Why Breastfeeding Can Make Sex Hurt
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Time to read 6 min
Pregnancy can change a body, but giving birth doesn’t automatically mean everything goes back to “normal.” There’s a reason why doctors suggest waiting several weeks after giving birth before resuming normal sexual activity.
But while some body parts may just need time to heal, if you’ve decided to breast/chestfeed, you may discover some uncomfortable side effects that last as long as you’re lactating.
Fun fact: This is called Genitourinary Syndrome of Lactation (GSL)!
Granted, this name was only very recently coined by a team of doctors hoping to bring attention to the impact lactation can have on one’s quality of life. According to a recent study , GSL “manifests through a variety of discomforts, including:
- vaginal dryness,
- dyspareunia [painful sex],
- urinary symptoms,
- and even alterations in sexual function,
resulting in a significant impact on quality of life.”
It may come as no surprise that women and AFAB people have been tolerating symptoms for, like, ever. Thankfully, this group of dedicated doctors is hoping to not only improve the postpartum experience of their patients, but educate other healthcare professionals about GSL as well.
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Hormones
So, why does lactation cause painful sex? Honestly, the answer probably won’t surprise you: hormones.
Prolactin suppresses other hormones
There are significant hormonal changes associated with lactation. First, there is a rise in prolactin post birth. Prolactin is the hormone needed to trigger the creation and build up of milk. However, prolactin suppresses the release of estrogen and androgens. (Which in turn suppresses ovulation, decreasing the potential for another pregnancy.)
The act of suckling stimulates the release of prolactin and the prolactin increases milk production. The symptoms of GSL will continue as long as the cycle of suckling → prolactin → milk production does.
The impact of estrogen and androgens on the vulvar area
Estrogen plays a crucial role in maintaining the thickness of the vulva, vaginal wall, and urethra, as well as lubrication. Thinning vaginal tissue and lack of lubrication can cause pain with penetration.
If this sounds like something you might go through during menopause, that’s because it is! Genitourinary syndrome of menopause (GSM) is very similar to GSL.
And! There are estrogen receptors throughout the female genitourinary tract: the clitoris, bladder, urethra, etc. Is it any wonder why estrogen has such an impact on how we feel down there?
Sometimes referred to as lactational atrophic vaginitis, the genitourinary symptoms typically present as:
- Vaginal dryness
- Itching
- Burning
- Irritation
- And dyspareunia (painful sex)
This may also lead to urinary symptoms like urgency and frequency due to increased tension in the pelvic area.
There are also androgen receptors among the skin of the vulvar area, and androgens work alongside estrogen to maintain the blood vessels in the vaginal tissue. The healthier our blood vessels in that area are, the easier it is for them to create natural lubrication.
If you experience superficial dyspareunia or vestibulodynia and you’re breast/chestfeeding, it could be due to the decreased androgens and estrogens from lactation.
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→ Why is sex painful? Common causes of "superficial" dyspareunia
Estrogen helps the vulva heal postpartum
Another important role of estrogen is helping the body heal after birth. Estrogen promotes the growth of skin cells and enhances the body’s ability for wound-healing—lost or damaged skin replaces itself with new tissue. If estrogen levels are lower, it would make sense that lactating people may have “delayed or impeded recovery as compared with postpartum [people] who are not breast/chestfeeding .”
If you attempt intercourse after giving birth and you are breast/chestfeeding, consider that the discomfort you may be feeling could be due to the fact that you are not fully healed. Give it another few weeks and the healing process may be farther along.
How do I ease painful sex caused by lactation?
This is a great question and one you are likely considering with care. On one hand, if breast/chestfeeding has worked well for you and your baby so far, you probably feel good about your ability to provide nourishment to your newborn. On the other hand, it might be having a negative impact on your sex life. It’s totally okay to have mixed feelings about this and to even consider stopping breast/chestfeeding if it’s impacting your quality of life. Before making that decision, though, consider the variety of treatment options.
Pharmacological options
Vaginal estrogen therapy may be considered for people experiencing GSL. It is a proven effective therapy for vaginal dryness, dyspareunia, and other vaginal symptoms, though there haven’t been robust studies done yet on estrogen therapy for lactating people. The concern would be that estrogen could transfer to breast/chest milk or cause decreased milk supply, however, in one study, even at a high dose, there were no measurable traces of estradiol detected in milk samples. Another study concluded that it likely wouldn’t impact milk production.
There’s more research to be done, so wanting to discuss the pros and cons with your doctor is completely understandable! It’s worth noting that in one study 52% of participants reported that vaginal estrogen cream felt that their perineal pain was “very much better.” No adverse side effects were noted in this study.
Non Pharmacological options
If you’d like to start with an intervention that doesn’t require a prescription, we’d suggest starting with lube or vaginal moisturizer. There are countless over the counter options (including our Oh Naturale Organic Aloe Lube !).
Also—we can’t recommend pelvic floor physical or occupational therapy enough! Pelvic PT or OT can help you heal postpartum whether or not you are breast/chestfeeding. While we know it isn’t accessible to everyone, all birthing folks could benefit from seeing a PT or OT during pregnancy and after birth for an easier healing process.
Check out these postpartum favorites
Change the way you play
If one of the reasons sex is painful for you has more to do with your brand new breasts/chest than your lower bits, it’s totally reasonable to take chestplay off the sexy menu! Your nipples may be sore and chapped, your breasts heavy and tender. If this is the case, talk to your partner. Tell them they can look but don’t touch or show them how you prefer to be touched or caressed for now.
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In the meantime, be patient with yourself and your body. It has gone through so many changes! And if you’re breast/chestfeeding, some of that postpartum pain may take a little longer to heal. The symptoms are treatable—and now that it’s got a name (officially!), don’t hesitate to see your doctor if genitourinary syndrome of lactation is affecting your quality of life. If penetrative sex is off the table for you now, consider having sex with your clothes on or discovering new ways of having sex!
Breast/chest-feeding can cause pain during sex
This is because lactating lowers estrogen and androgen levels, which are important hormones for vulvar health
You have lots of options for increasing comfort during sex while lactating
The Author || Nicole Guappone
Nicole Guappone is a writer and pelvic health nerd living in the Chicagoland area. She’s been published by Rolling Stone, Glamour, Allure, The Establishment, and more. She’s worked sex toy retail and written sex toy reviews from the perspective of someone with pelvic floor dysfunction. Ohnut helped her on her journey to pain-free sex.
Nicole has an MFA in nonfiction writing and recently completed the Mind-Body-Pelvic Health Academy training program with Dr. Brianne Grogan, DPT. Her non-human companions include two cats and four koi fish.
