The first few weeks after giving birth are typically a whirlwind of diapers, feedings, and little sleep. But as time goes on, you settle into life as a new mama and start maybe, possibly, sorta thinking about having sex again – as soon as the doctor gives the green light. Yay! Or, maybe not.

A recent survey found that 44% of women are nervous to slip between the sheets post-delivery. And for good reason, since our bodies go through some major trauma and changes (tearing, anyone?) before, during, and after delivery, making sex OK at best and painful at worst.

One of my friends asked her doctor how to fix the stabbing pain she felt during post-baby sex and he advised her to get drunk beforehand. Not super helpful.

“This is pretty common,” says Debra Wickman, MD, a gynecologist based in Arizona. “Many women discover a ‘knife-like’ pain in their vagina the first time they have vaginal penetration after giving birth.”

Why Post-Birth Sex Hurts

Not every woman will have the same experience, but there are a few common causes of sexual pain post-baby.

Estrogen Gone Wild. Estrogen is at its peak during pregnancy and then drops in the days and weeks post-delivery. These shifts can manifest in physical ways, including vaginal dryness and a burning sensation – especially if you’re breastfeeding.

“The vagina is very sensitive to this change, and can become ‘atrophic,’ much like the condition that occurs after menopause,” explains Dr. Wickman. “The situation is temporary, and variable between women – some experience more than others.”

Misfiring Muscles. Changes to the pelvic floor muscles – along with the uterus and vagina – can cause pain. “It can take weeks – up to six or eight – for the uterus to shrink back to pre-pregnancy size,” says Dr. Wickman. “This can also change the position of the cervix, making contact like thrusting uncomfortable.”

It’s not clear why muscles contract so much post-delivery, but it could partly be thanks to tensing up during those painful moments in bed.

Mental Blocks. Almost 80% of new moms experience a mild form of depression post-delivery commonly known as the “baby blues”, and between 10% and 20% experience postpartum depression, according to Shannon Chavez, M.D., a clinical psychologist and sexologist based in Beverly Hills, Calif.

How to Make Post-Baby Sex Fun Again

Like pregnancy, the pain you feel during post-delivery sex is temporary. There are some ways to speed up the process – or at least alleviate some of the pain – as you wait for your body to return to normal.

First of all, give yourself a break. You just spent the past nine months growing a baby. That’s a really amazing feat, so it’s perfectly fine to give yourself a break. In fact, you should demand it.

“One of the most important things you can do to regain a better sex life after baby is to set some limits,” advises Madeleine Castellanos, M.D., a sex therapist based in New York City. This means setting limits with others around you to protect your time as well as setting limits with yourself so that you don’t exhaust yourself. Taking time for yourself helps you recharge and helps remind you that you are a sexual woman underneath being a mom.”

Use some accessories in the bedroom. We don’t just mean sex toys (though those are a great choice, too). Plenty of foreplay, including kissing and cuddling, can release chemicals that can help you loosen up for sex. Silicon-based lubes, or a bit of vaginal estrogen, can also help make up for any vaginal dryness caused by a drop in estrogen, too.

Another good choice? Hot and cold therapy, according to Dr. Wickman. “It helps to alternate application of heat – to improve circulation, or cold for soothing relief,” she explains. “Warm water over the area several times daily is also very helpful, and the area should be cleaned with water after each trip to the bathroom.”

Do a full-body and pelvic floor workout. Exercise probably isn’t a high priority, but regular workouts (once your doctor clears you) and a healthy diet work wonders to help get your hormones back in balance.

Studies have shown that women actually enjoy sex more on those days when they have actively exercised, probably due to the increases in blood flow and boost in testosterone. A study conducted by the University of Texas at Austin found that women who biked for 20 minutes had a much higher blood flow to their genitals.

Strengthening the pelvic floor muscles through strengthening exercises like kegels can help long-term, too. These exercises can be done solo, but many women don’t know how to do them correctly. If you have questions, a urologist or physical therapist can help you learn to contract the right areas with mechanical stimulation.

The Bottom Line

You are amazing and deserve to have great sex post baby, but things aren’t always going to be perfect. Have patience with yourself – and use plenty of self-care – and you’ll be back to enjoying sex on your schedule – as long as the baby isn’t demanding your attention, that is!

Meagan Morris is a freelance health journalist living in Omaha, Neb. She loves dogs, Pilates, The Backstreet Boys (yes, still!) and can bench press more than most guys. You can read more of her work here or follow her on Twitter @upsidemeagan.