Nearly one in three UK women still experience painful sex a year after giving birth, research has suggested.
Birth can leave a long-lasting physical legacy
The study of 482 women who attended maternity units in Birmingham found more than half had at least one sex-related problem.
Birmingham's Perinatal Institute found birth-related health problems were most likely in Asian women.
The Journal of Clinical Nursing study found women resumed a sex life on average eight weeks after giving birth.
Some waited just a week, while others waited for a long as a year.
The average for women who had assisted deliveries, using forceps or other devices, was 10 weeks.
The study, which quizzed women at least a year after they gave birth, found 87% reported at least one health problem.
Problems were most common among Asian women, older women and those who had larger babies and longer deliveries.
MOST COMMON PROBLEMS
Sex-related health issues: 55%
Stress urinary incontinence: 54%
Urge urinary incontinence: 37%
Painful intercourse was reported by 19% of women who had a Caesarean, 34% who had a normal birth and 36% of who had an instrument-assisted birth.
Sex-related health problems were highest among instrument-assisted births (77%) and lowest among Caesarean births (51%).
Two-thirds of women having normal births reported at least one problem related to sex.
Forceps deliveries were associated with higher levels of stress, urge, and continual incontinence.
Having an epidural did not lead to an overall increase in health problems.
Asian women were more than two times more likely to report pain (62%) than white women (35%). They were also more likely to report continual urinary incontinence.
Midwife Amanda Williams, who worked on the study, said: "We believe that our study points to the need for health professionals to provide ongoing support for women who have given birth."
She said this should focus on issues such as problems with the perineal area, between the vagina and the anus, and other sensitive health issues.
She added: "This, coupled with greater public awareness of these issues, will hopefully make it easier for women to get help for both short-term and long-term health problems."
Dr Maggie Blott, a consultant obstetrician at London's King's College Hospital, said: "Post-natal care is something we do incredibly badly in this country.
"Care is quite good up to about 12 days post delivery and essentially that is that."
Dr Blott said women were supposed to get a thorough check six weeks after delivery, but often this was simply about contraception.
She said: "We need to raise awareness, so that women realise it is not normal to have long-term problems, and seek help."
She said it was important that GPs took a proactive role in spotting women with potential problems, and ensuring they were given proper care and support.
She also called for obstetricians to set up clinics to provide the specialist care that these women need.