• What’s Normal Anyway?


    One of the things I hear frequently is an interpretation of normal. The conversation may go something like this:

    “I had a baby 4 months ago so when I tried sex its painful, but that’s normal and is something I’m working through.”

    “I am going through menopause right now so sex is painful and not as much fun as it used to be but that is normal.”

    While something may be common - return to vaginal penetration after vaginal delivery or changes in sexual satisfaction during and after menopause it does not make it normal and there are things that can be done to make it more enjoyable. I highly encourage my patients to re-interpret what they are feeling as such.


    Hormones play a big role in vaginal changes 

    Being pregnant is a rollercoaster of emotions and hormones. The ride doesn’t end at birth. Your body continues to adapt to the changes it has experienced over the past 40 weeks and hormones continue to be at different levels than what they were prior. 

    During pregnancy progesterone is produced at a high rate which is how your joints are able to relax to accommodate and make room for baby. Progesterone drops off after pregnancy immediately. 

    Estrogen is the other major hormone which is at high rates during pregnancy and immediately drops after delivery

    The tissue in your vulva (the outer part of a women’s genitals) has a high number of estrogen receptors. This means the tissue is very estrogen hungry. It helps to make the tissue elastic (stretch) as well as lubricated. When the tissue received a lower concentration of estrogen it can make the tissue brittle, sensitive and painful.

    In addition to dropping postpartum, menopause is another cause of big hormonal shifts. With menopause, the ovaries stop making estrogen, which can cause your vagina to become dry and less elastic or “stretchy.” 

    So yes, while this is common and part of the normal hormonal cycle, having a burning sensation during initial penetration is not normal and is easily treated so that intimacy can be enjoyable again.

    Depending on the type of delivery 

    While episiotomies are becoming less and less common they still do occasionally occur during vaginal delivery. In addition, perineal tearing while preventable (a study showed that women who hadn’t previously given birth who started perineal massage at 34 weeks of pregnancy had a 10 percent relative reduced risk of tearing requiring sutures than women who didn’t practice perineal massage) will have is frequent during childbirth and can range from a shallow injury which doesn’t involve sutures to a tear going from vaginal opening to anus requiring extensive sutures. Depending on the depth as well as length of tear can have lasting ongoing discomfort. Stretching and mobilizing the tissue can help improve pliability of the scar and reduce sensitivity of the vaginal mucosa.

    The major takeaway:  If you are experiencing discomfort during sexual intercourse and think its normal, re-frame your mind. While this is common it is not normal and Pelvic Floor Physical Therapy should be your first line of treatment


    Find out about how a Pelvic Floor Specialist can help!



    Stay Healthy, Stay Safe, Stay Bodywise!