Sex after birth
Two of the most common questions I get when doing postnatal Women’s Health check-ups or Healthy Mummy Assessments are ‘when can I start to have sex again?’ and ‘when will I be ready to have sex again?’.
While the questions are similar, there is a slight difference and I often reflect on how birth is both a physiological and psychological experience. This overlap can be seen in the two questions above and hence, the answer is also interconnected.
So when can you have sex after birth?
To begin, the pure physiological changes are usually obvious and understandable; they usually include a combination of pain, bruising, minor bleeding, problems with scars from an episiotomy, healing/scars of tears or a C-Section. Increased or decreased sensation is also common as well as issues caused by a weakened pelvic floor, which if you are unlucky, can lead to temporary problems with incontinence and other dysfunctions. Other physiological aspects are also increased volume of the breasts due to breastfeeding (which often cause sensory changes both good and bad), cramps and altered vaginal discharge.
Now that I’ve made you all scared, I also want to say that you are unlikely to have all, if any, of the problems above and most of all, they can all be helped and rehabilitated with time – do not worry or stress, healing is a normal part of having a baby.
The second issue, where physiological and psychological experiences overlap, is the hormone levels inherent in having a baby and what it can cause. Early on after birth your hormones are still likely to be high, and this can cause, among many other things, vaginal dryness that will remain until your body has stabilised itself – something that may take a while. This change in hormones are also linked to the ‘baby blues’, or intermittent moodiness, sadness or irritability that may come along in the weeks after birth as well as changes in sex drive. Needless to say, both of these will slow down your ability and desire to have sex.
Then there are pure psychological effects of having sex after birth – the shift (mainly by others) from woman to ‘mother’, no longer being centre of care and attention, and often a sense of loneliness once partners and family return to their own lives while yours has changed. Many women also find a conflict in being a woman and a mother at the same – post-partum body, emotional ups and downs, lack of personal time all add up to fight against feeling sexy or desirable, both important elements to having sex.
This is all a mighty cocktail of potential things that may make you hesitant, scared and struggling to desire to have sex. On top of this, there is the stress of taking care of a new-born and the tiredness it brings.
So? When can I start to have sex again and when will I be ready to have sex again?
To answer it to the best of my ability from a Women’s Health Physiotherapy point of view:
- The first bit of advice is medical and it is to wait until you stopped bleeding. This usually takes a few weeks, but there is a lot of variation. (If bleeding continues past 4 weeks, see your GP.)
- Second advice is to trust yourself and your instincts. If it feels good and natural, it probably is. There is nothing to stop you from having sex before your 6 week check if you feel it works for you.
- However, don’t rush and be prepared to take a step back, slow down and try again later – particularly if there is pain or you feel fearful of the idea. This is not a defeat or something to feel bad about; it is just part of the healing process. At a minimum you’d expect at least three weeks of healing if you had any tears or an episiotomy but it might take longer before you are comfortable and it feels natural.
- Do not fear it – it will get better, I promise. Fear avoidance is common and that can become an issue in itself, adding to the psychological impact of birth, making women feel inadequate or that something is wrong. Talk to your partner about what you are feeling.
- Intimacy and sex is looking after yourself – do prioritise it for you own sake. If you liked sex before there is no reason you won’t get back to it – but it might just require some work. Think about what made you ‘tick’ before – that probably hasn’t changed very much and take it from there.
- Along the same lines, intimacy takes many forms and while penetration might not be possible early on, don’t make this stop you from being intimate with your partner in other ways – find what works for you and build up from there. Many find massages a good way to share an intimate moment (see below) and allow for a slow build to normality.
- You are likely to experience vaginal dryness of some form – again, nothing wrong with you, just a hormonal effect. There are moisturising creams to help with this in daily life, and for sex be sure to use a good lubricant that works for you (I’m partial to Liquid Silk but everyone is different – try and see what works for you) and if you really struggle with dryness, please discuss with your doctor as there are prescription medicines that can help.
- To help with scar tissue, sensory issues and pain on contact, do start to massage your perineum (and if relevant, your C-section scar) with a suitable moisturiser/oil/lubricant as soon as you have healed. This is also something your partner can do for you and provide you both with intimacy.
- Once you are comfortable with penetration, massaging your pelvic floor before intercourse may help to increase comfort. See this pdf for a description and use lubricant! Again, something your partner can do!
- Vary your positions during intercourse – many women report some positions being much better than others. It can depend on your particular scar tissue, any perineum injuries and in what position your pelvic floor is most relaxed.
- If you had third degree tears or worse, liaise closely with your GP/Gynaecologist/WH Physiotherapist as these can require some more healing and some other adjustments – regardless, it is just a matter of extra time rather than something being wrong forever.
- Laugh about it and fall in love with your vagina again. Don’t be afraid to have a look as it is often not as bad as you think. Sex may be stop-start, it may take a while to get there and it may require lots of preparation. All part of the process. You’ll get there.
Hope this helped! If you are struggling, please don’t be afraid to seek advice – it is what we are here for. Let me know if you have any questions.
For some other reading on related topics, please check out the following posts: