As a postpartum doula and fertility awareness instructor, I often hear clients say, “My doctor cleared me for exercise and intercourse at my six week checkup.” But they may feel light years away from being ready for either of those things. Between sleepless nights, leaking and sore breasts, lochia (which we cover in this article ), a recovering pelvic floor (and placental site), and a completely disrupted routine, sex after birth can feel like an idea that belongs in another reality. Especially at a mere month-and-a-half after giving birth.
As it happens, there really is no magic number of weeks after which every couple is ready to start having sex again after birth—there are a host of variables that play into readiness, such as recovering from the birth physically and emotionally, being empowered about your family planning options, and having support in the transition of bringing home a new baby. You may also find that sex after birth will be different—not necessarily in a bad way, just different. But there are some postpartum sex red flags that may require troubleshooting, which we will also discuss, below.
Recovering from birth: The importance of postpartum support
For anyone who has given birth, they know that it is practically an assault on the body. And while the outcome—a baby—is indeed a beautiful one, even the most seamless of births seems to defy reality. For the not-so-seamless experiences, more complications and interventions means that more recovery might be needed.
If a Cesarean section (C-section) was performed, the mother is not only recovering from birth, but she is also recovering from major abdominal surgery. The first few weeks, even months, require an immense amount of healing on the mom’s part in a time where infants are also at their most needy. As mentioned in the piece on lochia, the placental site is an open wound in the uterus, about 8.5 inches in diameter, which is the size of a dinner plate. And it is usually just healed at six weeks after birth.
This is why moms often feel a gut punch when doctors give them the clearance (and usually an inquiry about their family planning options) at their six-week checkup. Family planning? You mean for another baby? I just had one. Don’t you need intercourse to have a baby?
But at some point—whether soon after, or much later after that appointment—moms do come around to the idea of having sex again. Recovery happens, the baby starts sleeping a little more reliably (we hope so, anyway), and you may start to notice (and even want to reciprocate) that sparkle in your partner’s eye once again.
It’s no secret that the more supported a mom feels, the easier time she will have recovering. The more support a mom has, the more room she will have in her brain emotionally for intimacy. While juggling other kid’s schedules, managing the house, meal planning, potentially going back to work—intimacy may get shoved into a corner of the brain that doesn’t often get visited. So anything off her plate that isn’t bonding with her new baby gives a new mom more room emotionally to even consider romantic thoughts when the time is right.
Postpartum family planning options
When that lovin’ feeling returns, many women want to make sure that they’ve got their postpartum family planning figured out. While many doctors suggest pharmaceutical methods of birth control, many women seek effective options preventing pregnancy that don’t involve synthetic hormones, side-effects, or the insertion of a device. For these women, the good news is there are effective methods of preventing pregnancy that don’t involve pharmaceuticals, thanks to evidence-based fertility awareness methods (FAM).
Those who use natural family planning or FAM know that the postpartum fertility cycle charting is a notoriously tricky time to learn to chart your cycle (read more about it in these articles). But it is possible to prevent pregnancy effectively with a fertility awareness method if you have instructor support.
The postpartum period is a unique time that requires professional help from an instructor in your fertility awareness method of choice. Whether or not you are breastfeeding, cycles may be either non-existent or unpredictable, and it’s crucial to feel confident in your method. Many women find they need to shift or change their method during the postpartum season from what they used before to better meet their current needs. That is okay!
Some women have fears about getting pregnant again, and it can get in the way of their romantic notions. This is normal, but it is helpful to talk about it with someone—be it a counselor or therapist or friend. Your OB or midwife should be able to refer you to someone. Postpartum Support International is another great option for finding support in your area or virtually. Processing things after birth takes time and it’s best done with others—not in isolation.
The more recovery you can process emotionally from birth, the sooner fear of pregnancy will dissipate. And having confidence in your FAM, and being on the same page with your partner regarding family planning goals, go a long way in assuaging postpartum fears of getting pregnant again before you’re ready.
Troubleshooting sex after birth
While there is no magic number of weeks that will tell every woman when she’s ready again for sex after bith, there are some red flags that warrant further action if they have not been resolved by six weeks postpartum. And while these issues may be common, they shouldn’t be considered standard.
It hurts!
The most important piece of advice I was given about having sex after you’ve had a baby (and that I still give to others) is to go slow. Like suuuuper sloooow. You may experience slight discomfort at first, but intercourse should not be painful. (Really, ever. But especially postpartum.)
If sex is painful postpartum, it could be a sign that the pelvic floor is still not recovered and/or could use some strengthening exercises. (Yes, physical therapy for your pelvic floor is real!) I love the Functional Pelvis, but there are many other Pelvic physical therapy options that your local care provider should be able to refer you to.
It’s not that you won’t ever return to normal, but there may be a new normal to be discovered. And, hey, you grew a baby and birthed it—all from your own body!
My libido is MIA….
This is also a common experience. For breastfeeding moms, low libido postpartum can be purely hormonal. From having a baby physically on you for many hours a day, many moms feel “touched out.” If you aren’t cycling again yet, you aren’t experiencing the fluctuations of estrogen and progesterone that usually are responsible for that sexy feeling throughout the month. This goes back to the importance of support, and also a gentle reminder that this is a temporary season. If low libido persists for months or even a year after weaning, it’s worth getting hormone levels checked. But in the early weeks and months, libido may know what it’s doing.
I’m interested in sex, but I’m dry down there…
Low levels of estrogen and progesterone for breastfeeding moms often results in vaginal dryness. Their libido may be there, but when it’s time to get down to business it’s the Sahara desert down there. This is also usually largely hormonal. A water based lubricant is often helpful (just make sure it doesn’t have any irritating additives or spermicides).
I don’t feel like doing anything anymore.
If you are feeling down emotionally for weeks on end, as in, more than a few days of baby blues, you should talk to your doctor about whether you might be suffering from postpartum depression. Postpartum depression (PPD) is a mental health condition that requires medical attention. According to the CDC, postpartum depression affects approximately 1 in 8 American women after childbirth. If you feel off emotionally, read more about how to recognize postpartum depression, and get help.
When a red flag in postpartum sex shouldn’t be ignored
Fear of pregnancy, painful intercourse, vaginal bleeding (not related to menstruation), and vaginal dryness can all be a normal part of the postpartum experience—up until a certain point. Every human body is different, so there isn’t a time I can say it should all be better. But if you still feel bothered by any of these issues, and if it seems like there is no resolution in sight, it’s worth seeing a practitioner or getting the right support. Sometimes, it really can be a hormonal issue that resolves over time. Other times, more pharmacological or manual therapies may be warranted.
Having a baby is no small feat. Your body has been through an immense change that doesn’t end after they cut the umbilical cord. The first year is especially filled with ups and downs. My hope is that moms can prioritize recovery from both pregnancy and birth, find community and professional support to get them through, and feel confident in their family planning options. There is no one “right way” to return to intimacy after giving birth. So if you didn’t feel ready to jump right back in to having sex 6 weeks after birthing a nine-pound baby, cut yourself some slack.
Additional Reading:
What’s the Best Postpartum Fertility Awareness Method?
Deciphering the Postpartum Period with FAMs
Three New Technologies to Revolutionize the Postpartum Period
Birth control after baby the natural way, technology assisted
Understanding and Recognizing Postpartum Depression
Everything You Need to Know about Postpartum Bleeding, aka Lochia
Painful sex before your period? How tracking your cycle could help stop sex from hurting
Three Science-backed, Natural Ways to Ease Childbirth and the Postpartum Period
Can you really use breastfeeding as natural birth control?
