DYSPAREUNIA (PAIN DURING SEX) AFTER BIRTH
I have decided to address this topic following several cases of women who have reported to me during gynecological examination episodes of pain during sexual intercourse after the birth event. clarity.
Let’s start by saying that, in medical jargon, this type of pain is called Dyspareunia. It is a symptom that can affect the teenage girl as well as the mature woman.
In the specific case, however, we focus on the symptom that appears after childbirth.
There are several factors that can lead to dyspareunia:
– sequelae of the episode. Episiorraphy is the suture that is performed at the vulvar level following the execution of the episiotomy (cut that is made by the doctor or midwife to facilitate the exit of the fetal head when it is realized that the woman is at risk of major lacerations or when it is necessary to accelerate the expulsion of the fetus). The healing of the episiorraphy
can lead to the formation of hardened and retracted tissue, especially if in the immediate postpartum there is an infection in the vulvar such that the wound had to heal “by the second intention”.
In practice, it may happen that despite the wound having been sutured (episiorraphy), the tissue, instead of healing, reopens and then heals taking longer, having to wait for the formation of healthy tissue that reforms from the bottom up.
However, this “healed” tissue is often retracted and hardened with the consequent appearance of dyspareunia due to a very strong pain especially at the entrance to the vagina;
– dyspareunia linked to myalgia. What is determined is a contraction of the muscle surrounding the vagina, triggered by a fixed pain which, obviously, worsens during intercourse attempts. In this case, there are stronger points of tenderness corresponding to the areas of muscle insertion, responsible for the painful symptoms felt inside the vagina;
– vaginal dryness.
The birth event causes a drop in hormonal levels with a consequence. First of all, on the mood but sometimes also on the vaginal lubrication.
– vulvar vestibulitis. We are talking about an inflammatory event that occurs mainly at the entrance to the vagina, linked to microtraumas that occur when sexual intercourse takes place at “wrong” times, not allowing the woman to be properly lubricated. Vestibulitis is also associated with hypercontractility and muscle pain.
The therapy obviously depends on the triggering cause. In general, it will be important to:
– Address and solve the problem of poor lubrication that can cause vaginal dryness and / or vulvar vestibulitis with local estrogen therapy so as not to interfere with breastfeeding;
– Addressing and resolving muscle hyper-contractility with self-massage or by sending the woman to rehabilitation therapy centers with specific techniques;
– reduce inflammation and local pain, with a vaginal gel based on aliamides, able to act on vaginal inflammation and promote proper healing. The gel has even better and faster results if it is applied in the vagina and on the vulva, where the scar is located, with local massages of 4-5 minutes, two or three times a day.
It should also be stressed the importance of adequate intimate hygiene in women who have given birth.
In fact, it is essential:
– an appropriate intimate hygiene with healing soaps that respect the vulvar pH and reduce vulvar and vestibular inflammation;
– self-massage with hypericum or aliamide oil-based gel;
– a specific gymnastics for the rehabilitation of the pelvic floor muscles, which are very lax and relaxed after birth.