Are you Postpartum and having painful intercourse? Did you have a tear or episiotomy during labor? Then you might have a painful scar.
For a visual presentation see my Youtube video explaining this same topic.
Did you know about 9/10 first time moms have some form of tear or episiotomy during their labor? That is an insane amount! I personally suffered from 2 tears postpartum, which was no surprise to me as my sons head was 99th percentile and he came down the canal quite quickly. However, I was not prepared for the postpartum pain that followed for months after.
Around 3 months postpartum I reached out to my OB office and let them know I was still having pain and asked what could be done about it. Well, the answer I got was a bit lack luster. I was told to just wait it out and pain after pregnancy was “normal” and it “should” go away with time. When I saw this response I was horrified! How long would this go on for? and “should” was a very scary word to hear in regards to the pain I was experiencing. I decided to take matters into my own hands and asked my OB for a referral to a PT who specialized in pelvic floor issues. Just to be clear, I should not have been forced to ask for a referral for myself, I should have been referred as soon as I was reaching out with continued pain. But alas, this is where our healthcare system is currently at.
Prevention
Perineal Massage
Why don’t we start at the beginning, because before you ever go into labor there IS something you can do to help prevent a significant vaginal/ perineal tear. Now to be clear, this isn’t a guarantee you won’t tear, and is more likely to reduce the severity of the tear, not the tear itself. The method I’m referring to is Perineal massage, and yes it is exactly as you are probably imagining. You have to massage the vaginal opening in order to help the tissue stretch and get ready for the passage of your child. Traditionally, women would have to reach around their belly and use their thumbs to try and massage the vaginal opening themselves, or have their partner do it. Lucky for us, there is a new device you can purchase which makes this significantly easier. It is a perineal wand. I will add a link here to find it on Amazon if you are interested in purchasing one for yourself. I did, and it really made a world of difference. It was safe, convenient, and private. Click here to find the Peri Wand I used https://amzn.to/41X2FPJ (Amazon). As an Amazon Associate I make a commission on products purchased through my links.
Not Delivering on Your Back
Trying to find a position to deliver on that is not on your back can make labor a lot smoother. When you’re laying on your back the tailbone doesn’t have the ability to move out of the way for your baby to come through, in turn increasing the pressure in your perineum as baby pushes through. By delivering on your side, hands and knees, or another position of choice you’re allowing the tail bone the ability to move out of the way, decreasing that pressure on the perineum ever so slightly, hopefully reducing either the incidence of tearing or the severity of the tearing. Of course, sometimes you need to deliver on your back for medical reasons. If this is the case you can try to boost your tailbone off the bed by placing a rolled up towel under each side of your hip so that you create a little space under your tailbone for movement. Always follow the guidance of your healthcare professional, just know there are options for you!
Treatment
As I said earlier in this post I reached out to a PT who was able to assess me with a physical exam and determine that the pain I was having was in fact due to a painful vaginal scar from my tear during labor. I was so relieved to finally know what was plaguing me for these months, and you know what is even better? THERE IS SOMETHING THAT CAN BE DONE! Yes, there is actually something you and I can do to help reduce the pain and get back to enjoying all aspects of life.
My PT told me that I had to start doing VERY gentle perineal massage (funny how perineal massage helps prevent and treat, huh) every day to help break up some of that tight, painful scar tissue. So this is what I’ve been doing… Using clean hands and pea sized amount of lidocaine cream, I was instructed to use 1 thumb to apply gentle pressure to the painful scar in intervals of just 5 seconds, for 5 rounds. If the scar is too tender, starting working the massage around the painful scar, until actual scar massage is more tolerable. Once using your thumb doesn’t cause as much pain and you are seeing improvement you could start doing the massage with the Peri wand as discussed above (not recommended to start with this as the wand might be too big). Over time the pain should decrease and the amount of pressure applied can inversely increase until you find the pain is gone.
Conclusion
The fact that this information was not readily available to me postpartum is a shame, as well as the lack of support I received while asking for help. Sadly, the drop off in care going from being pregnant to postpartum for the woman is a vast issue and there is room for much improvement. If you are suffering from pain postpartum and you have already reached out to your provider and found no solutions, advocate for yourself and try to see a physical therapist near you. It can’t hurt.
Resources
