Dear Dr. Kate: Painful Sex After a C-Section

photo by Ingorrr

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

I had a baby a few months ago — it was via cesarean — and I’ve noticed intercourse is now uncomfortable. I thought since I ended up having a planned cesarean I’d have less sexual problems postpartum, not more! Pre-kid, I never liked having my G-spot focused on, because it felt kind of painful — and this is the sensation I’m getting with just regular intercourse now. Could it be that 10 months of carrying a fetus around pushed my G-spot down a bit so now it’s getting in the way of intercourse? Or could it all be mental and/or hormonal — since I’m breastfeeding and never in the mood for sex and my libido is shot and my natural lubrication is pretty Sarahan…?

— Just Not That Into It

Dear J.N.T.I.I.,

Discomfort during intercourse is never mental – pain is real. Breastfeeding definitely lowers your lubrication levels, so you’ll definitely want to stock up on the lube. And never getting more than a few hours of sleep in a row isn’t helping either. You’ve only got so much energy in the day, and after taking care of your little one and breastfeeding/pumping, it’s no wonder you aren’t aroused by your partner as you were before.

Knowing that most new moms go through this, though, may not make it any more fun. Good sex will take more effort than before, whether it’s getting a babysitter for a few hours and getting out to a hotel if need be to have some alone time, or letting your partner give a bottle of pumped milk at night to let you sleep more. And hang in there, things will improve eventually!

— Dr. Kate

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.


  1. SS, I understand your concern. Many of us, like you and me, put our all into our kids when they were small, and some wonder if it was “too much.”

    I need to be honest. The people I know who practice Attachment Parenting tend to have better, happier and lasting relationships with their partners. I think your man SAW the effort you put into your kids and thought (maybe not even consciously) “Hey, she’s a great caregiver. She has a lot of love passion and empathy to give to others. I know she loves me as much as the kids, they NEED all that attention now. I know I’ll get what I NEED for now, and get even MORE later.” I know My Man learned this. Our kids are older, we’re still together, and the passion couldn’t be heavier, and our relationship only GREW in the lean years when the kids were babies, and we did for the kids what they really needed, and we’re reaping the rewards of it, in many many ways, NOW.

    I know FEW parents who Attachment Parent who end up breaking up. Maybe it’s the personality or the dedication of the people willing to put that much effort into parenting, maybe it’s the realization that taking care of other people IS worth the effort, maybe all that passion and love grows originally from the partner, to the children and back to the partner. I don’t know.

    Just that I see very few women who put the effort into their kids, putting them first for a while, not letting them cry, taking care of their needs when they were small having to raise kids alone later on. The divorce or break up rate among Attachment parents is very low and the satisfaction rate is very high.

    And, (as several of my kids are in their early 20s and considered “Grown”)I know your kids DO appreciate it. And I think it makes them more empathetic adults.

    Anyway, I think we’ve hijacked the thread here. Sorry E&L.

  2. Snooze-Cat said: “I’d rather be having fantastic sex than have a spotless house any day… 🙂 ” Hell yeah! (Houses don’t CARE if they are messy. PEOPLE do care if they are not loved, though. HUGE difference.) Thanks for the Kudos and respect for my profession. Not everyone wants or needs our help, but when they do, they are glad we are around.

    Good luck in whatever future you want and choose to make happen.

    Kids aren’t in the cards for everyone. Not everyone wants them, and I think some people make a good choice NOT having them, while other make a good choice by having them, ONLY you know what is the best choice for you. If kids are right for you, you’ll want them more than anything in the world. You’ll figure out whether it’s for you or not eventually, no rush.

    But, IMO, if one is going to have them, put your all into it. That’s all I was saying.

    I’m kind of a “all or nothing” person. I don’t believe in putting half assed effort into the raising of my OWN spawn. 🙂 My Man certainly never got ignored when the kids were babies, but both of us knew letting babies Cry It Out was not a very baby friendly or Family Friendly thing to do. (And bad for their cardiovascular system, as well. All that Cortisol is NOT good for the baby in any way. Fuck “the world is rough” idea, it SHOULDN’T be any “rougher” than it absolutely has to be for an infant. That’s why they HAVE mothers. To ease the transition into the Big Bad World gently and gradually.)

    If my husband was sick, couldn’t get his own food or drink, or just needed to be held because he was scared, and begging for my help, I wouldn’t say, “Now, honey, I was just in her an hour ago, according to the schedule, you don’t NEED anything. You just suffer for a while by yourself, and I’ll be in to see how you are when I have nothing BETTER to do with my time.” I wouldn’t treat HIM that way, I certainly wouldn’t treat an innocent, helpless baby that way, either.

    The best way to learn to deal with the Big Bad World is to have parents who you KNOW love you, SHOW you like they love you (one doesn’t let the ones they love cry helplessly alone) and have been there for you when you were young and helpless IMO (and the opinion of many.)

    Good luck, Cat, whatever life choices you make. There are a lot of choices out there. 🙂

  3. Wow… the vehemence is just another reason for me to say no to having kids. You LCs have good points and good hearts but crikes… I’ve noticed there are several ways to raise a healthy and happy kid.

    Fuzzy, hahaha, I agree with you: we’d have gone extinct a long time ago had not some things come naturally to the majority of women back in the day!

    Then again, now days with all the pressure we’re under to be uber-productive at work, have amazing, close-knit female relationships as well as have near-fairy tale romances with our SO’s (including porn-star sex ;), cook and clean like our moms and grandmothers, try to enlighten and liberate our fellow females, and overall save the world, all while taking time to make sure we ourselves are happy, content, self-aware, in shape, AND rested…. well… I can understand how it’s helpful to have a lactation consultant around: the reassurance and experience prob could come in pretty handy…

    Heck, I’m only 27, not married, no kids, probably am only fulfilling the porn-star sex “expectation” and I’M knackered on a nightly basis!! Granted, if I’m going to just get one done, I’d rather be having fantastic sex than have a spotless house any day… 🙂

    Anyway, kudos to Fuzzy for your knowledge and reaction and kudos to the LCs for their desire to help moms with their breastfeeding… and congrats to all for making it through so many kiddos! And luck to those trying to comingle kids and horizontal mambo-ing… 🙂

  4. Too funny. I didn’t call you a liar, just somewhat superfluous.

    Also unhealthily and unrealistically centered on your children. Doesn’t hurt kids to cry for a bit…..since life doesn’t always give you what you want, might as well learn that one early.

  5. Sure, I get that, nothing kills the mood faster than a screaming baby on the baby monitor (no, I didn’t let them cry, either!) But, I was commenting in general as well, about this sense I have that some women have made raising kids into their “career,” and it’s like the sexual part of their marriage just evaporates. I think it hits a nerve for me, because I know I was guilty of that for a while, and now I’m trying to figure out why a lot of women do that (me included)?

  6. SS, you make a point (as always) My Man was never left out in the cold, just subjected to a lot more quickies and middle-of-the-night-after-feeding love ins than before or after the kids were babies.

    Also, the way I look at it, my husband and I are adults, our desires can sometimes wait a little while, not forever, doesn’t mean “never” but wait until the baby is fed, cuddled and put to sleep.

    I know there was a lot of sex being interrupted by baby-crying when the kids were small. Man goes “Oh shit.” I go, “I’ll be right back.” Go into hallway. Do FAST MIND BODY GEAR SWITCH, into baby’s room, take care of baby. Go back into bedroom (second mind body switch) and make sure Man is OK. (That was, of course, once Baby was in his/her own bed. Our newborns slept with us, and the crib was only used to hold the baby during sex.)

    I’d never let a baby scream and be sad and missing me to keep on doing ANYTHING. (And for me to walk away from SEX takes a LOT of commitment to whatever is taking me away from it, even for a few minutes.) That’s what I meant by “take care of baby, then take care of self and then partner.” WHEN the baby is satisfied, you and your partner are much more relaxed, and of course, you know things will work out better, if the baby is well tended to.

    No Mom I know can happily get it on, if her child is in a state of Need. Well, very few.

    Obviously, we had no problem getting back to business quickly (6 weeks? Hell, we didn’t wait 10 days!) But a baby is not someone who can take care of herself. Adults can postpone needs/desires for a LITTLE while, babies NEED to be cared for when they need it. Their needs are survival needs.

    That’s what I was saying. (I also felt the need to defend the Integrity and necessity of MY chosen profession….People cut pretty damn close to the bone when they say to you, “What you do for a living has no meaning and isn’t needed.”)

  7. This is interesting, as it has been a discussion point amongst a few of my my friends and me: Is part of the lack of libido a lot of new moms face a result of placing kids first, and partners last? I’m not pointing fingers, I certainly did this (made my world revolve around my kids when they were little) but looking back, and reading about how men/partners/husbands feel about the lack of sex/intimacy after children, I wonder if there is some happy medium that we are missing in our child-focused society? It’s so easy to make things 100% about the babies, and direct all of your attention and emotion to them, it’s no wonder our husbands get left out in the cold for a while. I also think too many of us moms judge other moms, as in “who’s the most committed, making the healthiest meals, providing the most educational toys,” it becomes so competitive about being the “best” parent, when I think sometimes kids could use parents who are a little “less committed,” and by that I mean more relaxed, more able to laugh at themselves when they screw up, more able to say “daddy and I are locking the bedroom door, please enjoy your Cheerios and DVD.” …now I’m definitely off-topic…!

    To JNTII, way back at the beginning, to repeat something I heard on Oprah by a doctor who was describing the best way to get “back in the saddle” after childbirth: “Inebriate and lubricate.”

  8. I’ll have to politely disagree with your opinion that my profession is “unnecessary.”

    There are people who like to play at practicing medicine without any training as well. Doesn’t mean we don’t have any need for WELL TRAINED and seasoned physicians.

    IF you had worked with many breastfeeding moms, in a Western society, you would have seen that many have problems, and many are grateful for help.

    Some women DO feel that taking time to get to know their children and learn to feed them properly (and some women DO have an easy time, while others have many difficulty) is worth taking a few years a piece.

    No harm is done by CARING for the result of the breeding you do. When my babies were young, they took First Place. MOST mothers feel the same way. YOU may feel different, but I’m willing to bet IF you do have kids, they would have benefited from being Number One for a few years each…..not their care being an afterthought.

    You obviously made different choices. Don’t disrespect those who take parenting their children seriously.

  9. Ummm….let’s see. Three. Yup, that would be three. Now, it’s been a bit, long before they invented lactation consultants and when we still had to fight with the nurses to breastfeed, when we fed in cars and behind blankets…..but yeah, three. Pumped a bit, worked a full-time job, had enough spare milk to contribute to a milk bank for preemies—now there’s an idea from the dark ages! Weaned my youngest at somewhere around 2 and a half….by mutual consent, actually. Quite funny since she was potty-trained a year before I weaned her.

    I’ve taught women how to nurse babies. Don’t need a degree, certificate, or fancy schooling, just some common sense….and yes, I am aware that the “whole thing” goes in the baby’s mouth. Given half of a reasonable chance, the baby will show you that…. However, the preponderance of “specialists” in this particular field only serves to reinforce the idea that this is a difficult skill. Seems to me that the human race would’ve been long gone if that was so?

    At the end of the day, the point is that the child is fed. Doesn’t really matter how….breastfeeding is a wonderful thing, but there is no need to disrupt your entire life to achieve it. Kids are there to be along for the ride, not the sole focus of your life, and will be much happier in the long run for the realization of same.

  10. fuzzy, how many children have you breastfed, exclusively and successfully to the AAPs recommendation of at least 12 months?

    Just wondering. Some women DO have great difficulty learning to breastfeed. It isn’t just about “trying” there can be difficulties that some women REALLY need help to overcome. There is often MUCH more to it than “Stick kid to nipple.” (You don’t “nipple feed” anyway, you use the entire aureole and breast.)

    My guess is you’ve never done it? Or not for an extended period of time?

    The gratitude that many women show, when someone can help them find the way feed their child the way they want to is astounding. I’ve held more women in happy tears, at the end of a Consult than I can count. Babe, it about a hell of a lot more than “money” (Cuz we don’t make all that much of it.)

    Also, not all women have “really painful sex” after having babies, some do, but many do not. (I never did.) You might want to stick to talking about things you actually KNOW about….just a suggestion.

  11. Hang on here…..”take care of the kids, then yourself?” No, not really…..

    We aren’t back in the dark ages. There’s someone in here to help…a willing father. Nipple confusion is one of those overrated things that keep lactation consultants in business…you really truly don’t need to pay someone to teach you how to feed a baby. Sheesh.

    Stick kid to nipple. Stop reading 9 million books on how to do so.

    And sex after babies really is painful. Kegels do help.

  12. Chingona, I agree with you about the lack of need for Middle of the Night bottles by daddy. But, Nipple Confusion IS a serious issue for many mother baby dyads, and some beyond the 3 month mark. I’ve been treating Lactating dyads for 20 years, and I have seen Nipple Confusion as late as 12 months, yes, it is MORE common in the first 12 to 16 weeks, but there are no guarantees. And the babies who get it at 5 months or 9 months or a year are even MORE stubborn about going back to the breast than a newborn.

    In my experience, (and most good LC will agree with me) Nipple Confusion is the SINGLE most common reason breastfeeding fails. And one of those reasons is “my sister in law gave bottles from day 3 and her kids were fine.” You never know Who is going to be effected by it, or how badly, until it happens. One baby gets it, an other doesn’t. And too many women, when “older” babies develop Nipple Confusion think “Oh, the baby is just weaning.” (which in real life will NOT happen naturally before 12 months.) and just give up. It is very sad, and it is a missed opportunity to make sure that baby gets at least the 12 months (preferably more, if baby wants it) that the AAP recommends.

    Also, with Nipple Confusion, not only do you not know WHO is going to be effected, but you don’t know how bad it is going to be. Some babies get a little fussy, some cause ripped apart nipples and bleeding and pain from Mom (from trying to nurse like they passively “suck” from an artificial nipple) and some viciously refuse the breast. It IS a huge problem, and one that the medical profession just doesn’t see. (which is why we Community Based Lactation Consultants (most hospital based LCs deal almost exclusively with newborn issues) deal with nearly ALL of it. I used to be hospital based, now I’m Community. Aside from the fact that the money sucks, I much prefer Community based consulting.)

    As for “going back to work” when Humans were invented, “work” was done WITH your baby on your breast, so Nature hasn’t caught up with our Post Industrial Desires. (like Mom “working” in one place, and Baby somewhere else for most of the day)

    Babies and breastfeeding are the same as they were 20,000 years ago, so “work” doesn’t play into “what works” to help lactation. SOME babies will do OK with a bottle after 12 to 16 weeks, some won’t.

    After my first baby developed horrible months long case of Nipple Confusion, and it took us four months to straighten out, I NEVER gave an other one of MY babies a bottle. EVER. I never had a bottle in the house. If I needed to “work” away from my baby, My Man would feed said baby with my milk in a shotglass, by passing “sucking” altogether until I got home. (not to “bond” but to just get some milk into the baby, so I could bring in a few shekels.) I made sure to be gone no more than a few hours at a time, and we were OK.

    I also treat Nipple Confusion in my clients with feeding the resistant babies with Feeding Cups (small plastic cups like shot glasses) Soft Cup Feeders or sippy cups, if they are older. The ONLY way to treat Nipple Confusion is the elimination of the Bottle. Some kids can “go back” to the bottle a few months later, but once they’ve been Confused, I certainly wouldn’t recommend it.

  13. Madamoiselle L,

    While the “have the dad give a bottle” would not have worked for me either, I think you’re going a bit overboard on the nipple confusion thing, given that the baby is already several months old.

    Almost every source I’ve ever seen says this is primarily a problem when breastfeeding is getting established.

    Like many, many women who successfully breastfeed, I had to go back to work when my son was three months old. He went into daycare or stayed home with his dad and took bottles of breast milk that I pumped at work. Believe me, my son never got confused about which was which and maintained a very strong preference for the breast throughout infancy.

    If nipple confusion was so deadly to breastfeeding even after it is well established, women wouldn’t be able to go back to work and keep breastfeeding. Fortunately, most kids can adapt. (I also did not have to wean twice. He was off the bottle and on to a cup LONG before he was off the breast.)

    I don’t mean to disrespect your professional experience – but please keep in mind the kid is several months old already.

    The reason I don’t like the “have dad give a bottle” bit is because, if we’re talking the middle of the night, it’s counterproductive. She’ll have to do an extra pumping session – no fun at all – and she’ll be more engorged, which can make sex – or least having your breasts touched – more uncomfortable. But … different strokes for different folks. I know some couples do this and it works for them.

    I understand the goal is more sleep, but … it sounds like she’s talking about physical discomfort.

    Lack of sleep can definitely affect libido, but it doesn’t make a ton of sense to me that it would cause physical discomfort. From the description in the letter, this sounds like something beyond lack of desire or even lack of lubrication. It sounds like the physical sensations caused by intercourse have changed post-baby.

    I also don’t mean to disrespect Dr. Kate’s professional experience, but I’m left wondering if something else is going on. Even women who have c-sections can have pelvic floor issues caused by the extra weight of pregnancy. Could some stuff have shifted around inside, causing the stimulation of intercourse to hit different parts of her vagina than before? Could Kegels help? I don’t know, but I’m uncomfortable with the “just give it time” nature of the advice.

    I also know one woman who had pain with sex after multiple c-sections because of scar tissue/adhesions but it was more of an internal kind of pain, and I don’t know how likely that is with just one c-section.

  14. Sorry, Doc, I usually agree with you, but as a Mom and a Lactation Consultant, I have to disagree about the bottle of pumped milk. (Males do not lactate, they have relatively low prolactin levels, thus males DO NOT bond with infants via feeding. Not in primates. Their bonding takes place with other activities, not feeding.)

    First of all, Kudos to you for breastfeeding your child thus far! Good job, keep it up!

    As you may know, MANY babies will get Nipple Confusion if given bottles, some only in the first 12 weeks, others ANY time a bottle is introduced. The baby could refuse the breast, it could effect your milk supply, you could be so full of milk during sex (because of the bottle) that you can’t enjoy yourself at all.

    Plus, by four months your baby is well old enough for a sippy cup. Try taking the “valve” out of it, most breastfed babies see cups for “drinking” and breasts for “suckling” and won’t get the whole sucking on a “valve” thing. Or use a cheap sippy cup with a small spout and no valve. (If you choose, for whatever reason to pump your milk, but it is not necessary JUST to have sex with your husband, the baby can drain you quite nicely before.)

    There is NO reason to have to wean a baby twice and introducing a bottle is not necessary. They will go seamlessly from the breast to a cup, to eventual weaning.

    I have nursed 4 kids into toddlerhood, and am a practicing lactation consultant, so I’m going on not only more than 20 years of experience, but a lot of evidence based data here.

    SOME women see more dryness during breastfeeding, not all. (I didn’t unless I had an infection, everybody is different.) By 6-15 months post partum, while still nursing, your body is beginning to think about ovulating again, if it hasn’t already. Most women will be able to use breastfeeding to stall ovulation for about 6 to 12 months,(some as long as 2 years) but only if the baby is ONLY taking the breast, solids are not introduced, or only “for fun” and the baby is still waking at least every 4 hours to nurse. If you are menstruating, consider yourself fertile, even if you may still be anovulatory for an other few months. DON’T take a chance on Irish Twins.

    What many women in your situation find helpful, is of course, using a a good lube, like the Doc said. (As SS said, Astroglide with the GREEN cap has no glycerin etc or you could use plain old KY.)

    Nurse the baby right before you have sex, that way your breasts will be softer, and less likely to leak, also, the baby SHOULD be asleep for a few hours, and you will be able to concentrate on your own pleasure for a while. Make sure you have a LOT of pre intercourse stimulation. LOTS! Even with the lube, your own lube is still being made, but it may take longer to get it flowing. A lot of women find oral sex the best way to achieve this.

    Most of my clients (and myself) who tried to “get away” from the baby, by getting a hotel room, or having dad or someone else feed the kid etc found we were SO worried about the baby, we couldn’t think and sex was simply out of the question. We only relaxed when back in our own homes, baby only a few feet away in her bed.

    Many moms have found the best way to get back into the swing of things is to do what is best for the BABY first (no bottles, feed normally, don’t leave the kid overnight) and just do what you will be normally doing every day until ALL your kids move out: Take care of your kids, THEN take care of yourself and your man. (I mean, you’ll be having sex 3 to 7 times a week eventually, you can’t “leave the baby” and get a room every time you want to get it on. Just do what you will be doing for most of the next 20 years.)

    Making a Big Deal out of “trying” to enjoy sex, in an unusual situation will most likely only make you nervous and less likely to enjoy yourself. Most of your sex is going to be IN your house, with your kids in the next room, so doing something different than that rarely helps and only puts pressure on a nursing mom to feel she “needs” to enjoy sex NOW, hey he spent money and time on the hotel room! Don’t fall into that trap, you, your man and your baby may be likely to suffer. (There is nothing sexy about checking into a hotel room, for a night of “expected” steamy sex, with packing your sexy nighty and a breastpump in tow. NOTHING.)

    Better to stay at home, light a candle, make sure baby is fed and asleep, get a nice drink, (won’t hurt the kid, or you can just have juice or water) have your man start with a backrub and see where it leads.

    Keep the Astroglide on the nightstand, it may or may not evolve into the steamy sex you and your man have been missing, but eventually it will become that. And these months of being sex and sleep deprived will be only a memory. (Many moms find the New Dad can be happy with a nice blow job, if you simply can’t bring yourself to have intercourse at this exact moment.)

    If sex continues to be extremely painful, see your doctor, but make it clear to him or her, you are breastfeeding and want NOTHING to compromise this experience.(Meaning NO estrogen cremes, they can decrease your milk supply and are simply unnecessary for lactating women, although some doctors seem to put Lactation in the same category as Menopause.) It possibly could be an infection. After my second baby was born (a C Sec, NOT planned) sex was excruciating, and we found out I had Bacterial Vaginosis, and it was cleared up with a month of antibiotic creme. AFTER my OB wanted to put me on estrogen (because I was very sore) and I emphatically declined…good thing, it would not have done a thing for the bacteria he only tested for AFTER I refused to take the estrogen.

    Good luck. (Sorry for the length. But, I’ve been in this exact situation…four times. And helped thousands of other women through it personally.) It WILL get better. How do I know? Most people do go on to have more than one kid.


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