Postpartum Pelvic Pain: Why Sex Hurts After Birth And What Actually Helps

You had a baby, and months later something still hurts. Sex, sitting, the scar. And you've been told this is just what happens now.If that's you, this conversation is for you. I'm joined by Dr. Alexandra Dubinskaya, a urogynecologist and sexual medicine specialist in Beverly Hills. She chairs the communication committee at the International Society for Sexual Medicine and wrote the vulvodynia chapter in Taking Care of You. Much of her work is with women who come to her months or years after giving birth, still in pain, told there was nothing wrong. Her view is that women don't need protecting from information, they need it to make their own decisions.We talk about why sex can hurt after birth, starting with genitourinary syndrome of lactation, the hormonal drop that happens while breastfeeding. We get into tearing and episiotomies, granulation tissue that won't heal, and how the pudendal nerve gets stretched during pushing. She explains why that can cause numbness rather than pain. We also cover what to plan for if you already live with pelvic pain, and when a planned C-section is reasonable.If you're pregnant and want to know what to ask for, or already living with pelvic pain and weighing up a birth, this one is about having enough information to choose.Sponsors:- The Pelvic People, makers of the Ohnut and the Kiwi. 15% off with code TWTC15 at thepelvicpeople.com/twtc- Origin, in-network pelvic floor PT. Get your first month of On Track free with code TWTC at theoriginway.com/twtcConnect with Dr. Alexandra Dubinskaya:- Instagram, TikTok, YouTube: @DrUrogynConnect with Mathilde:IG: @theworldstightestcommunityWeb: theworldstightestcommunity.comNewsletter: https://tinyurl.com/4h4snzzdSupport: https://tinyurl.com/mtxnzhsdChapters:00:00:00 Introduction: Pelvic Pain After Birth00:01:34 Dr. Alexandra Dubinskaya00:02:09 Urogynecology, Birth as Risk Factor00:03:51 Informed Choice, What Women Are Not Told00:05:39 Painful Sex, Syndrome of Lactation00:06:28 Tearing, Episiotomy, Granulation Tissue00:07:00 Tool: Vaginal Testosterone, DHEA00:07:38 Silver Nitrate, Surgical Excision00:08:41 Conditions of Repair, Suture Sensitivity00:09:54 Scar Pain, Adhesions, Altered Anatomy00:10:25 Tool: Optimise Tissue Before Pelvic PT00:11:04 Pelvic Floor Trauma, Nerve Stretch00:11:47 Numbness, Paresthesia, Loose Vagina Myth00:12:44 Pudendal Neuralgia, Sitting, Positions00:13:15 Episiotomy Angle, Pudendal Nerve Injury00:14:08 Muscle Spasm, Nerve Compression00:15:22 Tool: Physical Therapy, Vibration, Heat00:15:58 Existing Pelvic Pain, C-Section Risks00:16:51 Tool: Epidural, Checks, Safe Words00:17:38 Choosing a Planned C-Section00:18:26 Information for Both Options00:19:12 You Are Not Alone, Finding a Provider00:20:17 Where to Find Dr. Dubinskaya