Sex after pregnancy

SHE was here for her six-week postnatal check-up. After her examination was over, I told her that everything was normal and she was cleared to resume all her normal activities. Her eyes opened wide and she lowered her voice to an almost whisper as she asked if I could just say that she needed another month before she could start having sex again. Her husband waited outside, completely unaware of her reluctance to resume sexual relations.

In the other room was another postnatal mother there for her routine check-up also. While examining her, I asked how she had been doing and if she had started her normal activities as yet. She gave me a sheepish look and admitted that she had started having sex just two weeks after giving birth. Her husband really wanted to and she felt okay, so they went ahead.

Sex after pregnancy is an important issue that is often not discussed in detail with patients, as the focus is normally on keeping a healthy mommy and delivering a healthy baby. It is a very important part of most relationships, however, and so mothers-to-be should ensure they discuss this aspect at some point during their visits. Health providers commonly recommend waiting until at least four to six weeks post-delivery before resuming intercourse to allow for full healing of all scars and to let the uterus return to its normal state.

Several issues can affect the ability to participate in and enjoy normal sexual activity after birth:

Starting too early

The uterus takes time to shrink back to its normal state and have the blood vessels and lining return to normal. Having sex too early puts the mother at risk for getting an infection which can become quite serious and even spread into the bloodstream. Oral sex is also off limits as there is a risk of the man blowing air into the vagina which can get into the blood vessels of the womb and cause serious illness or death. This has also occurred in a few cases after penetrative vaginal intercourse. Wait until your check-up before resuming sex, and if you feel ready before that, schedule an earlier appointment for review.

So what can be done in the meantime? Engage in foreplay or stimulate each other to the point of climax without doing vaginal penetration with any objects (including fingers).

Sore/sensitive breasts

Mothers can have issues with nipple sensitivity or breast tenderness from cracked nipples or breast engorgement or infection. In these cases breast stimulation is very painful and should be avoided until they are healed. Other methods of sexual stimulation should be used to compensate for that, and a close-fitting bra or tank top can be worn to make sex more comfortable. Some women are also surprised that milk let-down does not pause for sex as it is a natural response to the oxytocin released during climax. If that is bothersome, nursing the baby before or pumping the breasts empty may prove helpful. With more time and establishment of breastfeeding, leaking during sex tends to happen less frequently.

Pain

Soreness is common after delivery, especially if there were vaginal tears or cuts or a C-section was performed. Women and their partners should allow time for full healing and recovery to prevent reopening of or damage to wounds. Ensure that instructions for wound care are followed, including sitz baths and antibiotics where needed. Stimulation of the vulva and clitoris without penetration is possible until full healing takes place. Experiment with different positions to find the most comfortable ones and ensure constant communication throughout the process. If after the recommended wait time there is still significant pain and discomfort, then a pelvic physiotherapist may be needed (available in Jamaica).

Vaginal dryness

The change in hormones after delivery, as well as the hormones associated with breastfeeding, can contribute to vaginal dryness and make sex very uncomfortable. This is easily fixed by using a lubricant that can be bought in any pharmacy. Keep it handy by the bedside and use liberal amounts.

Vaginal looseness

The muscles of the vagina and pelvic floor are stretched during delivery. The normal tone of the vagina can be strengthened by doing Kegel exercises. This will also help with mild urinary incontinence that can occur after birth.

Low desire for sex

It is common to have a low sex drive in the weeks or months following delivery. Mothers are usually exhausted, stressed about caring for the new baby or babies, sore and sometimes overwhelmed. It takes a caring partner to be gentle and understanding and give a new mother the time and affection she needs to get back into the swing of things. Postpartum depression may also impact libido, so if a mother is feeling unusually sad, tearful, hopeless or not coping well, she should urgently discuss this with her doctor. Most times it will resolve on its own with some counselling, but in some cases it requires more intensive therapy and even medication.

Finally, contraception should be discussed with your health care provider and started before resuming sex. An unintended pregnancy, especially with a short time between pregnancies, can put the mother at more risk for complications. Feel free to ask about all the options so the best one can be chosen.

Sex after pregnancy should be approached with love, care, patience, understanding and gentleness, so that it can be a rewarding experience for both partners.