For some of us, sex just isn’t something we are thinking about in the early days after we have had a baby. Our body doesn’t feel like our own, it looks different after the incredible feat of growing a little human (or more than one). Our hormones are changing very quickly as we move from pregnant to breastfeeding and sustaining the life of a newborn, we are sleep deprived and very much in a strange new world.
But sex and intimacy are an essential part of what keeps us together with our spouses. It is what makes us more than roommates or friends. So how do we navigate the need for intimacy and sex after birth when it isn’t even on our radar?
The general guidance with regards to having sex after birth is to wait 4-6 weeks. This advice is usually given during a brief conversation which is limited to the fact that breastfeeding is not a complete contraceptive and to wait longer if you have had a tear or episiotomy that could become infected. However, this is a much more nuanced and individual conversation.
For many women, sexual function declines during pregnancy and does not return during the immediate postnatal period. However, research shows that 89% of women have resumed sexual relations within six months of birth. For some women, after 18 months they continue to have lower levels of sexual pleasure and emotional satisfaction. Some cultures will have traditions around the perinatal period, and these may include abstinence after giving birth.
There are many components affecting relationships and sexuality for parents after having a baby. These include the physical, emotional, environmental, and relational situation that the parents may be in. The first stage in rediscovering your sex life may need to be a conversation about how you are both feeling and what will help increase intimacy for you both. It is useful to remember that with regard to sex, men tend to be visual creatures and women are cerebral, that is their mind is the biggest sex organ. Having a busy mind will impact a woman’s sexual response.
Regardless of type of birth, vaginal or caesarean, there is a myriad of physical reasons for a delay in returning to an active sex life. For example, birth trauma such as a perineal tear, pain, breast sensitivity, incontinence, either urinary or faecal, and lack of sleep. Hormones change dramatically after birth. For example, estrogen drastically reduces, which can cause a loss of desire and reduced vaginal lubrication. If you have experienced a third or fourth degree tear you may have a prolonged period of recovery and a later return to sexual intercourse.
Prepping emotionally & physically
When recommencing sexual activity, it is important to think about using a lubricant to prevent damage to vaginal tissue that may already be thin or have reduced elasticity. Sleep deprivation has a massive impact on physical functioning. Any opportunity to rest needs to be taken. This may take priority over intimacy in the first few months after having a baby. Any one or a combination of these physical factors are enough to reduce a woman’s ability or desire to have, particularly a penetrative, sexual relationship. Seeing a psychologist or women’s health physio may be required and discuss any concerns with your doctor.
From an emotional perspective a woman, or their partner, may have post-natal depression or anxiety. Feeling a loss of pleasure, poor appetite, disturbed sleep, poor concentration, fatigue or hopelessness or constant feelings of stress will impact on how you relate to others and how much energy you have in the day. These symptoms can affect your perception of yourself and how you feel others view you. They are highly likely to reduce the desire or ability to be intimate.
Women may also have body image issues, poor levels of support, fear of getting pregnant again quickly, and being “touched out” where from a sensory perspective they are overwhelmed by the amount of physical contact they have had in a day just from meeting the needs of their child. Breastfeeding can also impact psychological health, as it is a complex skill to learn and is strongly linked with feeling like a successful mother. Women can feel judged about feeding in public or not breastfeeding. Their body may still feel like it belongs to their baby and their breasts may not feel like sexual organs.
Learning a whole new skill set and managing everyone else’s needs can leave the women’s needs at the bottom of the list and the incessant “to do list” can make it hard to switch off and relax into an intimate mindset. There are societal pressures pushing women to be sexual beings which may not fit with how they are feeling about their body. A partner may also view the woman’s body in a different way after birth.
Within the personal environment, there may be issues of privacy and space, with the addition of a new family member and usually the new child sleeping in the marital bedroom. The possibility of interruption may also inhibit the ability to relax.
The couple’s relationship will also impact the return to having sex after birth. Couples will have had a previous sexual relationship and the boundaries of this will determine a return to “normal” for each couple. How sex is defined by the couple will have an impact, as a return to penetrative sex may take longer than a return to intimacy. Communication will be a vital component in any return to sexual activity as responses can easily be misinterpreted and more complex issues created if they are not explored. For example, a lack of desire for sex may not be a personal rejection of the partner but could easily be interpreted in this way. It is important to be aware of the concepts of coercion and consent, no one should be feeling like they do not have a choice in their sexual relationship.
Prioritising intimacy for sex after birth & pregnancy
The early days of new parenthood can be a whirlwind of ceaselessly meeting the demands of your precious little. You are likely both exhausted from working together to feed, bathe, soothe to sleep, cuddle, coo and gaze at the new life you have brought into the world. In addition to the constant physical labour of caring for an infant, women experience huge hormonal and body changes that can leave the idea of sexual intimacy well out of mind.
It is very important that you talk to each other and allow a safe space for honesty around each other’s needs and lack of desire for intimacy. Trust that this phase will pass, and if it doesn’t feel like it will, seek support from your GP who can refer you on for counselling if needed, or physiotherapy if pelvic pain is an underlying concern.
In the meantime, try to fill each other’s love cups with affectionate touch. Plenty of long lingering hugs will cause your brain to release oxytocin, the love and connection hormone, but be sure to hold on for at least 20 seconds to let your brain do its part. Hold hands or cuddle up so that your legs are touching, or you are otherwise leaning into each other. Stop and smile at each other and marvel at what you have made and what you are managing to do together. Make your lover a cup of their favourite drink when you get yourself something.
When you feel brave enough to leave baby with a sitter, make special time to go out of the house for a date, just the two of you, and until then you can make special time together when the baby(ies) is asleep (for as long as they are asleep). Look deeply into each other’s eyes and admire the great job you are doing as parents to this precious new life. These are low pressure ways to feel connected when sexual intimacy feels beyond you. They require honesty and they build trust and resilience so that when you are BOTH ready to be intimate again it stems from a safe place you built on patience and love during a time of enormous change.
- See a doctor, physiotherapist, or psychologist if you need support.
- Practice your pelvic floor exercises regardless of the type of birth you have had, they assist with reducing incontinence risks and can improve sexual pleasure.
- Discuss contraception and be comfortable that you are preventing pregnancy if this is your wish.
- Be expressive with affection as much as you can to reassure one another that you are still very much in love.
- Schedule in romantic and sexual time to be sure you minimise distraction and interruption. Maybe plan for times outside of bedtime so that you still get valuable sleep time.
- Begin with massage and gradually increase foreplay and other forms of intimacy before having penetrative sex.
- Invest in lube.
- Get creative with positions that feel more comfortable for your abdomen after having a caesarean.
- It is a couple issue not a woman issue to be dealt with, talk, talk and more talk.
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Gutzeit, O., Levy, G., & Lowenstein, L. (2020). Postpartum female sexual function: Risk factors for postpartum sexual function. Sexual Medicine, 8(1), 8-13.
Holland, K. (2019). What to expect from sex after giving birth.
Raising children. (2019). Sex and intimacy after a baby.