Painful Sex After an OB-GYN–Attended Childbirth: Why It Happens, What It Means, and When It’s Not “Normal Healing”

Painful sex after childbirth is one of the most common—and least openly discussed—postpartum problems women experience. Many women assume pain is inevitable after delivery, especially if an OB-GYN was involved, stitches were placed, or the birth was described as “traumatic,” “long,” or “complicated.”

But here is the critical truth:

👉 Persistent painful sex months or years after childbirth is not normal—even if the delivery was managed by an OB-GYN and even if everything “healed.”

In many cases, postpartum dyspareunia (painful intercourse) has specific, identifiable causes related to how the vagina, perineum, muscles, and nerves healed after delivery—not hormones, not anxiety, and not a lack of effort.

This article explains:

Why painful sex can occur after OB-GYN–managed childbirth
How common delivery interventions affect vaginal and pelvic anatomy
Entry pain vs deep pain and what each means
How stitches, tearing, and “routine repairs” can cause long-term pain
When pain should improve—and when it won’t
When revision or specialist evaluation may help
Why surgeons such as Dr. John Miklos and Dr. Robert Moore are often consulted in complex postpartum pain cases

Painful Sex After Childbirth Is Common—But Persistent Pain Is Not Normal

Short-term discomfort after delivery is expected. Healing tissues, hormonal shifts, and temporary muscle weakness can all affect comfort early on.

However, pain that persists beyond 3–6 months, worsens over time, or makes penetration difficult or impossible usually signals a structural or functional problem, such as:

Over-tightened stitches
Scar tissue
Narrowed vaginal opening
Pelvic floor muscle dysfunction
Nerve irritation
Improper healing after tearing or episiotomy

Many women are told:

“Give it more time”
“You’re breastfeeding”
“Use more lubricant”
“This happens after babies”
“There is nothing wrong with you”

Yet years later, the pain remains.

Common OB-GYN Childbirth Factors That Can Lead to Painful Sex

Even when care is appropriate and well-intended, certain delivery events and repairs increase the risk of long-term pain.

Perineal Tears and Episiotomy Repairs

During vaginal delivery, tearing of the perineum (the area between the vagina and anus) is common. Repairs are usually done immediately after birth.

Problems can arise when:

Repairs are done for larger more aggressive tears or episiotomies
Tissue edges are pulled together too tightly
Cosmetic closure is prioritized over function
Muscle layers are over-shortened
Healing occurs under tension

Result: a vaginal opening that is too tight or scar-restricted for comfortable penetration.

“Routine” Perineal Stitching That Was Too Aggressive

Even without a large tear, some women receive routine perineal stitches that unintentionally narrow the vaginal opening.

This can lead to:

Introital stenosis (narrowed vaginal entrance)
Burning or tearing pain with penetration
Pain despite lubrication and arousal
Inability to tolerate penetration at all

This is one of the most common causes of entry pain after childbirth.

Assisted Deliveries (Vacuum or Forceps)

Vacuum- or forceps-assisted deliveries increase the risk of:

Deeper tissue trauma
Muscle injury
Nerve stretching or compression
Larger repairs

These injuries may not be obvious on visual exam but can significantly affect sexual function.

Prolonged Pushing or Difficult Labor

Long labors and prolonged pushing can overstretch or injure:

Pelvic floor muscles
Nerves supplying the vagina
Connective tissue support

This may lead to:

Muscle spasm
Tearing of inflamed tissue which requires surgical repair
Pain with penetration
Deep pelvic pain during intercourse
Difficulty relaxing during sex

Entry Pain vs Deep Pain After Childbirth: Why Location Matters

Entry Pain (Most Common Post-Childbirth)

Strongly associated with:

Over-tightened perineal repair
Scar tissue at the vaginal opening
Narrowed vaginal entrance
Pelvic floor muscle guarding

Symptoms include:

Sharp pain at insertion
Burning or tearing sensation
Feeling that penetration “won’t go in”
Pain immediately when penetration is attempted
Pain during pelvic exams
The feeling of a web or bridge of tissue making penetration difficult

Entry pain is not caused by low desire or anxiety—it is mechanical.

Deep Pain (Less Common, Different Causes)

More often associated with:

Pelvic floor muscle dysfunction
Vaginal or uterine support changes
Prolapse after childbirth
Adhesions or deeper scarring

Symptoms include:

Pain with thrusting
Pressure or aching deep in the pelvis
Pain in specific positions
Lower back pain as the day progresses
Inability to maintain a tampon
Feeling as it something is being hit with deep thrusting during intercourse

Deep pain requires a different evaluation and treatment approach.

Why Many Women Are Told “Everything Looks Normal”

Postpartum exams often focus on:

Whether tissue is closed
Whether bleeding has stopped
Whether infection is present

But appearance does not equal function.

A vaginal opening may look:

Symmetric
Healed
“Normal”

Yet still be:

Too narrow
Inelastic
Scar-restricted
Painful with stretching

This is why painful sex after childbirth is so often dismissed.

Pelvic Floor Muscle Spasm After Childbirth

After painful or traumatic delivery, pelvic floor muscles may tighten reflexively to protect injured tissue. Over time, this guarding becomes chronic.

Muscle spasm can cause:

Entry pain
Burning or stabbing sensations
Inability to relax during penetration
Pain even with gentle touch

Muscle spasm often coexists with scar tissue or narrowing, making pain worse.

When Conservative Treatment Helps—and When It Doesn’t

Conservative treatments may help when:

Muscle spasm is the primary issue
Scar tissue is minimal
Narrowing is mild

These include:

Pelvic floor physical therapy
Vaginal estrogen (when appropriate)
Scar massage
Dilator therapy (guided)

Conservative treatment often fails when:

The vaginal opening is physically too small
Dense scar tissue limits stretch
Over-tightened repair is structural

In these cases, revision perineoplasty or surgical correction may be considered.

What Revision Surgery After Childbirth Aims to Fix

Revision surgery is not cosmetic. It aims to restore function.

Goals may include:

Widening the vaginal opening
Releasing restrictive scar tissue
Improving elasticity
Reducing muscle tension
Preserving pelvic support

Success is defined by comfort and usability, not appearance.

When to Seek a Specialist Evaluation

You should consider a second opinion if:

Pain began after childbirth and never resolved
Pain is immediate at penetration
Bleeding occurs after intercourse
Pelvic exams are painful
You were pain-free before delivery
You were told “this is normal” but pain persists
Physical therapy is not helping even after a few weeks of therapy

Why Many Women Seek Miklos & Moore for Post-Childbirth Pain

Miklos & Moore

Dr. John Miklos and Dr. Robert Moore are internationally recognized for evaluating and treating complex postpartum pelvic and vaginal pain, including painful sex after childbirth and problematic perineal repairs.

They commonly see women who:

Developed pain after OB-GYN-managed delivery
Had perineal stitches or episiotomy
Were told everything healed normally
Have entry pain related to structural issues
Need revision focused on function and comfort

They see patients in:

Atlanta, GA
Beverly Hills, CA
Charleston, SC
Miami, FL
Dubai

Key Takeaway

Painful sex after OB-GYN–attended childbirth is not something women should simply accept. While short-term discomfort is common, persistent pain usually has a structural or functional cause—often related to perineal repair, scar tissue, or pelvic floor dysfunction.

With accurate diagnosis and realistic expectations, targeted treatment or revision surgery can significantly improve comfort, intimacy, and quality of life.