Postpartum Sex

The time following the birth of your baby will be exciting, complicated, and busy. Your body will go through rapid changes, adjusting from the pregnant to the nonpregnant state. As new parents, you and your husband will have an altered relationship. Being pregnant and in love is quite different from being parents and in love. After being free and spontaneous as lovers, you will now also be parents, with new roles, new responsibilities, and a whole new life.

The love relationship between you and your husband will continue to grow in many ways, and part of that love relationship will be the enjoyment of sex. You may be confused by what you are told or even by your own feelings as individuals and as a couple. A number of factors will influence your decision about when to resume sexual intercourse.

Medical Advice

Some caregivers advise their patients to delay having sex again until after the 6- week postpartum checkup. Others suggest waiting until the vaginal discharge has stopped. Waiting ensures that both the stitches and the placental site within the uterus have healed. With a cesarean birth, the abdominal scar must also heal. Until these areas have healed completely, bacteria could be introduced and cause an infection.

Fatigue

The first few weeks and months with the new baby will be the busiest. Your time will not really be your own. You might not get a decent night’s sleep for a while, and the days will be exhausting. Although your husband’s routine will be somewhat changed, your lifestyle will be changed much more dramatically. It will be difficult to be a good parent around the clock—but sexy, too? It just will not seem possible for a while!

Hormones

Your body’s hormones are actively involved in all the changes connected with birth and breastfeeding. It may take them some time to get back into balance. These hormonal changes may affect your feelings and sexual responsiveness. You may want very much to make love, or you may feel turned off by sex for a time. If you are turned off, do not berate yourself—the desire will return. The following four-step method can be used to help reawaken your sexual desire:

  1. Nonsexual touch. Daily hugging and cuddling, showering together, and nonsexual massage can help both partners to rediscover the pleasure of touch and to increase their anticipation.
  2. Sexual touch. Using massage on each other in a sexual way while continuing to avoid all genital contact will further increase desire and enhance awareness of each other’s sexuality.
  3. Genital stimulation. Gentle massage of the vagina, using a sterile water- soluble lubricating jelly, will help to determine the woman’s sensitivity and whether she is ready for intercourse. She can reciprocate by massaging her partner’s genital area manually or orally.
  4. Sexual intercourse. Using repeated partial penetration and withdrawal will ease the stretching of the vagina by the penis.

Practice these steps with a relaxed attitude.

Pain

Some new mothers find intercourse painful or uncomfortable, especially if they resume it too soon after giving birth. Some men are hesitant because of concern for their mates. Patience and gentleness are important. Your perineum and vagina must heal. If your episiotomy is overcorrected, making your vaginal opening smaller than it was before, or if you have vaginal adhesions, you should try gentle dilation, first using the fingers and then vaginal dilators from your caregiver. If your vaginal area is still tender, you may find that the most comfortable position is lying side by side, which takes the pressure off the episiotomy site. A warm bath before lovemaking may also help.

Decreased vaginal lubrication due to hormonal changes might also make intercourse painful. This situation may last longer for the breastfeeding mother. Applying a water-soluble jelly to the penis and vagina remedies this problem. Do not use a non-water-soluble lubricant, such as petroleum jelly, because it keeps air out and allows bacteria to grow.

Breastfeeding

Some breastfeeding mothers enjoy sex immensely; others do not for a while. Fathers have feelings about breastfeeding also. Some find it very attractive, while others find it is somewhat inhibiting to their sexual feelings.

Breasts are an important part of human sexuality—first, as the means of nourishment for babies, and second, as a source of sexual stimulation and pleasure. If you have been thinking of breasts as being intended solely for sexual pleasure, both of you will need some time to get used to the idea of breasts filled with milk. Some nursing mothers do not enjoy breast stimulation, and many couples find new areas of the body for sexual foreplay. At the same time, you need to be assured that your baby will not contract an infection if your love play includes your breasts.

One thing that may catch you unaware is a leaking of milk during love play or orgasm, resulting in both of you getting soaked. This happens because oxytocin is released during breast stimulation and orgasm, and oxytocin is the hormone that triggers milk let-down. This release of milk is normal and natural. It may help to make love after nursing, when the breasts are relatively empty (and the baby is more likely to be asleep). You could also try wearing a nursing bra and pads to prevent leaking at a stimulating moment. Towels to keep the bedding dry are also a logical preparation.

If you bottlefeed your baby, you may still have an uncomfortable amount of milk within your breasts for a few weeks after delivery. Since sexual activity involving the breasts encourages milk production, you should avoid the breasts during sexual foreplay to discourage milk production.

New Responsibilities

The baby, no matter how adorable he is, may almost seem to function as a “chaperone,” which can be very inhibiting at times. The spontaneity in your love life may take a dive: “Is the baby going to wake up?” “Do we have enough time between feedings?” Sexy feelings hardly get a chance if you are always listening for a cry.
Your new responsibilities may fatigue both of you, especially during the early weeks of adjustment. But the tension and fatigue may build even further if you do not take some time out for yourselves. Change, feed, and cuddle the baby, then put him to bed, shut the door, and take time to talk to each other, relax, caress, and make love.

Fear of Becoming Pregnant

No matter how thrilled you both will be with the new baby, the thought of having another one right away may be alarming. The two of you will need to address family planning before the postpartum checkup and then discuss it with your caregiver. Exclusive and frequent breastfeeding may inhibit ovulation and the onset of your period, but it is not 100-percent effective at preventing pregnancy.

Combined oral contraceptives that contain both estrogen and progestin are not compatible with breastfeeding, since the estrogen reduces milk production and alters the composition of the milk. This results in babies who gain weight slowly and require supplementing with formula. To ensure an adequate milk supply and success with breastfeeding, wait 6 months before starting combined pills. Progestin-only birth control pills, Norplant, and Depo-Provera are compatible with breastfeeding, since they do not contain estrogen. There is a concern among some professionals, however, that even though the quantities are small, these synthetic hormones do pass into the breastmilk. The longterm effects of early exposure to contraceptive hormones are not known. The potential effects on the baby may be reduced if these hormonal methods are delayed until the baby is 6 months old.

Due to changes in the vagina and uterus following childbirth, your old diaphragm may not fit correctly. It may also be dried out and contain tiny holes. You can be refitted at your 6-week checkup. The sponge method of contraception is no longer available in the United States. Menstrual periods must resume with regularity before the rhythm method can be used. A condom and foam or jelly may be best for the first few weeks. The condom will decrease the possibility of introducing infection, and the foam or jelly will lubricate the vagina. Remember that all methods are only as reliable as those who use them.

In 1996, the FDA endorsed two methods that could be used for emergency contraception in cases of unprotected sex or in cases where the primary method failed (for example, condom breakage). One method involves the woman using a high-dose birth control pill. The first dose must be taken within 72 hours after unprotected intercourse, with the second dose taken 12 hours later. This method is considered a one-time method and 75-percent effective. When using this method, it is important that the woman also begin using a reliable form of birth control. Another, more effective method is the insertion of a copper-T intrauterine device (IUD) within 7 days after unprotected intercourse. Following the insertion, the IUD can be left in place for up to 10 years. Emergency contraception is not well known in this country. Studies have shown no long-term or serious side effects.

Feelings

Warmth and affection mean a lot to new parents, especially during the early adjustment period. A cuddle and hug may mean more to you than making love for a while. For many couples, the baby arrives before they have a chance to become content with their sexual life. The movies do not tell you that a satisfying and exciting sex life can take years to develop.

Many a man feels pushed aside when a baby arrives needing so much attention. Instead of feeling that he has gained a child, he may feel that he has lost a lover. If your husband feels this way, you will need to reassure him and to tell him that your seemingly endless involvement with the baby does not mean that your love for him has diminished. You will receive a lot of touching and body contact while caring for your baby all day, but your husband, at work, will not and will need this when he gets home. Encourage him to help with the baby, and do not forget to give him an extra hug and kiss now and then.

You may find it quite a change to be home alone with a baby, especially if you have always worked outside the home. You will need to be reassured that your new role as a mother is important, even though you will not be earning money for it. You will require love and confidence boosting, and will need your husband to tell you that you are still desirable. If he takes no special notice of you until you flop into bed exhausted, your frustration and resentment may build.

It would be sad if you chose to forgo warmth and affection from your husband out of concern that they would lead to sex. Try not to put so much emphasis on having sexual intercourse and wondering if “tonight is the night.” Loving each other does not have to be sexual intercourse or nothing at all. Cuddling in each other’s arms, touching, kissing, giving or receiving a massage, and enjoying each other are very important ways of feeling close.

The main thing that you and your husband should try to do is to keep in touch with each other’s feelings. The concerns that you will have as new parents will not really be isolated problems, but rather typical of what you will find throughout your life as a couple. If you can talk about your feelings and needs now, you will find that your understanding of each other will enhance your sexual relationship for the rest of your life together. Couples who are honest and patient with each other do not have trouble finding solutions to sexual problems. Talk about your feelings, keep your senses of humor, and look together for solutions. After all, you will be friends and lovers long after your child has grown up and left home.

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