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Post baby hanky panky? For some women, it’s painful.

By Natalie Rosen

This blog is a summary of our published article: Rosen, N. O., Dawson, S. J., Binik, Y. M., Pierce, M., Brooks, M., Pukall, C., Chorney, J., Snelgrove-Clarke, E., & George, R. (2022). Predictors of two trajectories of dyspareunia from pregnancy to 24 months postpartum. Obstetrics & Gynecology. https://doi.org/10.1097/AOG.0000000000004662

When new parents hear “post-baby-hanky-panky”, some automatically think “hells no!”, “yeah right”, and “who has time for that?”, while others are thinking “yes please”, “get me back in the saddle” and “I need some adults-only time”.

Whenever you’re ready, you probably weren’t expecting sex to be painful. So if or when this happens, your next questions might be: “Is this normal?”, “how long will the pain last?”, and “what can help?”

You’re not alone with these questions and we conducted a study to find out some answers. You can find a brief video summarizing the results as part of the postbabyhankypanky series, “Pain During Sex”

What did we want to know?

In this study, we wanted to answer two main questions:

  1. Is new mothers’ pain during vaginal intercourse—called dyspareunia—captured by one or multiple patterns of change over time?
  2. What factors predict these patterns of change?

What did we do?

We recruited 582 people from the IWK Health Centre in Halifax, Nova Scotia during their 20-week ultrasound appointment. Participants completed surveys online twice in pregnancy (20-weeks and 32-weeks) and again at 3-, 6-, 12- and 24-months postpartum, answering questions about their pain experiences. We also collected information via from their medical records related to their labour and delivery.

Two White women, one in a lab coat, likely a doctor, and another in casual dress. Doctor is holding a clipboard and speaking while the other women listens, Both seated and in front of a white background
Photo by MART PRODUCTION from Pexels

 

What did we find?

Pain during sex was pretty common, ranging from 31% of people reporting pain at -months postpartum to 12% at 2 years postpartum.  But we also found two distinct groups for pain during sex, illustrated in the figure below:
While 79% experienced little pain, we found that 21% experienced moderate—that is, fairly significant—pain when they attempted vaginal intercourse. That’s 1 in 5 women.  By “significant”, we mean that women reported their pain to be on average > 4 on a scale of 0 = no pain at all and 10 = worst pain imaginable. For most people in both groups, the pain worsened during pregnancy and peaked at 3-months postpartum, then steadily decreased from there, with little change after the first year. You might be wondering if things like prior chronic pain, how you delivered the baby (vaginally vs caesarian section), if you had any vaginal tearing, received an epidural, had an episiotomy or even if breastfeeding has something to do with what pain group people fell into. The good news is that none of these biomedical factors seemed to play a role in predicting whether women would fall into the moderate or minimal pain group.  But we did find one key psychological factor to look out for. Those who reported a lot of negative thoughts and feelings about pain—which is called pain catastrophizing—at 3-months postpartum were more likely to experience moderate and persistent pain during sex throughout pregnancy and the postpartum period.

 

Why are these findings important?

Welcoming a new baby is one of the most universal experiences of women worldwide and presents many new challenges for parents. Sex is one important way that couples report feeling connected to each other and it helps them to face these new challenges as a team. Our study suggests that a significant minority of women—1 in 5—report moderate and persistent pain during sex in pregnancy and up to 2 years postpartum, which can interfere with their ability to reap the benefits of a satisfying sexual relationship. The fact that biomedical factors, which largely can’t be changed, did not predict which pain group women fell into may be reassuring to first-time mothers. The results from this study can be used to help health care professionals identify who is at risk of persistent pain difficulties and might benefit from early intervention, particularly those who are having a lot of negative thoughts and feelings about the pain and its impacts.
A mixed gender couple cuddles together with a baby in between them on a bed, sharing a white blanket.

Photo by William Fortunato from Pexels

What’s next?

If this sounds familiar, talk with your healthcare professional as there are proven ways to help manage the pain, including cognitive-behavioral therapy, pelvic floor physical therapy, and topical medications. You are not alone if you’re experiencing this pain and it’s gone on longer than you thought. Have a look at some of these tips for talking to your partner about sex. You can also check out the other videos in the #postbabyhankypanky series, whose broader goal is to normalize sexual concerns postpartum and to increase communication about sex after baby. You might even share these videos with your partner as a way of starting the conversation.  And consider talking to a health care professional for additional help.

 

References

Rosen, N. O., Dawson, S. J., Binik, Y. M., Pierce, M., Brooks, M., Pukall, C., Chorney, J., Snelgrove-Clarke, E., & George, R. (2022). Predictors of two trajectories of dyspareunia from pregnancy to 24 months postpartum. Obstetrics & Gynecology. https://doi.org/10.1097/AOG.0000000000004662

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