Postpartum sex isn’t always comfy. We explore why with help from an expert.
Having a baby is wild—bordering on miraculous. A brand new human being (or more than one!) is built inside someone’s body.
That alone is mind blowing. But wait—there’s more! A tiny human squeezes out of the vagina like a very small and very brave spelunker, or a doctor surgically airlifts the baby from the uterus.
Then, after all that work, mammas get sent home within a couple of days and are told a la Tim Gunn to “make it work!”
Fast forward six weeks and they see their doctor again, who will peer under the tissue paper gown and say
“Things look great, you can have sex now.” —wait what? Sex?
That may be the last thing on your mind, and that’s quite alright.
Making a baby is a lot of work. It’s ~40 intense weeks of sorting through the body’s equivalent of a warehouse of Ikea furniture instructions to ultimately assemble an infant. Except the assembling is happening inside someone, so it’s understandable that the body may need a little more than 6 weeks to feel up to doing anything, let alone having sex.
While some folks may feel ready at that 6 week mark, many don’t. In fact, 41-83% of new moms experience sexual dysfunction (low libido, pain with sex, not finding sex pleasurable) 2-3 months postpartum and 17-36% of new moms experience painful sex 6 months after birth.
There are a lot of reasons for this pain. The body goes through enormous of changes—for one, the uterus expands to about the size of a watermelon during pregnancy! From supporting all that size and weight for 9 months, the pelvic floor muscles can be a little worse for wear (we call this pelvic floor dysfunction), which can make sex uncomfortable. Plus, mamma’s hormones are in flux! Levels of estrogen and progesterone, hormones that affect sexual desire and lubrication, dramatically decrease after birth. This can make becoming aroused or lubricated more difficult—especially when breastfeeding, which lowers estrogen levels even more to help with milk production.
A lot can happen during birth as well. The pelvic floor can be injured. The vagina or perineum can tear or a doctor might perform an episiotomy to make room for the baby to be delivered. A c-section can lead to scar tissue to form in the abdomen, which can impact surrounding structures. This scar tissue can also irritate nerves in the area, which may then send the pain to the labia or perineum (we call this referred pain). All of this trauma, regardless of where exactly it originates, can lead to pelvic floor dysfunction. This can result in a variety of symptoms, such as:
- Pee problems: urinary hesitancy, frequency, incontinence (leaking)
- Poop problems: constipation and fecal incontinence
- Sex problems: pelvic pain and dyspareunia (pain with sex)
Sometimes using a good water-based lubricant or a tool like Ohnut to adjust penetration depth may help decrease pain with sex or make the return to sexual activity less daunting. Moms may also benefit from working with a pelvic floor physical therapist to address musculoskeletal dysfunction and postnatal pelvic strengthening.
Fun fact: in France, all new moms get pelvic floor PT postpartum! Get with the times, America.
Sex therapists and mental health professionals can help too! They can address low libido, body image, postpartum depression, or other emotional factors (like perceived partner rejection) that can make sex feel unappealing. Many new moms need more than one provider on the team to help address challenge with postpartum sex.
If it takes a village to raise a kiddo, it’s justified for a small village of medical professionals to recoup mom too.
Plus, penetrative sex isn’t the only way to be intimate with a partner. There are plenty of other ways to feel close, connected, and sexy without doing something that hurts or is uncomfortable for the time being.
New parents have a lot on their plates, and sometimes getting sleep is going to trump getting it on. Self care is important, especially when you’re elbow-deep in diapers and just focusing on surviving. If you don’t feel ready to have penetrative sex at 6 weeks (even if your doc has given you the green light), that is totally fine! Go at your own pace. Feel close to your partner in other ways, and keep talking through it. The village is there if you need them.
And remember, healing takes time. There’s no pressure to be exactly who you were, or to have sex exactly like you did, before having a baby. You’re doing great :)
Written in collaboration with Rachel Gelman, DPT.
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