‘Sex should not be painful after childbirth’

Most new mothers are told to expect pain and discomfort when they first have sex postpartum. But, according to Cape Town-based gynaecologist and endoscopic surgeon Dr Natalia Novikova, sex should not be painful after childbirth and is often indicative of an underlying (and treatable) issue.

“It’s important to establish the cause of the pain and to treat it,” she tells News24.

Novikova cites vaginal or perineal tearing and scarring (in the case of vaginal birth) and thin vaginal skin and dryness resulting from low oestrogen levels (often exacerbated by breastfeeding) as two of the more common causes of painful sex after birth.

Infections, like yeast infections, urinary tract infections (UTIs) or vaginal inflammation can also cause painful sex, as well as other reproductive issues (endometriosis, cysts or fibroids) or skin conditions (lichen sclerosis or eczema psoriasis).

Urinary incontinence

Besides painful sex, incontinence can also significantly impact the well-being of a new mother. Novikova defines incontinence as “the loss of pelvic organ control which can lead to the involuntary leakage of urine, wind or faeces during everyday activities such as coughing, sneezing, laughing and jumping”.

Because childbirth and pregnancy affect the bladder, women are twice as likely to experience urinary incontinence than men.

According to Novikova, this is largely due to the relaxing effect of the hormone progesterone on the vaginal wall, which weakens the vaginal wall. Age is also a factor, with urinary incontinence developing in older women due to an oestrogen decrease and thinning skin.

Birth trauma and vaginismus

Some women experience pain during vaginal intercourse as a result of birth trauma. Novikova explains that vaginal delivery, in particular, may damage the vaginal canal, the perineum and the pelvic floor muscles.

Some women tear up during birth or undergo an episiotomy and must deal with sutures post-birth. “This can form scars which can cause pain and discomfort during penetrative sex,” says the gynaecologist.

Novikova adds that the inherent fear of painful sex – due to infection, ageing or previous trauma (such as rape) – can also develop into vaginismus, which is the body’s automatic and involuntary reaction to sex where the vaginal muscles tighten up, making comfortable, painless penetrative sex impossible.

In her practice, Novikova treats vaginismus with a combination of botulinum toxin (botox) and vaginal dilators.

‘Recreate a pleasurable intimate experience’

Whatever the cause of a woman’s intimate pain and discomfort, Novikova stresses that finding and treating that cause is crucial to ensuring that a woman has positive sexual experiences moving forward.

“The goal is to re-create a pleasurable intimate experience. We know that sexual pleasure is created in our brain, so setting the mood is the start. Being rested, having enough sleep, and desiring intimacy is also a ‘must’, but I know this isn’t easy to achieve,” says the gynaecologist.

For new mothers struggling to get their mojo back post-birth, having a lubricant on hand can be helpful to ensure that vaginal dryness does not interrupt the process.

Novikova also suggests using a vibrator first to learn how penetration will feel post-birth. This will also help new mothers gain confidence and prevent tension and fear before getting back on the proverbial horse (when they’re ready).

Why ‘doing your Kegels’ isn’t cutting it

Ukraine-born Novikova is the doctor behind the popular @gynaetaboos account on Instagram, which offers women valuable tips and topical insight into sexual and reproductive health. She is also the founder of the Body + Skin Clinic, which offers pelvic/vaginal rejuvenation treatments and non-surgical options to improve pelvic floor laxity and incontinence.

In Novikova’s experience, most mothers she consults are seeking relief from recurring UTIs, debilitating urinary incontinence and painful sex – all of which significantly impact a woman’s quality of life. These ailments also have one common denominator: the pelvic floor.

But let’s be honest, pelvic floor health is way down the priority list of any new mother if it even features. In an ideal world, however, it should form part of every woman’s sexual health education because simply “doing your Kegels” is not cutting it anymore.

“It is advised that you make Kegel exercises a permanent part of your daily routine for sustained benefits,” says Novikova.

She explains that proper Kegel exercises involve tightening your pelvic floor muscles for 3 to 10 seconds, followed by a break as long as the contraction. This should be repeated 10 to 15 sessions, 3 to 6 times daily. But the reality is that most women are not contracting their pelvic floor correctly, let alone keeping track of the requisite repetitions (or making time for them).

High-end solutions

emsella chair

“The Emsella chair is a non-invasive and non-surgical treatment that strengthens your pelvic floor.” Photo: Supplied/Dr Natalia Novikova.

The Body + Skin clinic invested in two high-end pelvic floor strengthening and rejuvenation solutions for the Cape Town and Johannesburg branches: the Emsella chair and the Ultrafemme 360.

The Emsella chair is a non-invasive and non-surgical treatment that strengthens your pelvic floor and treats incontinence in under 30 minutes. It can also heighten sexual desire by encouraging blood flow to the pelvic area. This treatment employs electromagnetic energy to activate motor neurons in the pelvic floor and initiate 11 200 muscle contractions (as effective as doing many Kegel exercises).

“You can sit on it, fully clothed, and receive the treatment within 28 minutes. Come in your lunch break, catch up on emails, scroll on your phone or read a magazine. It’s that easy,” says Novikova.

A non-invasive alternative to labiaplasty

The Ultra femme 360, also non-surgical, is a safe vaginal probe that uses radiofrequency and ultrasound technology to “gently heat up and shrink collagen fibres” in each 8-minute session.

“It also normalises pH and treats vaginal atrophy and recurrent vaginal infections,” says Novikova.

Like the Emsella, the Ultrafemme combats incontinence but is also considered a vaginal rejuvenation tool that treats vaginal looseness, dryness and a loss of sensation. Moreover, it can change the appearance of your intimate area and, as a non-surgical solution, it rivals more invasive procedures like labia- or vaginoplasty.

Low-cost pelvic floor care

However, the reality is that most women will not be able to afford the high-end intimate treatments that the Body + Skin Clinic offers.

For anyone looking for low-cost ways to start taking care of your vulva, vagina and pelvic floor (pre- and post-birth), Novikova posts educational information and pelvic floor exercise on her website and Instagram page.

A pelvic floor physiotherapist in your area will also be able to help.

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