Research shows that the majority of women experience pain the first time they have sex after childbirth, regardless of whether they had a vaginal or c-section birth.

A study, from the Murdoch Children’s Research Institute, Australia, showed women who had given birth via c-section were twice as likely to experience painful sex 18 months after birth, compared with women who had a spontaneous vaginal birth.

Most health media websites agree it’s common for women to experience pain when resuming sex after c-section birth.

Furthermore, the American College of Obstetricians and Gynecologists states that nearly 75% of women experience painful sexual intercourse at some point in their lives, regardless of whether they give birth or not.

This data is absolutely devastating. Many women experience pain related to sexual activities; however, many women resume sex in the postpartum period as soon as possible, thinking more about their partner’s pleasure than their own pain.

Ongoing, painful sex after a cesarean delivery is something most women don’t expect.

What causes it, and how can it be treated or avoided?

When should I have sex after a c-section?

Any healthcare professional would recommend waiting at least 6 weeks after birth before having sex. This applies to women who have vaginal and c-section births.

Most c-sections are performed after labor has begun (emergency c-section), which means your body has undergone at least some of the physical changes of normal labor and birth.

It takes about 6 weeks for the cervix to close completely and for any postpartum vaginal bleeding to stop. A six-week delay also gives your body time to recover from surgery. Your incision needs time to heal, and there is likely to be bruising and tenderness around the site for some time.

Six weeks postpartum is just the average time the postpartum body needs to heal. Some women will wait longer than 6 weeks before having sex again, depending on how they feel, both physically and emotionally.

No woman should feel pressured to have postpartum sex before she feels ready for it. No woman should feel pressured to have sexual intercourse at any point in her life.

Painful sex after c-section?

Even if they have waited 6 weeks after birth before having sex again, some women experience pain during intercourse, which can be distressing.

The pain can range from a burning sensation to a feeling of painful internal pressure.

Here are the main causes of painful sex after c-section:

Low estrogen levels

A lot of hormonal changes occur after giving birth.

The hormone estrogen helps maintain the tissues in the vagina, keeping them supple and well lubricated. Breastfeeding can keep estrogen levels low, which means during sex, women can feel a lot of discomfort or pain, due to dryness and friction.

Using lube before sexual penetration sometimes helps – but not always. Some women are prescribed estrogen cream for vaginal dryness. This often resolves the problem within a few weeks.

Usually, estrogen levels will increase and return to normal levels when your menstrual cycle returns.

Pain around incision scar

The most common incision used for a cesarean delivery today is the ‘bikini’, or horizontal incision. The incision is made through the lower abdomen, just above the pubic hairline.

When the incision heals, the scarring isn’t just on the skin surface. There is also scarring to the tissue underneath the incision site, and to the uterus. These scar areas have restricted blood flow, and can be very sensitive to touch.

Many women who have had a cesarean section often prefer that their incision scar isn’t touched during sex. They might be surprised to find they also experience pain internally, even when their incision has long healed.

The scarring caused by the c-section incision can cause the muscles nearby to refer pain to certain areas such as the clitoris. The ligaments of the pelvic floor muscles run from the uterus to the labia. These ligaments can be caught in scar tissue, and certain movements can cause significant labial pain.

Fortunately, scarring can be improved, or even corrected, by making the scar tissue more flexible. This is done with scar tissue release therapy. With this physical therapy, the scar tissue is massaged and manipulated to become softer, which reduces tightness. It also breaks up any adhesions, where the scar tissue has attached to ligaments or to the uterine wall.

Pelvic floor dysfunction

It’s a common myth that pelvic floor problems only occur after vaginal births.

Pregnancy is the biggest culprit, as the muscles and tissues connected to the front and back of the pelvis are often stretched and even injured.

This can lead to tight muscles in the pelvic floor. These muscles spasm and become very tense, leading to painful sex. Women feel generalized pain in the vagina, or in a specific place, such as a point just above the cervix. Anxiety about painful sex can cause more tension, which leads to further pain experienced during intercourse.

You can seek help from a qualified women’s health physiotherapist, to re-train your pelvic floor. Therapies include pelvic floor relaxation, diaphragmatic breathing, vaginal dilators, and sometimes, muscle relaxants.

Painful sex isn’t normal, but it’s a topic women are often reluctant to discuss with their care providers, or to seek help about. Some women might decide their general practitioner isn’t the right person to help them discover what is causing painful sex.

It’s important to give your body time to recover from your c-section. Ask your partner to be patient and gentle, as you reestablish your sexual relationship. If pain continues, don’t hesitate to ask your doctor for a referral to a women’s health specialist, who can help you find out the cause and the best treatment.

Climax after c-section

Climax is reached after pleasurable sex. You shouldn’t purposefully avoid climax when you have sex after a c-section. Postpartum sex after a c-section shouldn’t follow an agenda. Psychological factors don’t understand about times, weeks or the way birth has happened.

It’s very important a woman reaches climax during sexual intercourse – especially during postpartum sex. Healing will happen much faster, as trauma (physical and psychological) can be released by resuming a pleasurable sexual life.

When a woman climaxes, her hormonal flow will help with healing. The recovery process will be much faster and the couple will be able to enjoy sex again as much as they did before the cesarean birth.

How long does it take for the cervix to close after a c-section?

After birth, the cervix will go back to its non-pregnant status. When the cervix has dilated, as a result of labor contractions, it will take approximately six weeks for it to close and get back to its non pregnant state.

Even when cervical dilation has not taken place – as in an elective cesarean delivery – the cervix has still been modified and the early postpartum hormones are making sure it stays open. It’s important that the lochia (vaginal bleeding from the placental site) comes out.

Whether you’ve had a vaginal birth or a cesarean delivery, your cervix will very likely be closed and back to its non-pregnant status at six weeks after giving birth. If you’re still bleeding at that stage, mention it to your health care provider at your six week postpartum checkup. If you’re feeling unwell at any time during the first six weeks, make sure you contact your midwife or doctor, who will be able to suggest the most appropriate action to regain your health and make sure your body is fully healed.

How long does sex hurt after a c-section?

Women should not have to experience pain during sexual intercourse. If it happens, the couple should stop that type of sexual activity as it obviously means the woman isn’t ready yet to have sex.

Enjoying sex is a must for both you and your partner. There are reasons for not wanting to resume sex in the first few months postpartum. A huge change has happened in your life – an even bigger change if you’re a first time mother. Breast feeding and sleep deprivation can play a very active role in having a low libido. The first few months postpartum are the time to focus on healing and on your new baby.

If sexual intercourse is painful and you still feel like having sex after a c-section you might want to try other sexual activities, such as oral sex or mutual masturbation until resuming intercourse is an appealing activity for both partners.

Sex 3 weeks after c-section

If you feel like having sex just 3 weeks after a c-section, go ahead – as long as it is something you want to do and you feel ready to do. Three weeks postpartum is early for most women to resume any kind of sexual activity. Intercourse should be out of the picture until at least six weeks but having your partner to pleasure you with his hands or mouth in a very gentle way is okay if you feel up to it. Just make sure you talk it through beforehand and ask him to stop if there’s any discomfort.

If you experience just pleasure, that’s great! Orgasm is much more effective than kegel exercises to bring your pelvic floor muscles back in tune after giving birth.