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Ep. 16 | Combating Painful Postpartum Sex with Molly Bachmann, PT, DPT

birth doula hormones pelvic floor therapy pelvic health podcast postpartum sex wellness May 01, 2024

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In this episode, Molly Bachmann, PT, DPT is back to talk about the often neglected issue of painful sex postpartum. This conversation between Allison and Molly discusses the biological, structural, hormonal, and sociocultural aspects that cause or contribute to painful sex postpartum, including pelvic floor stress, scar tissue, muscle tightness, nerve damage, exhaustion, relationship dynamics and a socially induced rush to resume sex. 


01:57 Welcoming the Guest: Molly Bachman

02:18 Discussing Postpartum Struggles and Painful Sex

02:48 Understanding the Commonality of Painful Sex Postpartum

03:36 The Role of a Pelvic Floor Therapist in Postpartum Recovery

03:47 The Importance of Early Intervention in Pelvic Floor Issues

04:53 The Impact of Childbirth on the Pelvic Floor

05:38 The Importance of Postpartum Exercises for Pelvic Floor Recovery

05:57 Understanding the Impact of Birth on Pelvic Floor Muscles

10:57 The Role of Pelvic Floor Therapy in Postpartum Recovery

12:43 Understanding the Reasons for Painful Sex Postpartum

12:58 The Role of Hormones in Postpartum Sexual Health

18:34 The Impact of Scar Tissue on Postpartum Sexual Health

21:44 The Role of Muscle Tightness in Postpartum Sexual Health

23:58 Understanding the Impact of Nerve Damage on Postpartum Sexual Health

30:20 The Importance of Postpartum Support and Self-Care

32:33 The Importance of Addressing Painful Sex Postpartum


The postpartum experience is one often filled with A TON of emotions. In addition to navigating the responsibilities of motherhood, many women are silently dealing with uncomfortable and sometimes painful postpartum experiences. In this podcast, we are joined by Molly Bachmann, PT, DPT,  a pelvic floor physical therapist and birth doula, who shares her insights on a particular postpartum issue – painful sex postpartum. 

The Reality of Painful Postpartum Sex 

Painful sex postpartum, as Molly emphasizes, is a surprisingly common condition. However, due to the stigma and embarrassment often attached to discussing such issues, many women suffer in silence. This lack of conversation leads many to believe that they're the only ones going through it. 

Understanding Your Pelvic Floor 

The pelvic floor muscles play a vital role during childbirth, undergoing an immense amount of stress, similar to running two marathons (OK, MAKES SENSE NOW!? ANYONE ELSE??) Many women hope and expect that these muscles will bounce back quickly within the six weeks postpartum period, but that's not often the case. It's not realistic to expect such swift recovery from a muscle that has undergone so much stress. 

The Four Main Causes of Postpartum Painful Sex 

1. Hormonal Changes: Postpartum hormonal shifts, particularly the sharp drop in estrogen levels, can affect the vulva’s architecture, leading to painful sex. (And the longer you breastfeed, this will continue to occur due to the lower levels of estrogen).

2. Scar Tissue: The formation of scar tissue postpartum, particularly after a Grade 2, 3, or 4 tear, can contribute to pain during sex. 

3. Muscle Tightness: All birth, irrespective of how it went, causes injury to the body which can lead to muscle tightening and subsequently, painful intercourse. 

4. Nerve Damage: Sometimes, nerve disruption may occur, the most affected being the pudendal nerve, which could result in painful sex. 

This image is from Bodily. Read this awesome article on Birth Recovery and Postpartum Recovery Timeline.

Practical Solutions to Postpartum Painful Sex 

Pelvic floor physical therapy (PFT) has shown significant benefits for women experiencing painful postpartum sex (I can speak to this!!! 10/10 recommend PFT!). This therapy aims to loosen tight pelvic muscles, improve blood flow, and work on scar tissue, making intercourse more enjoyable. Due to the effectiveness and high success rate, even women who have been experiencing painful sex years postpartum can seek relief from pelvic floor physical therapy. As Molly expounds, "it's never too late." 

Take-Home Advice 

Women should feel empowered to advocate for their postpartum health. It's crucial to understand that typical postpartum clearance from a doctor doesn't necessarily mean that your pelvic floor is ready for sex. If you don't feel ready, don’t push yourself. Also, it's highly recommended to build your postpartum village – gather a support system that will help you transition into your new role without immense pressure. Remember, sex is supposed to be pleasurable and not a cause of pain or anxiety. However, if you're experiencing pain, know that it's not a normal part of the postpartum experience and you don't have to endure it. Reach out to professionals like Molly who dedicate their work to helping women regain control and enjoyment of their bodies after childbirth. 


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