic floor physical therapy can really help you resolve a lot of these common sex issues after baby. We have a specialized set of skills in addition to our general orthopedic treatment skill set that makes us able to properly treat all of the common “mom” issues with leaky bladder, diastasis recti, prolapse and SEX! All of the above issues rarely get better with time and having to prolong your suffering just isn’t necessary. I would highly encourage you to seek out help from a pelvic floor physical therapist to resolve your issues.

To take that first step, we are providing FREE sex assessments with one of our pelvic floor physical therapists at Revitalize Physical Therapy.

They will be able to help guide you with a treatment plan based on the root cause of your issues and will also provide you with a Personalized Better Sex Blueprint to lay out all the recommendations and steps to have better sex again! 

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Dr. Brenda Heinecke, PT, DPT, CSCS, is the owner and founder of Revitalize Physical Therapy and provides high quality women’s health physical therapy and sports performance enhancement.  She graduated from Northwestern University with a Doctorate of Physical Therapy, one of the top schools in the country. Through additional coursework and examination, she has become a Pelvic Floor Specialist and Certified Strength and Conditioning Specialist.  Dr. Heinecke is the proud member of the American Physical Therapy Association as well as several community organizations.

Her passion is helping women and athletes get better faster in order to live a healthy, active lifestyle for many years.  She also really enjoys working with athletes from unique sports and understanding the complexities of each sport.

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