Postpartum Sex

The Official Party Line
Traditionally, obstetricians have told their patients "no sex for six weeks" after giving birth. What they mean is to avoid penetration (inserting a penis, fingers, or other things into the vagina). Other doctors may specify only four weeks or when the lochia (postpartum discharge from the vagina) stops, whichever is later. Sex by manual or oral stimulation of the clitoris should not be a problem, providing there are no tears involving that area.

The main reason for avoiding intercourse is to allow the woman's genital tissues to heal, especially if there was an episiotomy or tearing. Avoiding infection is another reason. But these risks don't require weeks of abstinence from intercourse. In fact, the reason for the "six week rule" is more for the obstetrician's convenience than the new mom's medical needs. The postpartum re-check is traditionally at six weeks. Six weeks is, in turn, when the uterus should have returned to its pre-pregnancy size. This is the last of the major physical postpartum changes (again, from the obstetrician's perspective). Now, a woman doesn't need her uterus at its pre-pregnancy size for intercourse. But the obstetricians wanted "one-stop shopping" for the postpartum re-check, so they put everything, including "permission" to have intercourse at six weeks.

You can, but will you want to?
For many women, in the weeks and months following childbirth, their desire for sex is low or nonexistent. They may find that healing has not progressed enough to make intercourse pleasurable. The research on averages and statistics is spotty, so here's a sampling. One Australian study found that six weeks was the median time for women to begin intercourse again. But it also found that about half had problems initially and that persisted for the first year. Another study found that for 20% of first time mothers it took 6 months to feel physically comfortable during sex. The median time was around 3 months. Yet another study found that 57% of women were still having less frequent sex at 12 months after childbirth.

Causes Hormonal Factors
Hormone levels are also affected by breastfeeding. A woman who breastfeeds might not start menstruating again for quite a while longer than a woman who bottle feeds. This can translate into an extended decrease in libido. Women who breastfeed may also have the experience that their breasts leak during sex. Orgasm and breast stimulation can trigger the letdown reflex. Couples may find this awkward to deal with. Some women will wear a bra during sex. Women who breastfeed sometimes also comment that by the end of the day they are pretty well done with being touched.

Fear of Pain
Many women do not desire sex after childbirth because of pain, or fear of pain, during intercourse. The time it takes for a woman's desire to return to previous levels depends largely on her birthing experience. Women who deliver with the assistance of forceps tend to take longer to feel comfortable during sex. The same goes for women who experience internal vaginal tears. Women with swelling after childbirth and/or any breakdown of the perineum (the external region between the vulva and the anus that is made up of skin and muscle) also tend to take longer to feel comfortable during sex. Surprisingly, whether a woman has an episiotomy doesn't seem to make a difference.

If a woman experiences pain or fears pain she might try oral sex, manual sex, or being on top during sex, which can help her steer her partner away from sore spots. In any case, she can guide the penis into her vagina gently. Also make sure to use a lot of lubricant, as this will combat pain due to vaginal dryness.

Life-style Changes and Fatigue
As any new mother knows, the first weeks and months after childbirth are exhausting. Fatigue is one of the most common reasons for low sexual desire. Between recovering from childbirth, hardly sleeping, and the demands of breastfeeding, sex often falls to the wayside. Childbirth requires huge adjustments on the part of both parents and sex can be difficult to fit into an already packed schedule and into the changing roles of the individual parents and the partnership itself. For most women, decreased libido is only a temporary change that requires time to return to normal.

The Bottom Line
New mothers may find that it takes them a while to get back into the groove when it comes to sex. This can be related to a number of factors, including the disrupted sleep and exhaustion that comes with being a new parent, the precipitous fall of hormone levels after pregnancy, the physical discomfort that is common after childbirth, postpartum depression, and feelings of unattractiveness due to the physical changes that accompany pregnancy. Many, if not all, of these problems will improve with time. As these problems disappear, your sex life will probably improve.

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