Pelvic floor changes during pregnancy
The hormonal changes that occur during pregnancy have an effect on all the tissues in your body, including muscles and ligaments. This means that the muscles and connective tissues that need to work well for good pelvic floor function are affected, and can become more relaxed.
This is a normal and important change during pregnancy, as it acts to eventually allow a baby to pass through the birth canal more easily.
This change in tone, coupled by the increasing weight of the baby pushing down on the pelvic floor, can have the less-desired effect of decreased pelvic floor strength and support, leading to signs of incontinence (leaking) or pelvic organ prolapse.
Another factor that affects the pelvic floor during pregnancy is the bowels. Pregnancy hormone levels slow down gut movements, and make women more likely to experience constipation. It is important to manage this through fluid and fibre intake, healthy diet and exercise and supplements if needed, as excessive straining to pass bowel motions can put further pressure on the pelvic floor.
Sex during pregnancy
For most women, continuing to have sex during pregnancy is safe and important for the relationship of new parents-to-be. There are some cases in which your doctor will advise to you avoid sex in pregnancy, such as bleeding, low-positioned placenta or other increased risk of premature labour.
Some women may experienced increased libido and pleasure from sex during pregnancy, due to the hormonal changes and increased blood flow to the area. While some other pregnancy symptoms, like nausea or pelvic girdle pain may make sex uncomfortable for other women. The most important thing is to listen to your body and do what feels right for you.
Pelvic floor training during pregnancy
Continuing to train pelvic floor muscles during pregnancy is important! As it reduces incontinence, increases sexual function and improves recovery after delivery. There is also evidence that suggests that doing pelvic floor exercises during pregnancy reduces the length of second stage labour!
Since pelvic floor trainers have not been tested on pregnant women for ethical reasons, we do not recommend using this method during pregnancy to train your pelvic floor. Alternative ways to strengthen the pelvic floor during this time are recommended, such as manual Kegels, prenatal yoga or pilates.
When can I start having sex again after delivery?
The simple answer is; it depends!
Returning to sex after having a baby is very individual to each woman and her partner, and depends on many factors such as type of delivery, presence of perineal injury and pain levels.
For women who have had a vaginal delivery, it is usually advised to wait until after your 6 week medical check up before having sex, this also usually means when ‘lochia’ or post-partum bleeding has ended.
If during delivery you had any tearing or stitches in the perinuem, you may likely need further assessment and rehabilitation with a Women’s Health Physiotherapist before having penetrative sex. Even after you have been cleared by your practitioner, it is still very much about taking things at your own pace. While some women feel ready to explore sex after 6 weeks, for others it can be alot longer, this is normal! It is important to listen to your body and slowly work with your partner to find what is comfortable for you.
Remember sex doesn’t have to always be internal; perineal massage, external play and other forms of intimacy are great ways to transition back to sex. This is a nice way for couples to connect, which is important amidst the challenges of parenting a newborn. When you are ready for penetrative sex, remember that it is normal to experience some vaginal dryness after delivery. The use of a lubricant can help, as well as choosing sexual positions where the woman is in control of the angle and depth of penetration.
While a change in sex life is very normal after having a baby, sex shouldn’t be painful, so if you are experiencing pain be sure to chat to your health care provider.