Pregnancy and childbirth involves a huge number of changes in your body, from physical changes to the muscles and ligaments, to hormonal alterations, emotional and mental health changes. It is completely natural to feel apprehensive when it comes to returning to intimacy with your partner.
I have created this blog post together with a womens health physiotherapist @clarebournephysio and psychosexual and relationship therapist @katemoyletherapy.
Some of the things women express are:
- I’m scared it will hurt.
- I’m worried he will notice a difference.
- I just don’t feel sexy.
- What if I leak urine when we are having sex.
- It feels dry and sore.
- It just doesn’t feel the same .
Lots of women return to sex with no problem , maybe some initial discomfort but it improves quickly.
The concept of returning to intimacy after birth may be a million miles away from your mind, but hopefully your wounds and discomforts from birth will heal sooner than you think. Therefore it is never too early to think about contraception!
When can we try to have sex again?
There is no set answer to this. If your birth was uncomplicated and you gave birth vaginally, then you can listen to your own body. As a general rule we advise waiting 4-6 weeks to allow the bleeding to stop, and any grazes or tears to heal fully.
This depends mainly on the type of birth you had, so it is a good idea to discuss with your doctor or midwife before leaving hospital. However in most uncomplicated cases there is no specific time given – it depends on when you feel ready emotionally and physically which may be days, or months for different people.
Remember, you can conceive as soon as 3 weeks after birth, so if you don’t want to get pregnant you should use contraception (even if you are breastfeeding!)
Contraceptive choices after birth
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You can get pregnant from 21 days post-birth. This is more likely if you are not breastfeeding, but breastfeeding is not 100% effective at preventing conception. Therefore if you donβt plan another baby just yet then you should consider contraception.
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πWithin 48 hours of birth an IUD(copper) or IUS (mirena) coil can be fitted
πAt any time after birth you can use condoms, the implant, the progesterone only pill, the injection
πFrom 3 weeks after birth (or 6 weeks if breastfeeding) you can start the combined pill or the patch
πIf not inserted within 48 hours then from 4 weeks after birth you can have a coil inserted
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Anything that means you donβt have to remember to take something everyday, or put something on or in before sex is going to make that method less prone to failure.
Coils or implants are great because you donβt have to worry about contraception for the next 3-5 years, but can be easily taken out at any point you want to TTC again!
All of the above info was taken from @fpacharity leaflet, but speak to your GP or family planning clinic for more info!
What are the main reasons that sex could be painful after birth?
β‘οΈ if you have a vaginal tear a scar will form which is new tissue and can be sensitive.
β‘οΈscars can tighten areas of the pelvic floor muscles & if this happens it can cause discomfort.
β‘οΈ some tears overheal, creating something called overgranulation tissue which feels incredibly raw to touch – this needs review by a doctor or specialist midwife and may be treated.
β‘οΈ the vaginal tissues are dryer when breastfeeding as your oestrogen levels are lower, which makes the tissues dry. So whether you’ve had a vaginal delivery or caesarean section you can experience this.
β‘οΈ caesarean section scars can also cause some tension down into the pelvic floor muscles, which as mentioned previously can cause discomfort .
What can I do to help?
β‘οΈTake it slow.
Baby steps back into sexual experiences can be really helpful for helping to re-establish couple sexual & intimate contact. We can often experience whatβs called touch fatigue, if we have a young baby or small children, & it can feel a bit like we are being grabbed at a lot. Try & separate adult to adult touch, from child to adult touch. Acknowledge that this touch is part of a different relationship, of which physical touch & intimacy is mutual.
Your 6 week check from you GP is a rough guideline about when it is safe to get started but it is not an instruction; itβs important you feel both psychologically & physically ready. This may be several more weeks or months.
β‘οΈCommunicate.
Your partner is likely to be feeling anxieties about starting a sexual relationship again too, & may feel nervous about hurting you.
So if you are able to talk it out then it stops you both jumping to the wrong assumptions which may cause unnecessary friction in your relationship.
β‘οΈPrepare for vaginal dryness
Itβs important to know that breastfeeding can also cause vaginal dryness due to lower oestrogen levels in the body, & that this can cause friction making penetration more painful
Use lubricant ( we recommend Yes Organics) especially those that provide their lubricants with applicators so you can insert them inside the vagina easily (you can also use a syringe if you need!).
β‘οΈTry to relax the pelvic floor
Start by spending time together focusing on eye-contact, kissing, & skin on skin contact with no agenda other than to relax with each other psychologically & physically again, without intercourse even being on the agenda.
Also if we are feeling really tense or anxious it means that we can physically tense, making intercourse more painful if the pelvic floor is not relaxed.
β‘οΈPerineal massage and vaginal dilators
You can begin to do some perineal massage from 6 weeks of any vaginal scars to help stretch and reduce any discomfort.
You can also practice c/section scar massage to prevent build up of tension in the lower tummy.
β‘οΈOpen up your definition of sex.
So much of what we are taught about sex is focused on intercourse & penetration, but what this does is exclude people who donβt want to, or canβt have this type of sexual experience.
For women the highest density of nerve endings is in the clitoris (around 8000) & clitoral stimulation is the most common way that women achieve orgasm. Donβt exclude all types of sex just because one type isnβt currently available to you.
Don’t suffer in silence π
You can ask to see your GP again and they may refer you to a women’s health physio for support.
They can assist you with pelvic floor release work and vaginal dilators can really help
Another great resource is the My Pelvic Floor Muscles online course. This course was created by specialist womens’ health physiotherapists, and takes you through the background knowledge and practical tips to help improve your own experience.
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