Resuming sex after childbirth: 5 things you need to know

Your life, schedule and household will look completely different with a newborn in the house – even if this isn’t your first baby. You may be longing more for a nap than you are for intimacy with your partner, but sooner or later, your sex life will resume.

You may be wondering: When’s the right time?

Timing. It’s a personal decision, of course, and there’s no firm post-delivery date by which a new mom is deemed safe to have intercourse. But many health care providers recommend waiting six weeks – no matter how you delivered your baby. Dr. Jaleema Speaks of Novant Health WomanCare - Winston-Salem, said she and “most providers encourage waiting until the exam at your six-week follow-up prior to engaging in intercourse, as certain lacerations may require additional healing time.”

Up to two weeks postpartum, you still have a risk of complications. (What a magnificent feat you managed! Giving birth is a herculean task.) Waiting allows your body more time to heal. You may be experiencing postpartum discharge, have vaginal tears and a diminished sex drive. If you had vaginal tears that required stitches – or had an episiotomy to aid in a difficult delivery – you may need to wait even longer before having intercourse. If you did need stitches, you won’t likely need a clinician to remove them. Most sutures are dissolvable, Speaks said.

Know what you might expect. “Being emotionally and psychologically ready for intimacy is important,” Speaks said. She emphasizes that point to her patients. Giving birth is a massive physical and emotional effort, and having a newborn at home is life-altering – even if you have other children.

You may also experience vaginal dryness – a normal condition after childbirth that can be exacerbated by breastfeeding. Be prepared with lubricant and over-the-counter pain relievers, in case you experience pain. If you feel a burning sensation after intercourse, apply some ice wrapped in a towel to the painful site.

If you had a vaginal delivery, your pelvic floor muscles have been stretched, which may make intercourse feel different. Kegel exercises can help tone your pelvic floor muscles, which will help. If you are experiencing urinary incontinence – another condition common to the third trimester and postpartum periods – Kegels and pelvic floor therapy can help with it, too.

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Novant Health Forsyth Medical Center and Thomasville Medical Center are among just 17 North Carolina hospitals to receive the coveted U.S. News and World Report High-Performing Hospitals designation for maternity care.

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What you can do to ease the pain. Kegels are easy to do and can be done nearly anywhere – even sitting in your car in traffic. Your bladder should be empty first. Then, sit or lie down. (Captain Obvious alert: If you’re driving, you should not lie down!) Then:

Tighten your pelvic floor muscles. Hold for a count of 5.

Relax the muscles as you count to 5.

Repeat 10 times, three times a day.

Is birth control necessary? The short answer: Yes. You can get pregnant again in as few as three weeks after childbirth.

How long should you wait to try to conceive again? Some research suggests waiting at least 12 months postpartum before trying to get pregnant again. That’s to help prevent – or reduce – pregnancy complications such as premature birth and low birthweight. But not every woman has the luxury of time on her side. Talk to your doctor about your desire for more children. He or she can help guide you on timing.

If you are exclusively breastfeeding and haven’t resumed having your period, that may provide you with close to 98% protection from pregnancy for six months postpartum. So, breastfeeding alone is not a failsafe method of birth control. Sex after pregnancy does require a reliable form of birth control.

Some options include:

• An implant, such as etonogestrel (Nexplanon)
• A copper or hormonal intrauterine device (IUD)
• Progestin-only contraceptives, such as the injection medroxyprogesterone (Depo-Provera) or the minipill norethindrone (Camila, and more)
• Condoms and spermicide

According to the American College of Obstetricians and Gynecologists (ACOG), the cervical cap, diaphragm and sponge can be used starting at six weeks postpartum “when the uterus and cervix have returned to normal size. If you used a diaphragm or cervical cap before childbirth, you should be refitted after childbirth.”

Birth control methods that contain both estrogen and progestin — such as birth control pills — may pose an increased risk of blood clots for a short time after delivery. (Progestin in the synthetic version of the hormone progesterone.)

“Typically, we recommend waiting for six weeks postpartum to begin using combined (estrogen plus progesterone) contraception,” Speaks said. “But, different types of contraception, and when you restart them, may affect breastfeeding/lactation. Many physicians feel that a low-dose estrogen pill will not impact breastfeeding.” Talk to your doctor about the best choice for you.

Just not in the mood? It’s understandable. You’ve been through a lot over these last 10 months, and your body has changed – and will continue to. Remember that intercourse is just one part of intimacy, and talk to your partner about other ways to feel close and connected.

And if you have blues you just can’t shake, it could be postpartum depression. Don’t ignore the signs, and talk to your doctor about what you’re feeling. Treatment is available.