Episiotomy & Painful Sex After Birth (including vaginismus chat): Why It Still Hurts (And What Nobody Tells You)

Painful sex after birth is common, often long-lasting, and rarely explained. In a large Australian study, 86% of first-time mums said sex hurt the first time after giving birth, and nearly one in four still had pain at 18 months. If that’s you, it isn’t a “you” issue...!

In this episode of Ground Floor, holistic pelvic care practitioner and doula Naomi Gale looks at the episiotomy: what it actually is (a surgical cut through skin and muscle, not a tear), why it became routine in the 20th century before the evidence existed, and why the Cochrane review, the WHO and NICE now say routine episiotomy isn’t justified.

She also covers the forceps exception, where a cut can protect against severe anal sphincter tears, and why the real question is why so many of us end up with assisted births in the first place.

Naomi then widens the lens on why sex can hurt or feel different after any birth, including caesareans:

• The six-week check myth and how long postpartum pain really lasts
• Tears vs episiotomy, scar tissue, tight stitching and the “husband stitch”
• Lost sensation, numbness and difficulty reaching orgasm
• Breastfeeding hormones, low oestrogen and the genitourinary syndrome of lactation
• The vestibule, where much postpartum pain actually lives
• Vaginismus after birth and why the body braces
• Pudendal nerve stretch and pudendal neuralgia
• Informed choice, the cascade of intervention and writing consent into your birth preferences

Naomi shares her own births (an induction, forceps and an episiotomy with her son; induction, epidural and ventouse with her twins), her postpartum incontinence and painful sex, and the holistic pelvic care journey that changed it.

Naomi is a holistic practitioner, not a medical professional. This episode is for information and informed choice, not a diagnosis.

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