Painful Sex After Childbirth: Is This Normal or Not?

A Clear Decision Guide + Self-Assessment Checklist for Mothers

Painful sex after childbirth is common—but common does not always mean normal or permanent. One of the hardest parts for new mothers is knowing whether discomfort is part of healing or a sign that something went wrong and needs medical attention.

This guide is designed to answer one simple question:

“Should I wait this out… or should I be worried?”

Below you’ll find:

  • A clear “Is This Normal or Not?” decision guide
  • A postpartum painful-sex checklist you can use at home
  • Guidance on when to seek help and what kind of help matters

PART 1: “IS THIS NORMAL OR NOT?” — A SIMPLE DECISION GUIDE

Use this step-by-step guide honestly. No minimizing. No “I should just push through it.”

STEP 1: How Long Has It Been Since Childbirth?

⬜ Less than 8 weeks postpartum

  • Mild discomfort can be normal
  • Penetration may still feel tender
  • Healing is ongoing
  • Spotting and light bleeding is normal

➡️ Usually normal — waiting is reasonable

⬜ 2–3 months postpartum

  • Sex may still feel “different”
  • Discomfort should be clearly improving
  • Pain should be mild and decreasing
  • Light bleeding or spotting  is not unusual

➡️ Usually normal only if improving

⬜ More than 3–6 months postpartum

  • Pain is unchanged or worse
  • Sex still feels sharp, burning, or impossible
  • Bleeding during and after sex

➡️ 🚩 NOT normal — evaluation recommended

STEP 2: Where Is the Pain?

🔴 Pain Is Immediate at Penetration (ENTRY PAIN)

Pain feels like:

  • Burning
  • Tearing
  • Sharp pain right at insertion
  • “It won’t go in”

➡️ 🚩 NOT normal
This strongly suggests:

  • Over-tightened perineal repair
  • Scar tissue at the vaginal opening
  • Narrowed vaginal entrance

🟠 Pain Happens Only with Deep Thrusting

Pain feels like:

  • Pressure or aching deep inside
  • Pain in certain positions

➡️ May be normal early on
➡️ Not normal if it persists past 3–6 months

STEP 3: Is the Pain Improving Over Time?

Ask yourself honestly:

  • ⬜ Is sex noticeably easier than 1–2 months ago?
  • ⬜ Is pain less sharp than before?
  • ⬜ Is recovery faster after intercourse?

If YES ➜ likely normal healing
If NO ➜ 🚩 not normal

STEP 4: Was Sex Pain-Free Before Childbirth?

⬜ Sex was comfortable before pregnancy and childbirth

➡️ New pain afterward is not expected
➡️ Strongly suggests a delivery-related cause

STEP 5: Are Any of These Happening?

  • ⬜ Bleeding after sex months postpartum
  • ⬜ Tampons are painful or impossible to insert or maintain
  • ⬜ Pelvic exams hurt
  • ⬜ You tense or clench involuntarily
  • ⬜ Lubrication does not help

➡️ 🚩 NOT normal — do not ignore

PART 2: POSTPARTUM PAINFUL SEX — SELF-CHECKLIST

Check all that apply. The more boxes you check, the more likely this is not normal healing.

  1. Timing & Pattern Checklist
  • ⬜ Pain started after childbirth
  • ⬜ Pain has lasted longer than 3 months
  • ⬜ Pain has lasted longer than 6 months
  • ⬜ Pain is not improving
  • ⬜ Pain is worsening
  1. Pain Location Checklist
  • ⬜ Immediate pain at penetration
  • ⬜ Burning or tearing sensation
  • ⬜ Feeling like penetration “won’t fit”
  • ⬜ Sharp pain at vaginal opening
  • ⬜ Deep pain with thrusting
  •     Lower back pain as the day progresses
  1. Birth & Repair History Checklist
  • ⬜ Vaginal delivery
  • ⬜ Perineal stitches
  • ⬜ Episiotomy
  • ⬜ Vaginal tearing
  • ⬜ Vacuum or forceps delivery
  • ⬜ Long or difficult labor
  1. Functional Red Flags Checklist
  • ⬜ Bleeding after intercourse
  • ⬜ Pelvic exams are painful
  • ⬜ Tampons hurt or won’t insert stay in place
  • ⬜ Vaginal opening feels too small
  • ⬜ Pain despite lubrication and arousal
  • ⬜ Fear or muscle clenching during sex
  1. “Dismissal” Checklist (Important)
  • ⬜ Told “this is normal after childbirth”
  • ⬜ Told “give it more time”
  • ⬜ Told “use more lubricant”
  • ⬜ Told “everything looks healed”

➡️ Persistent pain despite reassurance is a reason for another opinion

PART 3: WHAT THESE RESULTS MEAN

If MOST of your answers fall under “Normal”

  • Pain is mild
  • Improving month by month
  • No sharp entry pain
  • No bleeding
  • No mechanical restriction

➡️ Waiting + gentle care is reasonable

If MULTIPLE RED FLAGS are present

  • Entry pain
  • Pain > 3–6 months
  • No improvement
  • Bleeding
  • Pain with exams

➡️ This is NOT normal postpartum healing

This pattern often points to:

  • Over-tightened perineal repair
  • Scar tissue at the vaginal opening
  • Narrowed vaginal entrance
  • Pelvic floor muscle guarding layered on top of structural issues

PART 4: WHEN TO SEEK HELP — AND WHAT KIND MATTERS

Reasonable first steps:

  • Pelvic floor physical therapy
  • Vaginal estrogen (when appropriate)
  • Scar-focused therapy

But seek specialized evaluation if:

  • Penetration is mechanically limited
  • Pain does not improve with therapy
  • Vaginal opening feels physically too small
  • Pain began only after childbirth

Why Some Mothers Seek Advanced Pelvic Evaluation

Miklos & Moore

Some women seek evaluation from specialists such as Dr. John Miklos and Dr. Robert Moore because they focus on post-childbirth pelvic and vaginal function, especially when pain is related to:

  • Perineal repairs
  • Scar tissue
  • Vaginal narrowing
  • Persistent entry pain

They often see women who were told:

  • “This is normal after having a baby”
  • “Everything healed fine”
  • “Just relax”

…but whose pain never resolved.

FINAL TAKEAWAY FOR MOTHERS

✨ Painful sex after childbirth is only “normal” if it is clearly improving.

You should be concerned—and seek help—if:

  • Pain lasts beyond 3–6 months
  • Pain is immediate at penetration
  • Pain was not present before childbirth
  • Bleeding or sharp pain occurs
  • You feel dismissed despite ongoing pain

You do not have to accept painful intimacy as part of motherhood.