"Drink a glass of wine, grab some lube and go have sex," the facilitator of my Upper West Side new moms support group said breezily. About a dozen of us very-postpartum ladies sat in a circle on the floor of a kids’ gym as our babies squirmed around on their tummies and we nodded in agreement.
So what did I do? After my OB/GYN cleared sex at my six-week postpartum checkup and our tiny human (finally, thankfully) fell asleep, I poured myself some Cab Sav, snagged the organic lube and summoned my husband to the bedroom. Everything was going great. We were clearly still into each other … until … no … NOPE … OW!
It became clear that nothing was going in there — or even getting close anytime soon. Every time we attempted, I felt excruciating pain. I had never experienced painful sex before, and quite frankly, I was shocked.
When I went back to the OB/GYN, I learned everything was "normal." I just needed something called pelvic floor physical therapy. Pelvic floor PT is a way to strengthen the muscles that support your growing uterus during pregnancy. These muscles are also key to continence, sexual arousal and orgasm. I thought I was well-equipped with postpartum knowledge — breastfeeding 101, the bleeding, hormone swings. But pelvic floor PT never came up. I wish I had known about it sooner.
Once I got started with a therapist, it helped me tremendously, and I became a huge fan of pelvic floor PT. This is what my experience with pelvic floor therapy was like.
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Pelvic floor therapy can help even if you have a "normal" birth
In all the research I did leading up to holding a newborn in my arms, I never learned that my pelvic floor could, essentially, freak out postpartum.
I was told my pelvic floor was experiencing some sort of PTSD after 20-something hours of labor and 26 minutes of pushing. It tensed up anytime anything got close to the opening.
Another way to say it: My pelvic floor was tight. Plus, I had some irritated scar tissue from a second-degree tear.
It's pretty awkward at first, but you'll get used to it
When I walked into my first pelvic floor PT appointment, I almost walked out. The physical therapy studio looked like a gym with people all around working out — exercising on ellipticals, lifting dumbbells and pulling rowing cables. It was difficult to wrap my head around the idea that a therapist would soon evaluate my most private of parts in this bright, open space.
It turns out there was a secret back room, and that’s where the pelvic floor action goes down.
There are two types of pelvic floor PT: internal and external. The former involves a therapist taking a gloved hand and doing massage work internally (in the vagina) to relax tight pelvic floor muscles. External PT is more like traditional physical therapy in that you do exercise moves and stretches with your therapist to strengthen your pelvic floor muscles.
When my therapist brought me to the back room, there was a massage table, a chair and not much else. I stripped down, and she gloved up. Soon she was up in there — much like an OB/GYN might be — evaluating the situation.
The therapist massaged around the pelvic floor — belly, thighs, buttocks — as well as internally to find and release tension. (You can have muscle knots in your pelvic floor just like in your back!)
Is it awkward? Absolutely. But I got used to it after going weekly for several months.
The techniques you'll learn about can make a big difference
My therapist also taught me relaxing breathing techniques, stretches and other gentle ways to help heal my pelvic floor.
The treatment included working with dilators during sessions and at home. These medical tools used inside the vagina can mitigate pain (and even anxiety) around penetration. It wasn’t sexy, but working with dilators helped build my confidence.
It took a few months and some setbacks, but eventually, my sex life came back. Before I knew it, I was peeing on a stick again. Our second daughter was on her way!
You can do pelvic floor therapy for subsequent pregnancies
My pelvic floor physical therapy experience wasn’t one-and-done. Once I discovered these magical pelvic floor fairies, I became somewhat of a groupie.
To prepare for baby number two, I tried external pelvic floor PT to get "in shape" for labor and delivery. The therapist taught me stretches to keep my pelvic floor relaxed and targeted movements to strengthen it. This included every possible iteration of a Kegel, exercise balls to sit on and Pilates rings to hug between my thighs.
With their doctors' sign-off, some people even have their pelvic floor physical therapists do perineal massages in the weeks leading up to their due date. This can stretch things out before delivery. I considered this but ended up not doing it — mainly because I moved during my third trimester.
Going sooner rather than later can really help
This time around, I knew what I needed to do. A week after giving birth, I asked my OB/GYN for a script for pelvic floor PT and booked an appointment right away.
This therapist used massage to "wake up" my dormant abdominal muscles and get my pelvic floor to relax. Instead of waiting six months to have sex again, I did so comfortably about two months postpartum — a huge win for me.
My therapist also advised me on the most comfortable positions to have sex (pillow under your butt) and other pain management techniques. She helped me mentally and emotionally, cheering me on through those early days of newborn fog. It was like having a postpartum coach with a medical background.
Pelvic floor therapy can be expensive, but it doesn't have to be
Since pelvic floor physical therapy is a niche specialty, it’s not always easy to find a provider, and it can get pricey if you have to pay out of pocket.
When I lived in New York City, finding a pelvic floor physical therapist was low drama. My OB/GYN provided me with a long list of names, and many took insurance. Navigating this in the suburbs was much more of a challenge. My new OB/GYN provided only a handful of names — and many of them didn't take insurance or have any openings.
So I searched my local Facebook moms' groups for referrals and finally discovered someone nearby who didn't cost a small fortune and had excellent reviews. While she had a waitlist, I got off it quickly.
Pelvic floor issues are common, and there’s amazing care if you seek it. My only regret is not going to see one sooner.
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