Sex

Life with a newborn can be exhausting and emotionally overwhelming. As you adjust to your new role as a mother, you may be recovering from vaginal tears, a caesarean section, breast tenderness, hormonal highs and lows and sleep deprivation.

Resuming an active sex life will likely be low on your list of priorities at the moment, but you will once again feel the urge. Do not feel the need to rush, allow your body to recover and remember, very few couples are sexually active within the first four to six weeks after delivery. To reduce the risk of infection we recommend you wait until the bleeding (lochia) has ceased before you resume intercourse.

If you are breastfeeding, your estrogen levels are low so you may experience vaginal dryness. Don’t skip the foreplay and keep a supply of water-based lubricant (K-Y jelly) by your bedside table and if you experience any discomfort, stop. Sex after pregnancy will become easier with each subsequent attempt.

Unless you are looking to expand your family quickly, be sure to use contraception each time you have sex –breastfeeding is not a reliable form of birth control and fertility returns soon after delivery.

Frequently asked questions about sex after childbirth.

When can I resume sexual activity?
I am having pain with intercourse now. Is that normal?
I am experiencing vaginal dryness. Is something wrong?
Sometimes during intercourse or after orgasm my breasts leak milk. Why does that happen?
My breasts are extremely tender during sexual foreplay. What should I do?
I have been diagnosed with post partum depression. Will this have any effect on my sex life?
If I am still breastfeeding when I resume intercourse do I need to use some form of birth control?
To be honest, I just don’t feel like having sex yet. Is there something wrong with me?

Q: When can I resume sexual activity?

Everyone will resume intercourse at a different time depending on when they feel comfortable. This will be different for everyone. Some factors that may affect the timing may include mode of delivery, type of tear, fatigue, etc. Only ~50% of women have resumed intercourse by 6 weeks post partum and 90% at 3 months. If you are uncertain whether it is safe then you should ask your health care provider.

Q: I am having pain with intercourse now. Is that normal?

Pain with intercourse after having a vaginal delivery can be normal and may depend on whether or not you had a tear at delivery. It takes time for the vagina to heal, just like an injury to other parts of the body, and sometimes scar tissue can be sensitive and tender. If you are experiencing intolerable pain and continue to have pain after multiple attempts, then you may have resumed intercourse too soon and should allow more time for healing. Using lubricants during intercourse may make it more comfortable if you are tender.

Q: I am experiencing vaginal dryness. Is something wrong?

Many women and their partners may interpret this as a decrease in sexual arousal or desire, which, in fact may not be the case. This is an especially common issue for mothers who are breastfeeding. The hormone responsible for breast milk production (prolactin) will cause your ovaries to produce less estrogen. In turn, the lower estrogen levels decrease the production of natural vaginal lubrication. When estrogen levels are low, the vaginal tissues can also become more sensitive. Many women may require a water-based lubricant in order to help with this issue. Even though there is not a lot of evidence to support its use at this time, a short course of local estrogen cream or estrogen tablet in the vagina may be prescribed for you by your physician when your natural estrogen levels are low because of breastfeeding.

Q: Sometimes during intercourse or after orgasm my breasts leak milk. Why does that happen?

This is caused by the hormone oxytocin. Sexual arousal or orgasm can cause the release of oxytocin. Oxytocin, in turn, will act on the mammary glands causing milk “let down”. This is a normal occurrence. If this is a concern to you and your partner, you can nurse prior to intercourse. Nursing will decrease the chance of “let down” occurring, or it may reduce the quantity of milk that is expressed.

Q: My breasts are extremely tender during sexual foreplay. What should I do?

If the tenderness is only experienced during foreplay then it is likely due to increased sensitivity from breastfeeding. This again, may be due to the letdown reflex mentioned above. It may also be a result of your breasts being engorged with milk. In both of these situations, nursing before intercourse may help. If not, you may have to avoid breast stimulation until your sensitivity has returned to normal. If you are experiencing persistent breast pain not associated with sexual activity then you should see your health care provider as there could be other reasons for your pain that may require investigation or treatment.

Q: I have been diagnosed with post partum depression. Will this have any effect on my sex life?

Postpartum depression certainly affects many aspects of life. Research has shown that mothers with post partum depression are more likely to lack sexual desire and are likely to have intercourse less often. There may be a lot of reasons for this. However, if you require medications for your depression they can also play a role in decreasing your sexual desire. Selective serotonin reuptake inhibitors (SSRI’s) are the most common medications used to treat depression. They can cause some aspect of sexual dysfunction in more than 50% of people using them. Some studies have actually quoted that number to be as high as 90%. There are ways to improve sexual function in those with depression but it goes without saying that your mental health should take precedent. First work on your mental health so you can support your new family and maintain a strong and positive relationship with your partner. This in turn will allow you to focus on ways to improve your sex life.

Q: If I am still breastfeeding when I resume intercourse do I need to use some form of birth control?

Breastfeeding is not a reliable form of birth control! Many physicians would not recommend starting a combined hormonal (estrogen/progestin) contraceptive method (pill, patch or vaginal ring) until at least 6 to 10 weeks after delivery. The reasons are two-fold. The first is that estrogen may have a theoretical effect on your breast milk supply if you have chosen to breastfeed. At 6 to 10 weeks postpartum, you will have a well-established supply of breast milk and if there is an effect on the amount it will likely not be noticable. More importantly, in the post partum period you are at an increased risk of acquiring a blood clot in one of your veins because of the changes that occur to your body during pregnancy and delivery. In those who haven’t been pregnant, a combined hormonal contraceptive method only slightly increases your risk of a blood clot from an already very low risk. Typically, combining these risks should be avoided. There are other forms of hormonal contraceptive methods that are safe to use in the post partum period. There is a progestin-only pill, and a progestin injection, both of which are safe to be started at the time of delivery. Progestin-releasing and copper intrauterine devices could be inserted shortly after delivery, but most physicians prefer to wait >6 weeks after delivery. Barrier methods such as condoms may also be used at any time.

Q: To be honest, I just don’t feel like having sex yet. Is there something wrong with me?

Not at all. In the post partum period women go through many changes. There are the physical changes such as the weight gained during pregnancy, breast tenderness, and healing associated with a vaginal tear or cesarean section. There are emotional changes such as the stress associated with caring for a new baby and the uncertainty of not knowing what to expect. There is also the overwhelming exhaustion from disrupted sleep patterns and…..oh yeah…..the time it takes to care for a newborn!! Don’t panic. It is going to take time for all of these adjustments to take place and the amount of time will differ for everyone.

written by Dr. Paul Davies

References:

• Leeman, LM., Rogers, RG. Sex After Childbirth: Postpartum Sexual Function. Obstetrics and Gynecology. 2012.
• Signorello, et al. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. American Journal of Obstetrics and Gynecology. 2001
• De Judicibus, MA., McCabe, M. Psychological factors and the sexuality of pregnant and post partum women. 2002.