You made it through pregnancy and delivery and you’re getting the hang of this new parenthood thing! Great work! You go to your postpartum visit with your provider and they give you the go ahead to have sex. Sex? It might be the furthest thing from your mind. You are focused on feeding your baby, sleeping, and trying to get a bite of food here or there, right? I know. I’ve been there. It can be rough. But the truth is you will want to have sex again, hopefully, and it will be a little different than it was before. Let’s talk about having sex after you have a baby…
Let’s get some logistics out of the way first. Most providers tell women to wait at least 6 weeks after delivery to begin sexual activity. This is to allow your vagina and uterus to heal appropriately. If you had a vaginal delivery, having your provider evaluate your vaginal tissue and make sure that you’ve healed well is very important before jumping into sex. If you had a C section, we usually still recommend waiting 6 weeks to reduce your risk of infection since your uterus is still healing. At your postpartum visit you should also talk to your provider about contraception. There are good options out there available to breastfeeding women so make sure to talk to your provider about this! Remember that breastfeeding could prevent pregnancy, but not reliably. It is never clear when a breastfeeding woman will get their first period, and once they have a period, it means they ovulated 2 weeks prior. This is why you should never depend on breastfeeding as reliable form of birth control. Contraception is super important so make sure you leave your providers office with a birth control plan!
So, you’ve gotten the go-ahead from your provider, you have reliable contraception, and your partner is ready, are you ready? I have to tell you, it will feel different. It is not uncommon for sex to be uncomfortable the first few times after childbirth. This could be from vaginal dryness because while you are breastfeeding you have low estrogen levels causing dryness in the vagina. Sex may burn or cause pain due to this. I always recommend starting with lot of lubricant when first getting back to sex. Even if you didn’t need lubricant prior to baby, I highly recommend you use one now. If lubrication doesn’t relieve your discomfort or if you are having pain with sex you should reach out to talk to your provider. Another reason you could have ongoing pain is from your vaginal laceration. Although this has healed, the tissue might feel tight or sore as it stretches again. This should be temporary and improve quickly, but if it’s not improving, you need to come in and see your provider. Yet another reason you might feel pain is because the muscles of your pelvic floor just had a small human pass through them, and sometimes this can leave these muscles tight and sore even months after your birth. Sometimes this will improve with time, but sometimes women need help learning how to relax and strengthen these muscles. A half to a third of women will experience pain for the first few months after childbirth. If your pain is not improving over the first few times you engage in sexual activity, you need to see your provider. Sometimes we can prescribe medication to help that vaginal dryness. Sometimes women need perineal massage to loosen the tight areas or scar tissue over their laceration site. Pelvic floor physical therapy is also extremely important in helping relax those tight pelvic floor muscles. Your provider can talk to you about these options or refer you to a provider that can get you the help you need. Remember that sex doesn’t always equal intercourse. There are other ways to maintain intimacy so feel free to experiment and explore each other. Please do not suffer if your pain is not improving. If something is painful, you will not want to do it! Avoiding sex due to pain can cause anxiety, depression and lead to relationship issues.
Sometimes after having a baby, women will have issues with leaking urine also. This is very common. That pelvic floor gets pretty beat up when that baby comes through there. Even if you had a C section, many women still feel some bladder dysfunction after baby. None of this makes you feel sexy. Start with doing some Kegel exercises where you tighten your pelvic floor for a few seconds to strengthen it. If you don’t know how to do these, here is an easy guide https://www.nafc.org/kegel. If this does not improve things over a few weeks, please reach out and see your provider. Pelvic floor physical therapy can make a huge difference to stop urinary leakage!
But wait, when is there time to have sex after you have a baby? You have a newborn that keeps you up at night and needs your attention 24/7. How do find the time? It’s hard and I’m not going to sugar coat it. A healthy sex life is an important part of our relationships so it’s important to commit to finding some time. Talk to your partner about times that might work well, but here are a few ideas. Nap time is a great time, although early on it might seem hard to plan ahead of time as baby sleep schedules aren’t always predictable. Sometimes at the end of the day we are so tired from being with baby, that the fatigue can seem unsurmountable and this might not be the best time to plan for sex. Early mornings sometimes before baby is up and you’ve just gotten a little sleep, can be a nice time. Getting a date night to yourselves and leaving baby with a trusted family member or friend is also important and might be an opportunity for you and your partner to have some intimate time. Having a new baby puts stress on relationships too, on top of everything else. Sometimes it can feel like you are doing it all and your partner might not be contributing as much as you’d like or not doing things how you would want. You might feel feelings of resentment or anger towards your partner. None of these are good for the bedroom. Getting a date night without baby is important so that you can reconnect, communicate without being interrupted, and spend some time focusing on each other and your relationship. Babies can put stress on a relationship, but it can also bring you closer together.
Postpartum depression is common during this period and like all depression, it can definitely affect your sex life! Your provider should have talked to you about depression and mood at your postpartum visit. If you are having symptoms of postpartum depression or are struggling, please reach out to your provider because we do have resources to help you and get you the support you need.
Lastly, it’s not uncommon to have low desire for sex in the postpartum period. I hear this from women a lot. You have a small human touching you all day so the idea of being touched by your partner may not sound all that desirable. There is no easy answer here. First, I will tell you this is normal. It is normal for most postpartum women to have some level of sexual dysfunction for some time. For most women it will improve. Making time for sex, committing to it, getting time alone with your partner are all things that hopefully will help foster some desire. Please be patient with yourself. If your desire isn’t improving over the first few months after baby, please see your provider.
It’s not always easy to bring these things up with your provider, so hopefully your provider will ask you about these things, but if not, please bring them up. If you are struggling with any of the above issues, please make an appointment to address them. While an annual exam is a great visit for preventive health, unfortunately, providers have little time to adequately address these issues during these visits. Please call your provider’s office and make an appointment for the specific issue so that you and your provider will have time to fully address your concerns.
Ashley Fuller, MD, is a Swedish gynecologist. Dr. Fuller has a special interest in women’s sexual health, and her goal as a physician is to partner with women to help them decide on a course of action that will help them achieve their health and wellness goals.
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