When I see moms at their 6 week postpartum visit I discuss resuming sexual activity. As I broach this topic, I am greeted by a variety of responses, as different as the women themselves. Some laugh and say they have already resumed activities and all is good. More often, they give me a blank stare that says, “Are you kidding? I haven’t slept in weeks. I am constantly coated in spit up and you want me to think about nookie?” Whatever their initial attitude, I know that statistically by 3 months postpartum 90% of women have resumed sexual activity.
After you are fully healed and resume activity there is still a transitional time until things return to your new normal. Notice I said ‘new normal,’ because after children everything is different. Not necessarily worse or better, just different. If you keep waiting for your love life to be exactly how it was before the baby, you need to adjust your ‘sex-pectations.’
Before you resume intercourse, it is important to be cleared by your doctor that all is good ‘down there’. If you resume activity before you are fully healed it can prolong the healing process.
Will sex hurt after having a baby? If so, for how long?
This depends on the type of delivery. Most women experience some discomfort for 3-6 months. A vaginal delivery with no tears and a cesarean section without labor usually have the least pain. More severe vaginal lacerations often take the longest to fully recover, up to 6 months.
The most common types of pain are burning with insertion and sharp pain with deep thrust. The pain should get better with time and practice. Regularly using a water based vaginal lubricant during the postpartum period is a must. If deep pain is an issue, trying positions were the woman controls the depth of penetration is key.
While breastfeeding, the body’s estrogen levels are low, leading to vaginal dryness and decreased lubrication for a lot of women. If you continue to have pain and dryness despite lubricant, see your physician. A small amount of estrogen vaginal cream can be prescribed to help restore your hormonal balance and improve lubrication.
When will I get my ‘groove’ back?
The most common sexual issue that women have postpartum is a lack of desire. The incidence of low libido at 6 months postpartum is 44%. However, only 10% reported being bothered by their lack of desire. For a lot of women, just knowing that it’s normal to not feel like swinging from the chandeliers when they are 6 months postpartum, is reassuring.
Usually after the first couple of encounters the pain will decrease and you should enjoy lovemaking again. If you enjoy sex when you have it and it doesn’t hurt, that’s a great start. It’s OK that you don’t necessarily spend all day thinking about it.
Attempt to set aside a scheduled day and time for intimacy. Notice I said ‘intimacy’ and not just sex. For women, it is important to have time to connect with her partner, to help her feel more amorous. And for any guys reading this: helping with the laundry and letting the new mom take a nap is the BEST form of foreplay.
OK. It’s been 6 months and things STILL aren’t good. What’s next?
If at six months you are still having pain or not enjoying sexual intimacy then it is time to see your doctor.
Depression. If in addition to lack of sexual desire, you are also not enjoying any other hobbies, are feeling down and having crying spells, this could be a sign of postpartum depression. Talk about these feelings with your doctor.
Medications. Certain medications that treat high blood pressure, depression and contraceptives can affect sex drive. If you are on medications, do not discontinue abruptly but instead talk to your doctor to determine if these could be affecting your libido. If so, request a change to an alternative treatment.
Fear of pregnancy. When you have been up all night with a colicky newborn, if you do start to feel a little amorous, the thought of getting pregnant again can sometimes be enough to nix any ‘vavoom’ that you had percolating. Women often fear contraceptives might effect their breastfeeding, but there are multiple options that are both safe and effective.
While it’s normal to not feel super sexy in the postpartum phase, things will get better. Most women are back in the swing of things by about 3 months, but if you continue to experience pain and lack of sexual enjoyment at 6 months, follow up with your doctor for help.
At the risk of opening up an extremely personal discussion, we’d like to know your postpartum sexual experience. Maybe hearing from other moms will make women feel less alone with their issues. Let’s start the conversation but please. . .no over-sharing!
Dr. Heather Rupe
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