Oh yeah, we’re going there. And then some. Because the 6-week green light from your OB doesn’t mean you’re really ready.
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Sex. Three small letters. One massive, multifaceted, emotional topic. Especially postpartum.
Your journey begins with the 6-week postpartum check-up. Are you healed or close to it? Great. You’ll get the green light for resuming penetrative sexual intercourse (among other routine activities), and you’ll discuss birth control if that applies to you.
But are you really ready?
Here’s the super big important thing I want you to know: A medical thumbs-up on your perineal area does not, in and of itself, mean you areready for sexual penetration. That’s a whole other mind-body equation.
What it means is that clinically speaking, you are less susceptible to infection and undue tissue damage should you engage in penetrative sex.
If you are rarin’ to go at 6 weeks, and are having pain-free, lusty sex, well, more power to you! (And will you be hosting a seminar sometime soon? Cause yeah, you should.)
For others — many, many others — sexual function and sexual desire are a struggle. In a postpartum study by BMC Pregnancy and Childbirth of 832 first-time birth persons, 47 percent reported a lack of interest in sexual activity, 43 percent had vaginal dryness, and 38 percent had pain with penetration 6 months after birth.
If that sounds like you, pull up a chair and let’s chat some more.
“Sex is such a taboo subject and comes with so many ‘shoulds’ once you’re cleared medically,” says Mallory Becker, a registered psychologist who specializes in anxiety, relationships, and maternal mental health.
“There’s this expectation on women to be the same person they were before they were pregnant, before they delivered a baby… but you’ve been through a big journey and it’s such an identity change. There is no such thing as your pre-pregnancy body anymore. There just isn’t. Even if you look the same [as you once did], your body’s been through a beautiful, miraculous feat, and it’s just different.”
Postpartum has become, in many ways, defined by an elusive — and arguably damaging — chase towards what used to be. For some, sex can symbolize that you’re “you” again, or at least trying to be. But what if you literally chucked that expectation out the window?
That’s what Gina Senarighi, PhD, CPC, advocates for in her practice as a sexuality counselor and intimacy expert. “I would suggest that we stop thinking whatever ‘like before’ was. Our bodies are supposed to grow and change over a lifespan, and normalizing those changes (including, for many, childbirth) will help us stay sexually connected over time.”
Your bits have the go-ahead, but your inner sex beast? Gone, baby, gone. Yup. That’s common. So too is the lack of drive being a source of fear or feeling of failure. It goes something like this: My doctor said it was OK to have sex, but I don’t want to/I’m not interested/I just don’t feel like it/I’m scared to/I’m too tired to. What’s wrong with me?
There is nothing wrong with you.
The physical and emotional toll of birth, fluctuating hormones, stitches or scar tissue, lack of sleep — all very real roadblocks to being in the mood. And if you’re breastfeeding, vaginal dryness can be an issue, as well as the fact that your chest is now about utility versus pleasure.
This is why it’s helpful to separate sexual function from sexual desire, and look at your postpartum body holistically.
Kathe Wallace, PT, BCB-PMD, associate at The Pelvic Health Clinic in Seattle, WA, co-founder of the Herman and Wallace Pelvic Rehabilitation Institute, and author of “Reviving Your Sex Life After Childbirth,” begins with a series of physical and emotional questions. “If I do self-touch is it uncomfortable? Is there anything I’m worried about? Do I have bowel problems? Do I have urinary loss? Do I have things that are making me not feel sexy? Am I concerned about sexual activity?”
It’s important to self-reflect to determine whether you feel sexual desire, but are having pain with sexual function, or are experiencing the reverse (or perhaps both).
Your course of action is very different, depending
Physically, “the muscles that have been through childbirth need a certain amount of time to heal, and they also need activation and renewal,” Wallace says. Pelvic floor therapy may be something you ultimately need, but first, start at home with self-exploration and massage.
As she writes in “Reviving Your Sex Life After Childbirth”: “Even though not all tears after childbirth require stitches for repair, there is usually a certain amount of tissue stretching and/or tearing that can create scarring. This scarring can be painful and restrict the skin mobility if not moved. Moving the scar, through mobilization and massage, is a good idea prior to attempting sexual activity. It is common practice to massage scars after orthopedic surgeries for your knee or shoulder, but rarely is a new mom taught techniques for massaging an episiotomy scar or a childbirth tear.”
In her book, Wallace goes on to detail four mobility techniques you can do on yourself: side-to-side, up-and-down, scar rolling, and sweeping.
Sexual desire, on the other hand, is about arousal. When aroused, two things happen: The Bartholin’s gland will provide lubrication, and your vagina will lengthen 1 to 2 inches in a process called vaginal tenting.
What can get in the way of arousal? Oh, about a million things — especially in the first year.
“Most couples are overwhelmed and confused by the sheer volume of energy that goes into early parenting in addition to physical healing and managing everyday life,” Senarighi says. “Finding a way to stay connected in the fog of those early weeks and managing a home and all the new learning that is happening usually brings couples to some pretty intense conflicts.”
After months of looking forward to birthing and bonding as a family, it can be a jolt when real life doesn’t live up to what you imagined. “In truth, much of the time [couples] can feel disconnected, as birthing and non-birthing partners will have very different experiences with a new baby.”
Parent Kate C. struggled with it for a year postpartum: “My first daughter was born very fast with vacuum assistance because her heart rate dropped dangerously. They had to do an episiotomy and I wound up with a third-degree tear. I expected it to hurt for a while, but no one prepared me for how painful sex would be — and would remain — until I stopped breastfeeding, when my estrogen levels returned to normal, and the scar tissue loosened up.”
Kate adds: “I had to get a prescription for numbing cream — yes, so I couldn’t actually feel it—so we could have sex for the first year. It was awful and I’d never heard anyone talk about it beforehand.”
Dryness, as it turns out, is quite common. “The postpartum period, especially in breastfeeding women, is marked by a decrease in circulating estrogen. Decreased estrogen can cause the tissues in the vagina to become thinner, drier and less elastic,” explains Dr. Stephanie Liu, MSc.
“For some women with significant vaginal dryness they may require topical low-dose estrogen. However, for breastfeeding women I recommend monitoring milk supply as estrogen can be absorbed and potentially decrease milk supply.”
Make lubricant your BFF right now
Lubricants are not only safe to use, they are encouraged!
“Vaginal dryness while breastfeeding is what I’m up against these days,” shares new mother Kristen S. “I’m 4 months postpartum and it’s becoming an issue. I was going to use K-Y Jelly, but my husband read that it’s not to be used by breastfeeding moms.”
Dr. Liu says she is not aware of any medical reason why traditional K-Y would not be suitable while breastfeeding. However, in her practice, she recommends using water-based lubricants.
Many leading brands offer water-based formulas, such as AstroGlide, which recently came out with a glycerin- and paraben-free blend featuring minimal ingredients. (Whichever brand you choose, avoid scented, flavored, and lubricants with stimulating effects.)
“Some people feel lubrication is a failure and it’s not,” Wallace adds. “Experiment with different types of lubrication and be willing not to be restricted in its use, especially during early postpartum!”
“It took me a full year to be OK enough to start trying to have penetrative sex, and honestly the first couple times I was not only uncomfortable for parts of it but also terrified due to the mental trauma of it all. I wish they had recommended seeing a sex therapist or something to figure out how to get back into the groove,” shares parent Priscilla B.
Add to this the fact that nearly
“Especially when there is birth trauma involved, my recommendation for everyone, even if you may feel OK, is to go through a certified trauma treatment, Becker suggests. “In psychology we say, ‘neurons that fire together wire together.’”
Becker encourages trauma treatment so sexual touch does not become a trigger, and the birth person has room to process what happened with labor and delivery. “Left untreated it can cause many issues, like fear of having future children, intimacy issues, or constant PTSD symptoms.”
On the flip side, partners may experience a form of trauma too, particularly if the labor and birth were difficult, there were complications, or they witnessed vaginal birth and did not intend to. “I see that happen frequently as well,” Becker says. This may manifest in emotional distance or a lack of sexual interest.
Here, the same guidance applies: Communicate, take small steps toward intimacy, and, if it suits your situation, seek professional help from someone experienced with postpartum couples. “Both of you are different. You’ve become parents and it’s different. But ‘different’ doesn’t mean bad. It means you have to create a new expectation, and a new way to dance together with your roles,” Becker says.
First things first. You do not “owe” your partner anything, this is not a “duty,” and you don’t have to “prove” anything. Emotional and physical consent are, as always, a necessity.
When you are ready to foray into intimacy, and the two of you have openly communicated about it, start with the basics. As in zero or first base.
“I recommend you start slow,” Senarighi says. “For some birth parents, simply getting aroused may feel scary at first. Allow yourself to become aroused without the pressure of having penetrative sex. And when/if you do incorporate penetration, be sure you work up to it gradually — especially for people who have experienced birth trauma.”
Cuddle. Hold hands. Talk about memorable experiences. Create a list of things that you enjoyed together before the baby. In other words: Date! And then, when you’re ready for the next step, play.
“The couples I’ve worked with who already have a solid practice of talking about sex and exploring pleasure and meaningful connection with non-penetrative sex fare better when they reconnect with intimacy postpartum,” Senarighi says.
Like so many other parts of being a new parent, go easy on yourself. You’ve been through a life-changing event. This stage will not last forever.
“There are just so many changes that happen biologically and emotionally and relationally. The pieces of the puzzle have changed, so you have to figure out what the new picture looks like. We try to jam the old pieces in together and some of them don’t fit anymore,” Becker says. “That’s why it’s so important to go slow, to talk about things, and to make sure that you’re feeling loved and connected, as well as having desire before adding anything physical.”
Mandy Major is a mother, certified postpartum doula PCD(DONA), and the co-founder of Major Care, a telehealth startup offering remote doula care for new parents. Follow along @majorcaredoulas.