Sex After Prolapse: A Guide to Navigating Intimacy with Confidence
In this insightful blog post, Dr. Margo Kwiatkowski PT, DPT, CSCS, PCES dives into the challenges of intimacy after prolapse during the postpartum period. With practical advice on exploring sensual touch, preparing your body for intimacy, and rebuilding connection with your partner, she offers empowering tips for navigating this vulnerable time. Whether you're struggling with physical discomfort, hormonal changes, or simply feeling disconnected, Dr. Margo’s guide will help you rediscover confidence and intimacy in your relationship.
The postpartum period is one of vulnerability, learning, and acceptance. For many people, learning to navigate a new body is a challenge; one complicated by the needs of a newborn baby. A softer belly, a higher body weight, and stretch marks might impact the way you feel about yourself and how you view intimacy with your partner. Add to that some vaginal dryness from hormone changes and a diagnosis of pelvic organ prolapse and intimacy is the last thing you desire. Physical closeness with your partner during the postpartum period can still happen and can still be special. Prolapse does not have to steal this from you.
Readiness for intimacy and intercourse is going to vary greatly from one person to another. It is absolutely ok if you are not ready to have intercourse six weeks (or six months! or even longer) after giving birth.
Exploring Intimacy Beyond Penetration: The Power of Sensual Touch
As a pelvic health physical therapist, I am often reminding patients that intimacy is not limited to vaginal penetration. Many people have pelvic pain or other conditions that limit their tolerance to penetrative intercourse. If the idea of penetrative sex after a prolapse diagnosis makes you uncomfortable, start with sensual touch instead.
Sensate Focus is a technique used in behavioral therapy to change a person’s perception and receptiveness to sensual touch. In this practice, you and your partner take turns being the “toucher” and the “receiver.” The goal is to focus on the sensual feelings without the burden of what “should” happen sexually. By leaving the expectation of orgasm behind, you create a space for safe exploration of your new postpartum body. There are five steps to Sensate Focus, each one taking you further into bodily comfort with your partner.
Navigating Postpartum Changes and the Impact on Sexual Desire
Another important consideration during the postpartum period is that sexual desire and receptiveness can be drastically altered while lactating. Estrogen is low for all postpartum people during the first few months and will remain low in those who continue lactating. Low estrogen contributes to vaginal dryness, tension, and pain. One treatment strategy to mitigate these symptoms is to use topical vaginal estrogen prescribed by your physician. The topical medicine is safe to use while breastfeeding and pumping as it does not get absorbed into the systemic system.
Oxytocin is another hormone in abundance while breastfeeding. It is released during the milk ejection reflex and also during orgasm. These increases during lactation have been linked to reduced desire for sex.
Sexual desire is a complex topic during the postpartum period and many new parents report a decrease in libido regardless of lactation status. Desire might be even less for those diagnosed with prolapse as some studies have demonstrated that symptoms such as incontinence, prolapse, and pain have a strong negative impact on sexual desire.
These mental, hormonal and physical changes can all contribute to decreased desire for sexual intercourse. Talking to your partner can help reduce miscommunication and expectations. Desire for, and feelings about, intimacy will change with time. In the meantime, find ways to enjoy little moments together. While you are navigating your postpartum healing after prolapse, you can utilize small things like a kiss, huge or laugh to maintain a connection without sex.
Is Sex After Prolapse Safe?
Most people with prolapse are able to experience a full sex life. I am still often asked if certain positions are “dangerous” or if they might make prolapse worse. The general consensus from medical providers is that there are no positions that are off limits unless they are painful, significantly increase your symptoms or cause unwanted symptoms.
If you are trying to find a position for intercourse that is comfortable for your body, you might consider the effect that gravity has on your type of prolapse. For example, someone with a rectocele might benefit from bolstering their hips on a pillow or wedge which allows gravity to pull the tissue back up.
Tips for Preparing Your Body for Physical Intimacy
When you are ready to resume physical intimacy, here are some tips to set yourself up for success. Just as we warm up for exercise, some people need to warm up before sex!
Tissue Preparation
Scar tissue can be present after childbirth from tearing, episiotomies or cesarean sections. This tissue needs to be addressed with hands-on techniques in order to facilitate proper tissue healing. Vaginal delivery scar tissue can be found in the perineum, labia, around the urethra, or even deep in the vaginal canal (sulcus tear). Mobilizing this tissue both internally and externally can help reduce pain, improve blood flow, and help return the tissue to its natural state. In order to see the best results, scar tissue mobilization is best practiced a few times a week either by yourself or by your pelvic floor therapist.
Relaxing Tight Pelvic Floor Muscles
Another tissue preparation technique is to learn how to relax and release tension in the pelvic floor muscles. Pelvic floor muscles that are overly tense can contribute to pain both during and after intercourse. This muscle tension can also increase prolapse symptoms!
Diaphragmatic breathing and using a pelvic wand are two of the best strategies to encourage relaxation in the pelvic floor muscles. Diaphragmatic breathing lengthens the pelvic floor and improves blood flow. A pelvic wand is a tool used vaginally or rectally to reduce muscle tension through trigger point release. Many people with pelvic floor tension use them prior to intercourse to encourage relaxation.
Enhancing Orgasm Strength and Sensation After Prolapse
Postpartum people sometimes experience a loss of sensation during intercourse and a sense of vaginal laxity. This is even more prevalent in those with prolapse. Factors that contribute to vaginal laxity include physical trauma during childbirth, age, number of vaginal deliveries, and being early postpartum. Laxity of the vaginal walls is caused by either overstretching of the elastic fibers or by weakness of the pelvic floor muscles. There are a number of things we can do to improve tone of the vaginal walls and muscles including pelvic floor muscle training, restoring estrogen to the tissues, increasing blood flow, and surgery.
Here are a few of my favorite tips to increase the strength of your orgasm:
- An orgasm requires a strong contraction. A strong contraction requires muscles that can fully relax. Performing some pelvic floor stretching exercises before intercourse can help “prep” through inhalation and relaxation.
- The pelvic floor muscles and the transverse abdominis (deep core) work together to help increase the contraction strength of the other. By co-contracting both the pelvic floor and the deep core during an orgasm you can increase the strength of the contraction as a whole.
- You might need to experiment in different positions to determine which helps facilitate the strongest contraction for your body.
- For some people, the use of a tool like a vibrator can help with external stimulation.
Rebuilding Intimacy and Connection After Childbirth
Reclaiming intimacy after childbirth is a deeply personal journey that requires patience, compassion, and understanding—both for yourself and your partner. Embracing this time of change and healing can lead to a deeper connection, even amidst the challenges of postpartum life and prolapse recovery.
Remember, every step you take toward comfort and confidence is a victory. Seek support from professionals like pelvic health therapists, behavioral or sex therapists, communicate openly with your partner, and allow yourself the grace to explore what feels right for your body and relationship. Intimacy, in all its forms, can still be a beautiful part of your postpartum experience.
If you want to learn even more about the topics discussed here, you can do so with my Sex after Prolapse ebook.
About Dr. Margo Kwiatkowski, PT, DPT, CSCS, PCES
Margo Kwiatkowski is the founder of P4Moms Physical Therapy. She is a pelvic floor and orthopedic physical therapist based in Ventura, California. She had made it her life mission to educate about prolapse after experiencing the diagnosis after the birth of her first child.
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**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.