Painful Sex After Childbirth: When a Botched or Over-Tightened Perineoplasty May Be the Real Cause

Painful sex after childbirth is far more common than most women are told—and for some, it has nothing to do with hormones, lubrication, or “needing more time.” When intercourse becomes painful after vaginal delivery, especially if the patient had an episiotomy or tore her perineum and stitches were placed to repair the injury. This repair may be problematic and might have caused an over-tightened perineoplasty (repair of the vaginal opening and perineal body)

Many women hear:

“This is normal after birth”
“Just give it more time”
“You’re tense”
“It’s breastfeeding hormones”
“it looks normal”
“there is nothing wrong with you”

But if sex was not painful before childbirth and became painful after vaginal delivery and a perineal repair, the issue is often structural, not psychological—and it may be correctable.

This article explains:

Why painful sex can develop after childbirth
What perineoplasty is and how it can go wrong
How a “botched” or overly aggressive repair causes pain
Entry pain vs deep pain and what each suggests
Symptoms that strongly point to perineal over-tightening
When conservative treatment helps—and when it doesn’t
What revision perineoplasty aims to correct
Why specialists such as Dr. John Miklos and Dr. Robert Moore are often consulted in these cases

Painful Sex After Childbirth Is Not “Just Part of Motherhood”

Up to half of women report pain with intercourse at some point after childbirth—but persistent pain lasting many months or years is not normal.

When painful sex is caused by:

Vaginal dryness
Temporary hormonal changes
Early postpartum healing

it usually improves over time.

However, when pain is caused by how the perineum healed or was surgically repaired, it often:

Persists or worsens
Does not respond to lubrication
Feels mechanical or restrictive
Makes penetration feel impossible

This is where perineoplasty enters the discussion.

What Is Perineoplasty?

Perineoplasty is a surgical repair of the perineum—the area between the vaginal opening and the anus. It is commonly performed:

After vaginal tearing
After episiotomy
Following difficult or assisted deliveries
To “restore” vaginal opening tightness
Sometimes intentionally tightened for cosmetic reasons

In childbirth settings, perineoplasty is often done immediately after delivery, sometimes quickly, under swelling, bleeding, and time pressure. It is most commonly performed due to tearing during the delivery or because the doctor performed an episiotomy or a cutting of the perineum to enlarge the vaginal opening to ease the delivery process.

When done well, it restores anatomy.
When done too aggressively or it scars too aggressively it can permanently alter vaginal function.

How Perineoplasty Can Go Wrong After Childbirth

A perineoplasty may lead to painful sex when:

The Vaginal Opening Is Over-Tightened

One of the most common problems is introital stenosis—a vaginal opening that is simply too small to allow comfortable penetration.

This happens when:

Too much tissue is removed
Muscles are pulled together too tightly
Sutures are placed under tension
Cosmetic tightening is prioritized over function
Vaginal/Vulvar scarring is aggressive

Result: penetration stretches tissue beyond its limit, causing pain.

Scar Tissue Forms at the Vaginal Entrance

The perineum is prone to dense scar tissue, especially when:

Healing occurs under tension
Infection or wound separation occurred
Tissue was stitched too tightly
Estrogen levels are low (breastfeeding)

Scar tissue:

Does not stretch like normal tissue
Can burn, tear, or pull
Often becomes hypersensitive

Scar-related pain typically does not improve with lubrication.

Pelvic Floor Muscles Become Over-Shortened

During childbirth repair, pelvic floor muscles may be pulled together too tightly. Over time, this can cause:

Chronic muscle spasm
Inability to relax during penetration
Pain even before full penetration occurs

Muscle spasm often coexists with structural narrowing, compounding pain.

Nerves Are Irritated or Trapped in Scar Tissue

The perineum contains sensitive nerve branches. If scar tissue forms around these nerves, pain may feel:

Burning
Sharp
Electric
Disproportionate to exam findings

This pain may linger after intercourse and worsen with repeated attempts.

Entry Pain vs Deep Pain After Childbirth: A Critical Distinction

Entry Pain (Most Common With Over Scarring or a Botched Perineoplasty or Episiotomy Repair )

Strongly suggests:

Over-tightened perineoplasty
Narrowed vaginal opening
Scar tissue at the perineum
Pelvic floor muscle guarding

Symptoms include:

Sharp pain at insertion
Burning or tearing sensation
Feeling that penetration “won’t go in”
Inability to tolerate penetration at all
Pain even with arousal and lubrication

Deep Pain (Less Common, Different Causes)