Sex after Abstinence: Why It Doesn’t Have to Be So Scary

Introduction

Being in a relationship is something to celebrate! But having sex after you’ve been abstinent (for example, because it’s your first time, because you’ve just had a baby, or because you had a medical procedure) can feel scary. This anxiety is perfectly valid because it’s based in reality. Yes, real psychological and physical challenges can arise when you have sex again. But you don’t have to be scared. You just have to be prepared!


Why Sex Might Feel Painful After a Break

Similar to the nerves many first timers feel, you might worry that sex will hurt when you resume it after a break. A lack of lubrication and increased anxiety—which is completely expected—can make sex feel physically painful, according to Romper. Fixing lubrication is pretty self-explanatory, but anxiety can feel more complicated.

We all reduce stress in different ways, but some general recommendations include mindfulness, yoga, and exercise. You may also want to tell your partner that it has been awhile. They should know how to make the experience less stressful. And if they don’t, don’t be afraid to tell them.


Returning to Sex After Pain or Diagnosis

Returning to sex after a pain diagnosis can feel even more complicated. First, ask yourself: are you even ready to return? It’s ok if you’re not.

Chronic pain does not erase your libido on its own, but pushing through pain can create negative associations with something that should feel fun and enjoyable. Fear and anxiety can also cause your muscles to tighten instinctively. This is your body’s way of trying to protect you. That tightening can make sex even more painful, and the cycle continues.

And THAT can be a real libido buster, because who wants to participate in an activity that hurts? (My blog post on dyspareunia is particularly helpful here.) You should talk to your medical team and pelvic floor physical therapist about exercises that can help you prepare, such as dilator work and hip stretches.

In addition, if a hormonal component contributes to your pain (for example, as some women on prolonged birth control may experience), or if you are postmenopausal, you may benefit from estrogen or estrogen/testosterone creams.


Bleeding with Sex: What It Can Mean

Believe it or not, bleeding with sex is not limited to only the first time. Many things can cause postcoital vaginal bleeding in sexually active folks, including more serious conditions like cancer and pelvic inflammatory disease, according to the Mayo Clinic.

However, you may simply need more lube, more foreplay, or a different type of birth control that isn’t hormonal. There may also be no clear reason! Although it can feel embarrassing to talk about, you should always tell your doctor if it’s happening so you don’t miss an important diagnosis.


When Desire, Identity, or Emotions Shift

At any point in your sexual life, you may notice less desire than you used to. You may also experience challenges related to trauma, shame, orientation, identity, or addiction. The person you were when you were having sex at 25 may not be the person you are when you return to it in your late thirties.

This is where a psychologist or sex therapist can help. Sex therapists are real healthcare professionals trained to support people with a wide range of concerns, from lowered desire to difficulty maintaining an erection.


Final Thoughts

Sex is one of the most beautiful parts of being human, but it should never cause pain. It may feel silly to prepare for it, but remember: you can’t fully engage in loving someone else before you love and care for yourself first!

Mind Over Bladder

Cartoon waiting for the bathroom

When you think of bathroom training, you probably think of your little one learning to use the potty for the first time, but it’s for adults too – especially those with urinary incontinence

It may sound silly, but at some point, if you have urinary incontinence, your body needs to be retrained on proper voiding habits and mechanics. And just what do we mean when we talk about urinary incontinence? You may be familiar with the feeling of a little urine leaking after a cough (known as stress incontinence), as one in three women can relate, but there are other kinds of urinary incontinence as well. There is regular leaking throughout the day (overflow incontinence) due to your bladder not releasing urine when it should, and accidentally urinating before you’re able to get to the restroom in time because the urge is too strong, often described as “key in door” because people tend to leak on their way to the bathroom (urge incontinence). You can even have mixed incontinence, which is a combination of stress and urge incontinence. 

Ultimately, the goals of bladder retraining include urinating less frequently, urinating larger and healthier volumes of urine, and increased volitional control over voiding.

Part of bladder retraining is starting a bladder retraining diary that captures what life is like for you on a day-to-day basis with urinary incontinence. It may feel weird to do, but it is a legitimate way to help. You may use your bladder retraining diary to keep track of urges and leaks. You can record what times you go to the bathroom, how much you urinate (no need to measure fluid ounces, as using “Mississippi seconds” to time length of void suffices to gauge how empty or full your bladder is), and the type of fluids you’re drinking. Bladder irritants cause your bladder to contract even if it isn’t yet full, and this leads to incontinent episodes. The top three biggest offenders are caffeine, alcohol, and carbonated beverages. You may even choose to abstain from said food or drink. You may feel disheartened when you are first keeping track of what’s going on, but the idea isn’t to feel bad when accidents or setbacks are recorded in your diary, rather to use the diary in your detective work to help create patterns which will help you solve the problem. 

As for how you’ll actually retrain your bladder, you’ll start by extending the time you wait to urinate by 15 minute intervals. (People who don’t have urinary incontinence generally go to the bathroom six to eight times per day and zero to one time at night.) 

Kegels, or performing a pelvic floor muscle contraction, are a great bladder suppression technique. In other words, when you turn the pelvic floor muscles on while performing a Kegel, a message is sent to the bladder to turn off, which allows it to fill up for longer before needing to void. 

Speaking of Kegels, your pelvic floor physical therapist can demonstrate exactly how to perform Kegels properly. Don’t be embarrassed to ask us for a demonstration! They can be difficult to master, and helping you resolve urinary incontinence is what we are here for! The other reason why it’s best to check with a pelvic floor PT prior to initiating a Kegel strengthening program is because KEGELS AREN’T FOR EVERYONE. If a person has a history of overactivity, or tightness of the pelvic floor, Kegels exercises are contraindicated as they can exacerbate the problem. Some signs that may indicate overactivity or tightness of the pelvic floor muscles include pelvic pain, urinary frequency, and constipation, to name a few. 

Urinary incontinence can feel embarrassing, but you shouldn’t let that embarrassment keep you from speaking to your doctor or physical therapist about your symptoms. If you are determined to retrain your bladder, recognize, though, that it is a commitment. It may take as long as 12 weeks to see improvement. You may want to carefully choose a calm time in your life to embark on this journey, versus a time when you know it may be tougher to remain compliant. Still, it’s worth it because urinary incontinence can hold you back from enjoying all the things you love to do: seeing movies at the theater, taking long car trips, and traveling. It’s time to show your bladder who’s boss! I encourage you to talk to your doctor and physical therapist (or contact me for a free consultation) so you can get back to living life leak-free!

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732-595-1DPT (1378) | riva@revitalizephysicaltherapy.com

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