Painful Sex After Childbirth? Why Lubricants Alone Don’t Always Fix It

Added: 2026-05-31

[00:00:00]I'm Dr. Reena Malik, urologist and pelvic surgeon. And welcome back to the Reena Malik MD podcast, your trusted guide for leveling up your health, relationships, and sex life with evidence-based tools. Today, you are going to hear the first half of the Ask Me Anything episode. If you want to hear the full episode, these are exclusive to our premium members. Check out our membership at supercast.reamalikmd.com to learn more. All right, let's get into it.

[00:00:24]>> I was having pain in my pelvis with some blood in my urine. was getting treated by my primary care physician for repeat UTI is what they told me. Went to see a urologist after they did some imaging and found a small mass in my bladder and he's looking to do a cytocope. I'm not sure what that is. What exactly is this cystoscope supposed to do? Okay. So, I'm so glad you asked this question because blood in the urine is a serious issue and very often in women in particular, it gets dismissed as recurrent urinary tract infections. And so, in fact, there's actually data that shows that women are diagnosed much later than men when it comes to things like bladder cancer, which is a very serious condition that is found when you work up blood in the urine. Fortunately, it's a very small number of people who we find that have bladder cancer, like less than 5% when you look at all the people who come in with blood in the urine. But it is a disease that needs to be evaluated quickly and treated expeditiously because if it's delayed, people have worse outcomes in terms of survivability after getting treated for cancer. I'm really glad that she brought this up because I think it's important for women who are getting recurrent UTI and are having bleeding to ensure they really are having UTI. It's not something else.

[00:01:42]So, what's going on when you have blood on the urine? There's a specific workup we do and the workup includes making sure you don't have an infection. So, we'll send your urine for a urine culture and also doing an evaluation with imaging. Typically, that's a CT scan with contrast and without contrast and a delayed image. Basically, it's it's multiple pictures of the kidneys and the bladder to see if there's any masses or kidney stones or other abnormalities that might be causing the bleeding or an ultrasound if you're really low risk. And lastly, it's a cystoscopy. And I would tell you, don't freak out because they saw a mass on a CT scan or an ultrasound. Many times in my career, I've been told there's a mass on imaging and when I go look in the bladder, it's really nothing. And this is because the bladder is just a bag, right? And it can fold up on itself and it can look like there's a mass there, but there might not be. So, do not worry. The cytoscope is done and it's a procedure we do because we want to make sure there are no masses in the bladder.

[00:02:37]imaging is not good enough to tell us if there is a mass in the bladder. So you need to have a cystoscopy to make sure there are no tumors or stones or anything else abnormalities in the bladder. And so a cystoscope is essentially taking a small camera and going inside the bladder with the camera and taking a look around. Basically making sure there's no masses, no tumors, no stones, nothing else abnormal. It is a pretty simple straightforward procedure that we do all the time. That doesn't mean that it's without risk. Every procedure has risks.

[00:03:06]You can actually see bleeding after the procedure if there's any irritation from the cystoscope. For some people, it can be uncomfortable. And I made a whole video about cystoscopy and and what it feels like and what people perceive in terms of pain. It's very rare that people will have significant pain that requires them to go back to the emergency room because of pain. However, in a very small subset of people, it does happen. For the large majority, it's slightly uncomfortable and it's done very quickly. We get into the bladder, we take a quick look around.

[00:03:34]Takes about 5 minutes and then you're all done. And so, typically this is done with a numbing jelly that's put into the bladder and into the urethra. That kind of wait a few minutes for that to work and then we go ahead and look inside.

[00:03:46]And most people tolerate it really, really well. Afterwards, you might notice, as I mentioned, blood in the urine. You may also notice bubbles in the urine afterwards. And things to look out for are making sure you drink lots of fluids afterwards, that the blood clears up. If you start feeling lightheaded or dizzy afterwards or there's a lot of bleeding, definitely call the office or go to the emergency room. But again, these are really rare occurrences and for the most part, these are pretty straightforward procedures that we're doing just to make sure there are no severe significant abnormalities that need further attention.

[00:04:16]>> All right, next question. I recently gave birth and me and my husband have started having sex again, but I am hurting with the sex. I'm not feeling like I'm getting quote wet enough end quote downstairs. Is this normal after pregnancy?

[00:04:30]>> Yes, this is such an important conversation because what happens to your body after pregnancy? So during pregnancy, hormonal levels are really really high and because they're supporting the, you know, the process of of having the pregnancy and and all the things that your body needs to maintain the house for the baby to keep the baby healthy and grow. After pregnancy, you tend to have a drop in hormones and specifically a drop in estrogen and very importantly if you are breastfeeding that that drop in estrogen remains low.

[00:05:02]And so what you get is something we call the genital urinary syndrome of menopause. When you have low estrogen, your vaginal tissues or your ulvar tissues, they need estrogen. That the tissues need it to stay supple, to stay elastic, to stay moist, to allow to lubricate. And so when you lose estrogen, sort of like women go through menopause, they have dryness, discomfort, pain with sex. Sometimes they get at risk for urinary tract infections. In this circumstance, unfortunately, it's not very uncommon for women after giving birth to have pain with sex. That doesn't mean that it's okay, and that doesn't mean that you should live with it. If you are struggling with pain with sex, you can absolutely see your doctor and talk to them about maybe trying a temporary vaginal preparation of estrogen that can help restore the estrogen in the vagina and make sex more comfortable. You could also consider using lubricants, water-based, oilbased, siliconebased lubricants. knowing that water-based are the most common that you get over the counter, but they dry up because they evaporate. They're just based in water and so you'll need to reapply. You can use silicone or oil based which last longer, but some people have sensitivities to one or the other. So, make sure to check it out and try them out always away from your genitals before you put them on your genitals.

[00:06:14]And try to get ones that have sort of the least number of ingredients that don't have things that are more irritating. Sometimes the heating lubricants or the flavored lubricants or those things can have extra sort of ingredients in them that can be irritating. So try starting with simple ones. You can also use vaginal moisturizers. So vaginal moisturizers are similar to moisturizers that we use on our face. You apply them internally in the vagina and rub it in like lotion.

[00:06:37]The same thing that you would do with a vaginal estrogen preparation. And it essentially moisturizes the tissue just like you moisturize your skin on your face. And this can help with comfort as well. So lots of options. And just know that there's nothing wrong with you.

[00:06:51]This is completely normal physiology that's happening because you just gave birth and it will get better.

[00:06:56]>> All right. It's a it's a more of a personal question towards you. But they were asking if you did not become a urologist, what different field in medicine would you have considered going into?

[00:07:12]>> Oh wow. This is a very interesting question. So I um well let me start by telling you how I decided to become a urologist. So, I didn't know what urology was. I went into my third-year rotations, which in medical school you basically rotate on every specialty, surgery, medicine, psychiatry, neurology, so on and so forth. And so, when I did surgery, I was so shocked that I actually enjoyed surgery. I like the ability to like go work with my hands and fix a problem that a person had very immediately. But general surgery, I realized quickly, wasn't for me. So, I wanted to look at the subsp specialties of surgery. So I went and I rotated with urology, opthalmology, ENT.

[00:07:50]I never actually spent much time with ortho or neurosurgery cuz I didn't I was not really drawn to those fields. And so when I got down to it, I ended up really liking urology and ENT. They both had very specialized care of patients. They did uh very specialized surgeries. And so then actually my husband gave me some advice and he was like well pick the the field where the basic the most basic thing that they do is something that you don't mind. So for ENT oftent times it's doing things that are like tra tubes that are put in the trachea changing those or dealing with those and in urology it's often putting in catheterss. And I also had met both types of doctors and surgeons and spent time with them. And I really was drawn to urologists. I found they were really sort of funny and were happy and really liked what they were doing. They were also working with the robot at the time which was a new sort of surgical technique and they were really innovative in their field. So one I didn't mind catheterss. I didn't mind talking about genitals and I really liked the surgery options and I love that you took care of patients over time. So it wasn't like you just did a surgery and they were gone. That you those were your patients and you took care of them over years. And so I picked urology and I'm very happy with that decision. I guess if I had to pick again, I would probably consider a different surgical subsp specialty like ENT or opthalmology. Although at the time I was a little nervous about operating on the eye, which is why I didn't go into it. Uh, but I think it would probably be a different surgical subsp specialty because um that was my second choice. If you guys want to hear the second half of that episode, check it out at reinamalik.supcast.com.

[00:09:22]And as always, remember to take care of yourself because you're worth