Doctors generally adhere to a “no sex for six weeks” rule for both vaginal deliveries and c-sections. “That is typically when the uterus has returned to its normal size, there is no more lochia [postpartum vaginal bleeding], and any surgical incisions, lacerations, tears, and episiotomy wounds have fully healed,” says Felice Gersh, MD, an OB/GYN and author of PCOS SOS: A Gynecologist's Lifeline To Naturally Restore Your Rhythms, Hormones and Happiness.
But getting the “all clear” at your six-week follow-up OB appointment isn’t that simple. For many women, that benchmark comes before they are physically or emotionally ready. “A new baby changes everything and that includes a couple’s sex life,” says Dr. Gersh. “It’s important to recognize and anticipate this and not be harsh on yourself for having a low libido and for being tired. Nature isn’t really interested in a new mom desiring sex as an immediate new pregnancy would jeopardize the health of the first baby and the mom.”
Makayla, 25, is a first-time mom from Texas. “I had sex six weeks postpartum and it was very painful. I didn’t realize that my scar from tearing was so bad." This is a common experience for many new moms. “Sex after delivery, both vaginal and c-section, can be difficult and painful,” explains Judith Wenger, MD, an OB/GYN in New York City. “Women's bodies are still healing long after the ‘six week’ time frame." Many women deal with vaginal bleeding, healing stitches, swelling, soreness, and even hemorrhoids as part of their immediate postpartum recovery.
Sex can also be physically uncomfortable long after the six-week mark because of vaginal dryness. “All patients experience a lack of estrogen regardless of the type of delivery,” Dr. Wenger says. “Breastfeeding can also exacerbate this problem because it can delay the return of menstruation and so prolong the return of estrogen. Estrogen is essential for vaginal lubrication and so without the body producing estrogen, dryness may be a problem. Over-the-counter lubricants tend to be the mainstay choice for patients with postpartum dryness.”
"I had sex six weeks postpartum and it was very painful. I didn’t realize that my scar from tearing was so bad." —Makayla, 25, new mom
Megan, 32, from Washington, D.C, struggled with this herself. "After my first was born, sex was so painful that it just didn't happen for a while,” she recalls. “I expected it to be uncomfortable the first time, but after several attempts over months, I finally made an appointment with my OB to ask about it. I had delivered vaginally with some tearing and an episiotomy, so I had some scar tissue down there, plus I was breastfeeding. My doctor ended up prescribing an estrogen cream [which has been shown to help vaginal dryness], and once I started using that, we were finally able to get our sex life back on track. It took about a year for things to get back to normal. However, with our second, I was prepared for this and asked about it at my six-week postpartum follow-up visit. I used the cream right after that, and it took much less time to get comfortable with having sex again."
Of course, emotional complications come into play with postpartum sex. "In addition, with breastfeeding, lack of sleep, and the hormones and stress of a newborn baby, sex often becomes a lower priority," says Dr. Wenger. This was certainly true for me—in the first few weeks after having my daughter, I didn’t want anyone to touch me, since it felt like she was attached to me at almost every waking moment.
"I think sex is a mental game in the fourth trimester and beyond. You have to want that connection with your partner beyond your baby.” —Ashley, 35, mom
"I literally cringed at the word ‘sex’ for months after my daughter was born," says Ashley, 35, from Connecticut. "We broke the ‘rules’ and gave in at five weeks postpartum, but it was me trying to help him get through a tough period rather than the other way around." For her, postpartum depression and anxiety made it really difficult for her to enjoy or desire sex. "I did not feel over-touched or overwhelmed by my baby—she was truly a gift. I just had nothing left for my husband for months, never mind myself, given the incessant mental battles I fought all day every day." Once she got treatment for her mental health challenges, she says she was better able to want and enjoy sex.
None of this is to say that sex will always be painful and emotional and unwanted; all of the moms I spoke to for this article have gotten back to a normal, enjoyable sex life with some extra time and care. (In fact, a 2018 survey of 1000 moms found that 74 percent said their sex life was the same or better than it was before having kids.) For women struggling with postpartum sex, Dr. Wegner says it's important to take a holistic approach and take care of your physical and mental needs. "Lubricants and estrogen certainly are helpful for the discomfort of vaginal dryness but a good night's sleep and a relaxing evening are also helpful for making sex more pleasurable," she says.
"I think sex is a mental game in the fourth trimester and beyond," adds Ashley. "You have to want that connection with your partner beyond your baby.” To that end, Dr. Gersh also recommends trying to carve out some some alone time with your partner to rebuild intimacy. “I suggest having sex in the afternoon on the weekends when the baby is sleeping [or out with grandma] and you’re relaxed and not too tired,” says Dr. Gersh. “You and your partner should take it slowly, use an organic lubricant, and express your love for each other. Afterwards, you can take a little nap together and awaken refreshed and sure of your love and commitment to one another during this special time of life.”
Ultimately, the most important thing is to go at your own pace—and be understanding of your body's own needs and abilities. Like Dr. Gersh says, the body isn't necessarily designed to jump back into the sack right after having a baby, and that's okay. "Understanding nature’s plan makes your feelings understandable," she says.
Why some women have pushed back against the taboo of first trimester pregnancy announcements. And here's how to be a supportive friend to someone experiencing postpartum depression.
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