“Nothing magical happens at that six-week checkup,” says Allison Oswald, a doctor of physical therapy and a pelvic health specialist. “If you weren’t ready for sex the day before, it’s not like now you are ready.” Despite the fact that 83 percent of first-time mothers experience some kind of sexual problem after delivery, postpartum sex isn’t often discussed—either in doctor’s offices or between partners. “The biggest thing is open communication with your partner,” says Dr. Oswald. “All these emotional and physical and psychological components go into having sex after having a baby. Being able to vocalize your concerns or fears is the first step.”
It may be obvious, but it bears repeating: Just like every other aspect of your life, sex changes after you have a baby. “I don't subscribe to [the idea] of bouncing back, because we’re not going back,” Dr. Oswald says. “We’re going forward with this new us.”
3 Reasons Postpartum Sex Might be Painful
After childbirth, women tend to need more lubrication. “The vagina goes through a state of depleted estrogen, which can feel very dry,” says Meagan Haynes, an ob-gyn. “It doesn’t feel good, but almost every woman, whether they’re breastfeeding, pumping, or even bottle-feeding, will have some level of depletion until the hormones re-regulate after a few months.”
Tears, Lacerations, and Scar Tissue
“Stitches have to heal, and it takes time,” says Dr. Haynes. Whether you have stitches from an episiotomy or tear, scar tissue, or a sensitive C-section scar, when you are ready for intimacy, it’s likely that some part of your body will still be healing. Exploring your vagina with your own finger (with lube) can be a good way to identify what feels comfortable—and where—before you have penetrative sex.
Pelvic Floor Issues
“Pelvic floor muscles are responsible for our sexual function,” Dr. Oswald says. “If our pelvic floor is still healing and it’s still swollen or painful, that’s going to really inhibit our ability to want to have sex.” If you are experiencing pain from a tear, that pain can provoke muscle tension.
What to Try
Use lots of lubrication.
“Once a person is cleared for penetrative intercourse or placing anything inside of the vagina, I recommend copious amounts of lubricant,” Dr. Haynes says. Lubricant is typically either silicone-based or water-based, and the latter is the cleaner option. Water-based lube has other benefits over silicone-based, too: It’s what you want to use with a vibrator (silicone and silicone don’t mix when it comes to lube and toys), and it’s not sticky, unlike silicone-based products. “Water-based lubricants feel less sticky and more natural, but they do absorb quickly, so you may have to reapply more often,” says Dr. Haynes.
Vulvo-vaginal moisturizers are different from personal lubricants intended for use during vaginal penetration. Think of lube as the “in-the-moment" moisturizer to use before and during masturbation and intercourse, and a vulvo-vaginal moisturizer as a maintenance therapy you can use two or three times a week to help with dryness, says Kelsey Kossl, an ob-gyn. These moisturizers come in cream and gel forms, as well as moisture-rich, hyaluronic-acid-based inserts. Coconut oil is a safe and natural vaginal moisturizer, and vitamin E suppositories inserted vaginally can provide relief from dryness (and also help with postpartum constipation). A topical estrogen cream, often used to ease menopausal symptoms, including vaginal dryness and dyspareunia (the medical term for painful intercourse), may also be prescribed for postpartum dryness.
“Whether you have a partner or you don’t, masturbation is really important for positive sexual health,” Dr. Haynes says. And it can help women comfortably ease back into penetration after childbirth. “Think of [your vagina] like this: The more you use it, the better it’ll work for you.”
Try more foreplay.
“Foreplay allows your body a little bit of time [to prepare] before you jump into something penetrative,” Dr. Haynes says. Communicate with your partner about what feels good for your body right now and know that that may change over time. “Many women find that foreplay changes [postpartum],” says Dr. Oswald. “Women who are nursing may not want their partner to touch their breasts because that doesn’t feel good.”
Experiment with other forms of intimacy.
“There’s an overlap of the psychological, the emotional, and the physical in what feels intimate,” says Dr. Oswald. “Is it holding hands? Is it having your partner give you a massage?” If you’re not ready for sex, explore other ways to connect physically and emotionally. “Open communication is important to build trust,” she says. “You’re building a new relationship with yourself, your new body, and your relationship with your partner.”
Pelvic floor physical therapy
Wrap your head around this: Postpartum, your pelvic floor muscles may be both tight and weak. “They’re either hypotonic, meaning they can’t contract enough, or hypertonic, meaning they contract too much,” Dr. Oswald says. “They can also be both. After a vaginal delivery, those muscles can be very stretched out, but they can still be tight. Really tight muscles can still be weak, and when the muscles are stuck in either a relaxed or contracted [state], they can also be weak.”
“You need to be able to work on both,” she says. “That’s why the blanket statement ‘Postpartum women need to do Kegels’ is not always the best way to go. A Kegel is focused on just the squeezing and lifting, but [women also] need the lengthening down and the opening up for penetrative intercourse.” Treatment options for overactive pelvic floor muscles include pelvic floor physical therapy with a specialist. Many insurance plans cover pelvic floor physical therapy, but if you don’t have insurance or pelvic floor physical therapy coverage, there are apps, online resources, and books that can help you target the right muscles at home. There are plenty of online programs with breathing exercises and stretches that guide you through the process of identifying and relaxing overactive pelvic floor muscles. These breathing exercises, stretches, and meditations can be done at home while the baby is napping. If you do see a specialist, they may use a pelvic wand—which can also be purchased and used at home—to internally massage, which may help relax the pelvic floor muscles. Consult with your health care provider about which one might be best for you.
2 Reasons Orgasms Might Be Weaker
Pelvic floor muscle weakness
The vagina and pelvic floor muscles stretch during pregnancy, leaving them weaker after delivery, particularly if you had a big baby or have had more than one vaginal birth. Pelvic floor contractions are one part of having an orgasm, and the stronger your muscles are, the more impactful the muscle contraction—and the orgasm. Pelvic floor muscle-strengthening exercises are a common way to help weak pelvic floor muscles (which can also help improve urinary incontinence).
Tighter pelvic floor muscles
“For the pelvic floor muscles to orgasm, they need to be able to fully relax and fully contract, cyclically back and forth,” says Dr. Oswald. “That’s what happens when we orgasm. And if the pelvic floor can’t ever let go because of painful scar tissue, it’s always tight. That can lead to anorgasmia—the inability to have an orgasm—or orgasms that don’t feel as satisfying as they did prior to delivery and pregnancy.”
There are simple at-home pelvic floor therapy courses that include exercises that can not only strengthen those muscles but also focus on stretching and lengthening to potentially reduce myofascial pain and tightness in the pelvic floor muscles. Always consult your health care provider to make sure these exercises are right for you.
4 Reasons You May Not Feel Ready for Sex
“In the hospital, they tell you no sex for six weeks, as if you’re so horny after pushing out a watermelon and having your vagina bleed for what seems like forever,” says Karina Dearwood, mother to a toddler and, as of this writing, one week away from delivering her second baby. “Who wants to do that?” While Dr. Oswald may put it another way (“You’re not sleeping; you’re up every two hours”), the sentiment is the same: Stress, exhaustion, and those first six weeks of having a new baby are not good for your libido.
You’re worried about your partner.
When Dr. Oswald’s clients are nervous about their partner’s expectations around sex, she tells them: Take it one day at a time, and remember that you are in control. Communication helps. “You get to talk to your partner, and you get to figure out what’s going on with your body. You get to seek out the support that you need. You might need a physical therapist, a psychologist or therapist, or a sex therapist. There are so many different people that are there to support you.”
You’re anxious about penetration.
Sometimes the anxiety is “about the anticipation of what it’s going to feel like to have something go in [their vagina], which not only just [delivered] a baby, but has been bleeding for weeks,” Dr. Oswald says of her postpartum clients. “I am sometimes their first pelvic exam [since delivery].”
An internal exam with a pelvic floor physical therapist is different from a gynecological exam (no speculum involved, just one or two fingers). Afterwards, “sometimes women can be like, ‘OK, now something’s been in there. Now I feel a little bit more ready,’” says Dr. Oswald. From there she encourages them to use their own finger to do some exploration or work up to a vibrator.
You had a traumatic birth experience.
“If a woman had a traumatic birth experience and is in a lot of pain, everything tightens up because our body wants to protect us from pain or discomfort,” says Dr. Oswald. The effects of birth trauma can linger, and while a lack of libido postpartum is nothing to feel bad about, if you are feeling sad, anxious, or unsettled—or just ready to work through the emotional gravity of a difficult delivery—talk to your doctor or a therapist.
4 Things to Remember
Without birth control, you could get pregnant.
It’s possible to get pregnant as early as the first month after delivery, so if that isn’t part of the plan, consider your options before you start having sex. It’s safe to start certain types of birth control immediately after delivery—if you have a C-section, you can have an IUD placed at the time of surgery. If you are taking the pill, your doctor will prescribe a progesterone-only option until four to six weeks postpartum, since combined hormonal options like a patch or ring contain estrogen, and there is evidence that estrogen can contribute to blood clots in the early postpartum period.
Stress also impacts your pelvic floor.
Some of the nerves in the pelvic floor are part of the autonomic nervous system. This is good because the autonomic nervous system keeps us from, say, just peeing whenever our bladder is full. But it’s also the system responsible for the body’s fight-or flight response. “If we’re feeling tension or stress, if we have higher levels of cortisol, then our pelvic floor muscles tense up,” Dr. Oswald says. “And stress is all we’re dealing with postpartum. You’re meeting this new baby, trying to figure out who you are [now] and who this baby is. It can lead to a lot of tension in the pelvic floor.”
Pain is common but not normal.
“The biggest thing that I hope is shifting is the idea that, especially for women who had a vaginal delivery, pain is normal, and that you’ll just get used to it,” Dr. Oswald says. “The first time can definitely feel different. It might be slightly uncomfortable, but every time you have penetrative intercourse, it should get better and better,” Dr. Oswald says. “Lingering symptoms of pain are not normal.” If you are feeling pain during penetrative intercourse after trying to ease back into intimacy, talk to your doctor about your symptoms.
You deserve a fulfilling sex life.
“Going to see a pelvic therapist is not about just decreasing pain; it’s [about] improving overall function,” Dr. Oswald says. “Being able to wake up those muscles and our relationship to those areas of our body can bring on resolution and [help us feel] so much more connected to ourselves, which is just a really big part of the postpartum time.” The journey may start with making sex less painful, but that leads to vibrancy later on. “So often, our providers don’t talk to us about sex and libido and about having healthy, beautiful, fun sexual lives,” midwife Christian Toscano says. “In midwifery we talk a lot about how birth is an extension of sex. And we want you to have great sex.”