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!

Is Pelvic Pain Preventable?

Can Urinary Urgency, Pelvic Floor Dysfunction and Vaginal Pain Be Prevented?

You’ve probably been hearing a lot about pelvic floor dysfunction and pelvic pain—because people like me don’t stop talking about it (you’re welcome). You may be wondering, “Okay, Riva, we get that YOU see the world through the lens of PFD, but how common is it really?”“Can we talk about preventing pelvic pain?” Let me share some stats.

Research shows that at least a minimum, 30% of women have a pelvic floor disorder. So do 16% of men. Meanwhile, up to 25% of women have vestibulodynia (pain in the vestibule—the area around the urethra and vagina). And nearly 10% of women in their forties suffer from urge urinary incontinence.

Surprised? These aren’t always conditions doctors warn patients about. That’s why I’m here!

The good news? Many of these issues may be preventable. And the tips below aren’t just good for your pelvic floor—they’re good for your overall health and well-being.

Curb Constipation

Straining puts unwanted pressure on the pelvic organs. I’ve treated patients who developed prolapse (organ descent) after years of pushing and using faulty toileting mechanics.

Constipation can feel embarrassing, but there’s no room for shame here. It affects about four million people! You might have accepted it as just the consequence of a busy life, but that shouldn’t be the case! Chronic constipation burdens the pelvic floor, especially when you need to strain or push to pass a bowel movement. 

Remember: peeing and pooping should be passive. No straining required.

Constipation can be occasional or chronic. Chronic constipation may last more than over 12 weeks. Talk to your doctor for a treatment plan, and also consider more water, more fiber, and regular exercise.

If you have irritable bowel syndrome (IBS), you may hesitate to add fiber since it can upset your stomach. If that’s the case, speak with a nutritionist who knows IBS well. They can help you find safe ways to include fiber.

Stop Smoking

We all know smoking is bad news. The biggest fear is cancer, but smoking also increases your risk for pelvic floor disorders.

A 2020 study in the International Journal of Urology found that urgency and urge incontinence were more common in smokers and ex-smokers than in non-smokers. A study in Neurology and Urodynamics also found a possible link between urinary urgency and smoking.

The Michigan Institute of Urology explains why: frequent coughing (common in smokers) puts downward pressure on pelvic organs. Smoking also irritates the bladder—both big problems for pelvic health.

Run Right

Running is fantastic exercise. It can prevent cancer, protect your heart, and improve sleep. But it’s not without risks. One of them is pelvic floor injury.

As I told Runner’s World, good form and proper shoes are essential to protect your pelvic floor. If you’re unsure, work with a personal trainer who knows running mechanics.

One quick tip? Run with a slight forward lean. This prevents excess strain on the pelvic floor.

Choose the Best Birth Control

Thankfully, we live in a time with many birth control options. But what works for one person may not work for another.

Research in the journal Sexual Medicine shows that combined hormonal contraceptives can increase the risk of hormonally mediated vestibulodynia (pain in the vestibule). Why? Because these contraceptives affect estrogen and testosterone levels.

Many of my patients have seen pain improve with estrogen/testosterone creams prescribed by their doctors. Oral contraceptives can also cause other side effects, such as vaginal bleeding and weight gain—factors that may contribute to pelvic floor dysfunction.

The Takeaway

Pelvic floor dysfunction, urinary urgency, and vestibulodynia can be incredibly tough to live with. And yes, some of these lifestyle changes—like quitting smoking—are difficult. But they are possible.

We work hard to prevent heart attacks or skin cancer because we want to live longer. We should protect our pelvic floor for the same reason: quality of life. Both matter.

You deserve a life full of happiness and health—especially pelvic health.

Wanna learn more? Check out my previous blog – How to Press Fast Forward on Your Pelvic Floor Recovery

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

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