Knowing 1 in 3 babies is born via c-section you would expect the other ⅔ of women to have pelvic pain after birth. But this is not always the case. Cesarean births can also cause pelvic pain especially with arousal and intercourse. Many women are surprised to experience pain because their baby was not born from their vagina. We see women with pelvic pain during sex after a cesarean birth. The organs (uterus, bladder and rectum), the pelvic muscles, nerves and fascia are not able to move, slide and glide to allow for vaginal penetration and pelvic motion during sex.
During a cesarean birth, retractors hold the skin and soft tissue open for the doctors to be able to bring the baby from the uterus to the world.
Inflammation begins the healing process from the moment stitches are in place along the incision. Inflammation is not localized to the incision itself, but to the surrounding nerves, soft tissue and lymphatic system.
The abdominal and pelvic nerves around the c-section scar are also involved. Swelling involved in healing can continue to compress those nerves and cause them to slow pain signals to the brain and create tension in the surrounding tissue area.
Remember this is a surgery. Yes! A major abdominal surgery. Greater involvement than an appendectomy, inguinal repair and knee replacement. Oh and not to mention, you now are caring for a new human and experiencing hormonal shifts. Lower back pain, groin pain, tension in the hips and pubic bone may also occur from surgery. Adding these changes together plus the healing incision and inflammation around the abdominal wall nerves can create irritations, pain, pressure, itching or burning and other changes affecting our bladder, bowel and sexual function. This is why many women who have a cesarean birth have pelvic pain. It's the nerves! (If you have been with us a while you know I love nerves! Read this for more neurological nerding!)
Globally, we all understand sciatica. The pins and needles, burning, aching sensation down the back of our leg to our knee or foot. The sciatic nerve is the largest nerve in the body innervating your leg muscles.
Now imagine these same sensations, but in the abdominal or pelvic area! The nerves involved in any abdominal surgery are nerve branches from the lumbar spine. The iliohypogastric, ilioinguinal, genitofemoral and femoral nerves may sustain a stretch or compression injury during surgery. Here's what you may
experience, but not consider as a nerve injury:
Iliohypogastric nerve: Branch of T12- L1
Nerve blocks utilized to manage pain after a c-section birth in order to minimize the use of drugs like tramadol.
Difficulty activating your lower abdominal muscles, aka Mom Pooch
Pain at the upper pubic bone
Tightness or stiffness in the mid back
Ilioinguinal Nerve: Branch of L1
Difficulty activating the abdominal muscles including the transversus abdominis and the internal oblique muscles or delay of closing the gap of a diastasis recti
Outpouching of one side of the abdominal wall about the groin
Pain or numbness sensation of the genitals (specifically labia) or groin
Genitofemoral Nerve: Branch of L1-L2
Prolonged “round ligament pain” after birth of baby
Change in sensation to the clitoral region and the pubic bone
Pressure or heaviness in the labia after arousal or orgasm
Femoral Nerve: Branch of L2-3-4
Pain or numbness sensation in the anterior thigh from hip to knee
Weakness in the quadriceps and difficulty with single leg activities like walking up the stairs
Take home message- The nerves of your pelvis can also cause pins and needles, burning, itching, achiness, pressure, tightness/tension or dull sensations in the perineum, clitoris, vulva, pubic region, groin and inner thighs.
Throughout the body, nerves travel with the veins and arteries through tunnels. The tunnels are expansive to accommodate the three travelers to provide protection and support. With intimacy and arousal, the arteries and veins increase in size and take up more room in the tunnels. If a nerve is already compressed, the nerve has limited space in the tunnel and can cause more irritability, tension or pain. Any sensation of pressure, burning, tingling or achiness with arousal, orgasm or after intimacy should be addressed.
Side note: During penetration with deep movement, the bladder, uterus and rectum need to move and shift to enjoy sex! Scar tissue or fascial tension from healing can restrict movement of the organs causing deep pressure, a sensation of hitting a wall or even the sensation to pee during movement! Sex is a complex and amazing gift, but there can be many other issues causing pain.
Dr. Amanda Heritage, PT, DPT, PRPC is the owner of Breathe Life Physical Therapy & Wellness, LLC located in Collingswood, NJ. She has been practicing physical therapy for 11 years with a strong focus on pelvic health. She enjoys encouraging women and men about pelvic therapy as a treatment option for those suffering with pelvic pain, incontinence or constipation.