Ep. 123: Postpartum Intercourse Essentials, with Dr. Steph Perez

NOTE: This episode is not appropriate for all audiences, due to use of anatomical terms and discussion related to genital contact. Please be aware. 

After delivery, women have a 6 week check up with their OBGYN when they are given the "all clear" to return to intercourse. But is it really the right time? What if things don’t feel “all clear??” How do you know what’s normal healing vs unnecessary discomfort? Pelvic Floor therapist, Dr. Steph, joins us today to share her insights and experiences with the return to postpartum sex. 

GUEST BIO:
Dr. Steph lives in Alabaster, AL with her husband, Frankie, of 15 years and their three children : Sophia (9), Isabella (7), Dylan (4), plus a fur baby named Duke (6 month old Shepherd/Husky/Pit mix).  Working with patients for over the past ten years she realized a need for increased access and improved quality of care in the women's health and pelvic floor therapy world.  She created Empowered Wellness in order to provide pelvic floor therapy and women's health wellness on private, in-person,  concierge and virtual platforms, allowing for greater access and improved quality of care to women’s health services so that everyone can get the help and healing that they need.

You can check out Dr. Steph's work at Empowered Wellness. 

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Transcript

Caitlin: 0:06

Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started. Welcome back to the Woven Well Podcast. This episode is for all the postpartum ladies, or those who will be soon, or those who may be one day we know the drill. Six weeks after delivery, you go see your OB and you get the "all clear" for regular life activities like exercise and intercourse. But is it really the right time? What if things don't feel all clear? How do you know what's normal healing versus unnecessary discomfort? Well, to help us answer all of these questions we have Dr. Steph joining us today. Dr. Steph lives in Alabama with her husband of 15 years, Frankie and their three kids and puppy. She created her business Empowered Wellness to provide pelvic floor therapy and women's health wellness on a private in-person, concierge and virtual platforms in order to allow greater access and improved quality of care to women's health services, which we are all about here at Woven. So Dr. Steph, welcome so much to the show.

Dr. Steph Perez: 1:32

Thank you. I'm so excited to be here. Thanks for having me.

Caitlin: 1:35

I am really excited that you're here too. And for those who don't know, can you tell us a little bit about what it means to specialize in pelvic floor therapy?

Dr. Steph Perez: 1:45

Yes . So a pelvic floor therapist is a professional that has gone through extra training to be knowledgeable and being able to truly tap in and evaluate the pelvic floor in addition to the whole body. And I think most people, in most places, it is a physical therapist. We say pelvic floor physical therapist, but it can also be an occupational therapist, nurse practitioner, someone that has gone through this extra training. But it is not a part of a regular education of a pt, of a physical therapist. It is extra additional training coursework. And we help people first identify their pelvic floor. What is the pelvic floor? So the pelvic floor is the group of muscles in the base of your pelvis, kind of like a muscular hammock. It's actually part of your core. It's kind of the bottom of your core, and it's a very important group of muscles to understand how to access them and their roles and their jobs and how to check on what they do. And it's one of those things that nobody ever tells us about. It's just this unspoken understanding that, oh, you're a woman, you have a vagina. You must know everything there is about your pelvic floor. But in most cases, about 40% of women do not know what their pelvic floor is or how to relax and contract it. So , we as pelvic floor therapists help identify, teach people what their pelvic floor is, how to connect to your pelvic space. And then we have a , a specific evaluation process where we can check the pelvic floor for any weakness, any tight spots or just incorrect inconsistencies of how it kind of coordinates with the body.

Caitlin: 3:29

And it is worth finding someone like yourself who is trained in that extra knowledge, like you were talking about. It is not the same to go to an OB or to go to a physical therapist that does not have this additional training. You want to find someone who is trained in pelvic floor therapy. So first of all, thank you for your willingness to go and do that because we need this information.

Dr. Steph Perez: 3:54

You're welcome.

Caitlin: 3:55

And there are all sorts of topics that we could discuss today, but we're going to focus in on the postpartum ladies and their return to intercourse after delivery. This is very specific, but it's so important and maybe even not talked about enough. So inquiring minds want to know when is a woman really clear to return to intercourse after birth?

Dr. Steph Perez: 4:16

Well, that the answer to that question is, it depends. Every person is different. And this is where it's so important to get the education about all of this stuff with the pelvic floor because when you go to your OB, typically around that six-week mark, they're not even telling you what your pelvic floor is. Half the time they're not even doing a proper exam. And typically OBs do not do muscular exams. They do a pelvic exam that has, that is not checking your muscles. Typically, they just want to know, are you okay and do you want birth control ? But anyways, So,

Caitlin: 4:52

We could talk a lot about that.

Dr. Steph Perez: 4:54

Yes. So, you know, let's say from a six-week standpoint and then the six weeks is just, it's a tissue healing time. So usually we say tissues heal in about six to eight weeks. That's where that number comes from. But just because, you know, physiologically maybe your tissues have healed does not mean that you are truly ready to resume to penetrative vaginal intercourse. Some women are ready before, some women are, you know, maybe they didn't have much trauma. They feel ready, you know , they're three, four weeks postpartum and they feel ready to resume. But just because you're six weeks does not necessarily mean that you are ready from an emotional standpoint, a physical standpoint as well. Especially if you've had any type of perineal trauma, like tearing with a vaginal delivery. But even with c-sections, just because you had a c-section does not mean that your pelvic floor is not involved. Your pelvic floor still worked the entire pregnancy. And some women who have c-sections even went through a dilation and a pushing phase before they had the C-section. So that doesn't discount your pelvic floor involvement. So when you go and you get, you know, the green light from your OB or your birth provider , it's important that you get additional education and information on how to resume intercourse because nobody tells us that either. Same goes for exercise. So it's really important that when we're postpartum, and whenever we feel ready, that you take your time and use a lot of good healthy lubrication. Paraben-free, sulfate-free, glycerin-free. There's certain brands we want to avoid. But that you communicate with your partner and really let them know when you feel ready because we're touched out, we're touched out, there's a baby's, a baby is always on us. We we're not sleeping, we're not feeling in the mood. You know, from a biological physiological standpoint, if you look at it from that lens, we're not really supposed to be sexually active at early six weeks, eight weeks postpartum. Especially when you're breastfeeding, your estrogen levels are low. When your estrogen's lower, your tissues are more thin and sensitive. You are more prone to vaginal dryness. You don't have as natural lubrication ability. So that doesn't set you up for success. But if you want to and you feel ready, then that's why we just need to spend some extra time in foreplay and use lubrication to help things go as smoothly as possible. But there's some women who aren't ready, maybe they aren't , they're not healed all the way. Maybe that scar is not healed all the way. Or you just don't feel ready and you try and it doesn't work and that's okay. There's nothing wrong with you. I think a lot of women will carry guilt about this. They ask--a lot of my patients will ask me when , well , when am I going to feel ready? And that is so person dependent and it's, how's your life? How are you sleeping? How's your stress level? How much support do you have at home? So many things go into when you are truly feeling ready. So the six week number does not mean that you're ready and we just need to really shine more light and awareness on that, that you're ready when you're ready and all of the answers are, that's okay.

Caitlin: 8:11

Yeah, I love that you addressed so many of the common challenges related to it because there are physical, mental, emotional, like practical all of these different challenges that are going to combine to make it independent or make it different for each individual couple about when the right time is to return. And you know, I use the word couple there because a lot of times you just mentioned women can feel really guilty and when is it time? When is it time? And sometimes that can come from assumed expectations about their spouse. And so they put pressure on themselves to be available for their spouse. But keeping that communication open between husband and wife, that is so important because husbands want to support their wives. You know, and I talk a lot with couples about how to approach this unique time and sometimes that communication starts breaking down because we have those expectations that maybe our spouse didn't actually have, but we think that they do. And sometimes there are some difficulties there in the relationship, the communication, but I think that's one of those common challenges as well. So thank you for addressing so many of them. You know, there is a natural healing process that you mentioned , but at what point should someone actually contact a professional? You know, how do they know if something isn't healing or progressing as it should and they need a little extra help?

Dr. Steph Perez: 9:42

Probably the most common and important one is pain. You know, a lot of times after childbirth, as we get back to resuming penetrative intercourse, there is a certain level of discomfort that we consider normal. It's a lot of it is just the mental, it's getting your mind to be okay with that whole process again. But with each time it should become less and less. You should be able to be present and enjoy the process. So with time as you're working with your spouse or your partner , we want to really see that. And if the pain is continuing, if even if it's with initial penetration or deep penetration, that is not normal and that is not okay. If there's any bleeding that occurs afterwards, that's also a sign that maybe we need to cut back on that activity or that something might be off. And the pain can also be abdominally. I forgot to mention that too. Sometimes you might notice lower abdominal pain. With that, if you notice a decreased ability to orgasm or achieve that climax, then that would be another reason to speak up and see a professional. Those would be the main things we definitely want to speak up about. And you want to advocate for yourself. So you definitely want to go ahead and say, I need to see a pelvic floor therapist. I've had a lot of patients who have gone back to their providers and voiced their concerns. I'm having pain, I'm having issues. And they're dismissed and they're told, well, are you using lube? Well, use more lube. But they're never even told what lube to use or they're never told. Make sure you spend time in foreplay, communicate. I actually had a patient that was told to drink wine. Well you need to relax more. Go have a glass of wine before. So she did. And then it didn't help. And she went back to her provider and her provider actually told her to drink an entire bottle of wine. So , like you're just supposed to just

Caitlin: 11:47

There's so many issues.

Dr. Steph Perez: 11:49

Oh my gosh, it's crazy. But you should not be dismissed and understand as well that this referral, number one, you don't have to have a referral to go get evaluated, that's that you should just go straight away . But number two, your referral does not have to come from an OB. Your referral can come from a primary care, it could come from a chiropractor, it could come from your dentist. It doesn't have to be the OB. So if you feel you are being, you know, dismissed, then we can get help from from another provider.

Caitlin: 12:19

That is great to know that you can go at any time and get the support that you need and you don't have to have a referral, but you can have a referral if that's an option that's available to you. So I'm curious, you know, what approaches or what tools can actually be used to improve intercourse during this season when things really are challenging, what advice do you have?

Dr. Steph Perez: 12:44

So first we we talk about lubrication choice. I really like brands like Good Clean Love, Slippery Stuff, Uberlube, Coconu, or even just regular coconut oil because that does make a difference in the tissues and our overall vaginal health and that microbiome. So we go over kind of that type of thing. But also when we do our pelvic floor evaluation, we check if there was a tear, if there's a scar there, we have to massage and mobilize that scar. Probably the number one reason that we have painful intercourse postpartum is from that perineal scar if we had tearing with a vaginal delivery. So when that scar heals , it's very tight and restricted and tender. And so we have to massage that scar. Just like if you were to have any other type of surgery , you would need to massage the scar. But we are not told as women to massage our peroneal scars or our C-section scars. So if you have a scar, let's massage it. But first of all, we check that scar and we see, oh yeah, it's tight, it's restricted, it's tender, let's start doing some scar massage here. That usually responds very well very quickly. And once we get that on board with the whole picture where we're looking at the pelvic floor as a whole, so checking the muscles internally , a lot of times we hold tightness in our pelvic floor after birth, our pelvic floor, our pelvis in general are very emotional muscles and we will hold tension in them after we deliver almost as our body's way of self-protection. And so a part of this postpartum healing process is teaching your body. We have had the baby and now we can let go and return to kind of this normal balanced behavior. So identifying where there are tight spots, seeing if we need to do some more release work internally, whether they do it at home with the pelvic wand by themselves or we do it in the clinic. If there's a C-section, let's massage that C-section scar. That can a lot of times cause a deep pain with deep penetration. And then how can we connect our mind to our body and really teach the pelvic floor internally. Let's relax and release and let go. And then in addition to the rest of your system, you know, is your core firing? Well, do we have any diastasis recti to speak of, that separation of the abdominal muscles? Is your low back, your spine moving? Do you have any trigger points or tight spots in your glutes? And then once we check all that, we identify those areas, we address what needs to be addressed, then everything gets nice and balanced and your pelvic floor actually feels like it can relax, release, and let go and tolerate that, that intercourse and enjoy it , enjoy itself. Again,

Caitlin: 15:22

Man, this is so helpful and I love how you're addressing both those who delivered vaginally and cesarean section. You know, both are going to have ramifications after delivery and they can both be addressed and honored and acknowledged and treated. And so thank you so much for being on today, for sharing all this information. I'm going to make sure to have all of your contact information linked in the show notes for anybody who may be interested in working with you. But thank you so much for being on the show with us today.

Dr. Steph Perez: 15:57

You're welcome. Thank you for having me. I'm happy to help.

Caitlin: 16:01

We at Woven Well care so much about women's health and about your health. We believe that every woman deserves to be treated with respect and dignity as she's made in the very image of God. So we hope these resources help you to understand more about your body, your health, and how to advocate for your needs. If you'd like to hear more about these topics, make sure to subscribe to the show. Get these short weekly episodes wherever you listen to podcasts. As always, thanks for listening as we continue to explore what it means to be woven well.