WHEN TO RETURN TO SEX
It is generally advised for women to wait for 4-6 weeks after giving birth to resume sexual activity. This gives the body a chance to heal and reduces risk of complication and infection. In this time your tear/episiotomy scars should heal, the lochia (postpartum discharge) should have stopped and your cervix should have closed. It is usually safest to get checked by your healthcare provider to get the go ahead to resume sexual activity.
While some women are keen to resume sexual intercourse as soon as possible, many women are anxious about having sex again. This can be especially true if they have had any injury to the vulva and or perineum during a vaginal or attempted vaginal delivery.
Once you’ve been cleared to resume sexual activity from your healthcare provider, you should only resume sexual activities when you are ready. Sex after giving birth should not be painful. The first few times may be uncomfortable but if it is very painful or persistently painful then you should seek medical advice. It is also common to not feel any desire for sexual activity initially this is due to a number of reasons including:
- hormonal changes – low oestrogen (vaginal dryness) & higher oxytocin (this hormone triggers feel good baby hormones but naturally suppresses your sex drive)
- fear – of pain, of how things will feel different, of how your partner/ you view your body
- fatigue – having a newborn is easily the most exhausting time in many people’s lives
- no time – finding time to be intimate with your partner can prove to be a real challenge when you are caring for a new born
- painful and leaking breasts – this can be quite common when you are breastfeeding
PREGNANCY WARNING
It needs to be highlighted than some women can get pregnant again as soon as 3 weeks after giving birth even if you are breastfeeding and your periods have not returned yet. So if you do not wish to be pregnant again so soon you must use a contraception each time you engage in sexual activities.
IT FEELS DIFFERENT
Something that many women notice after giving birth is a change to the sensation or feeling of sexual intercourse. It is not always a bad change! Many women report increased pleasure and intensity of orgasms after giving birth. However in some cases some women report either a feeling of “difference”, lack of sensation, more room than before, heaviness or bulging in the vagina, pain on either touching or on penetration. This can be due to a number of reasons:
- change in the tone of your pelvic floor (hyper or hypotonicity)
- infection
- hormonal changes
- prolapse
Hypertonicity vs Hypotonicity
This is a very important topic to understand. It is one that is commonly misconceived or misunderstood. The first thing to understand is what is muscle tone. Muscle tone can be described as the amount of tension in a muscle at rest which is very different from muscle strength – which is how much force a muscle can create in response to resistance. Hypertonia or hypertonic muscles is where the tone in the muscle is too high. When the tone in the pelvic floor is too high the muscles become tense and are unable to relax. This can cause pain on penetration as well as other concerns such as urgency, constipation and pelvic pain. There can be a number of different reasons that people develop overactive pelvic floors and it can occur after giving birth. Many people assume that after giving birth there will be a drop in tone but the opposite can happen. Treatment for hypertonic pelvic floors is varied and multifaceted that includes breathing techniques and muscle relaxation techniques as well as some manual release of muscles, both in and around the pelvic floor and pelvis. Scar tissue massage around any tears or cuts in the perineum as well as desensitisation work can also have excellent results.
The opposite can also be an issue after giving birth, where the tone of the muscle has reduced and now there is more laxity as well as decreased strength and possibly sensation on penetration. As with any issue postnatal we always advise seeing a trained professional. There can be other reasons for decreased strength and sensation, for example nerve injury. These sort of injuries need to be assessed and addressed appropriately and on an individual basis. For those with straight forward issues see our reconnecting with your pelvic floor videos for how to start working your pelvic floor muscles.
Infection
It is important to rule out any source of infection. An infection for example, a urinary tract infection (UTI) or fungal infection can also affect the tissue of the vagina making penetrative sex very uncomfortable. Your healthcare provider will likely do some examinations to rule out any infection that would need to be treated first. Signs of infection can include redness, bleeding, pain in and around the vagina or urethra, increase in discharge or foul smelling discharge, itching or increase in frequency of urination to name a few.
Hormones
When you are breastfeeding the hormone oestrogen depletes significantly. This hormone plays an important role in both lubricating the vagina as well as tissue pliability so as this become low especially in women who are breastfeeding it can contribute to vaginal dryness as well as making the vaginal tissues thinner and more delicate. This not only contributes to discomfort during sex but can even make wiping or wearing tight clothes uncomfortable.
If you’re struggling with these feelings there are some simple at home remedies that can help such as keeping the tissues moisturised by applying a small amount of some food quality grade coconut oil, an over the counter vaginal moisturiser or chat to your GP or Ob/Gyn about whether you’d benefit from an oestrogen topical cream. Using a sitz bath again can help with painful or burning sensation.
When breastfeeding as well as lowering oestrogen levels, your body produces more oxytocin. This hormone makes you feel good and bonded to the baby but naturally suppresses your sexual drive. It can be thought of your body’s way of naturally trying to limit the chance of conception again. But this does not last forever and many women are relieved to hear there is a reason for this drop in libido.
HOW TO HELP WITH PENETRATION PAIN
The first couple of times you engage in penetration after sex you may find it a little uncomfortable. This is not uncommon but generally after a few times and with the right tools and advice any discomfort should ease off and things should return to normal. If however you’re still struggling with pain this is not normal and there could be a number of different reasons for this.
Lubrication
One reason for discomfort or pain during penetration can be due to low oestrogen levels which as mentioned earlier help with lubrication. For returning to sexual activity using a good quality lubricant should help. Try to avoid coloured, scented or flavoured lubricants as they can be irritants and can upset the natural pH balance in your vagina. Try different types until you find the one that works best for you. Remember silicone lubricants can affect the latex of some forms of contraception so take that into consideration.
Foreplay, Tools & Toys
Foreplay is important for arousal, increased blood flow to the genitals and and lubrication, however some women will not need or want any foreplay so communication at all points on when and how to return to sex is key. But for those who do want it or are anxious or having difficulty returning to sex this can be a way to ease back into it. The first few times does not need to be about penetration but mutual enjoyment and connection which can be done with touching, cuddling, kissing, mutual masturbation, massage what ever feels good to you and your partner.
If you have used toys or aids previously you may not wish to use the same ones or may prefer to try others. You can explore toys that stimulate in different ways, anything from penetrative toys to clitoral or anal based stimulators.
Aids such as the ohnut can help with controlling depth of penetration. Sometimes when women struggle with pelvic floor muscles that are hypertonic or “too tight” a set of dilators or a pelvic floor wand can help release some of the tightness and tension.
Positions
Different positions may be more comfortable/ enjoyable after giving birth depending on scar sensitivities, preference and your pelvic floor:
- Woman on top for control of depth of penetration and speed
- Side to side (spooning) again allows for control of depth, speed and access to clitoral stimulation from both parties
- Woman lying flat on your stomach which can allow for easing into penetration without going too deep
- Instead of standard missionary you may try the Coital Alignment Technique (CAT) position for more clitoral stimulation and less depth of penetration
- Oral sex can be a great way to ease into sex with digital penetration as opposed to a penis or dildo.
PERINEAL MASSAGE
Scar Sensitivity and Scar Massage
Just like scar tissue anywhere on the body the scar tissue in and around the genitals and in the perineum can become overly sensitised (even light touch feels uncomfortable) or can develop constrictions around the scar tissue. To prevent sensitivity increasing once the wound has healed it should be touched regularly ie when cleaning in the shower do not avoid touching your scar.
If however after a few months the sensitivity has not settle and is still tender, in these cases a program of scar desensitisation can be undertaken with generally very positive results. Like with any scar sensitivity work it starts with very gentle touching to desensitise the area. This can be done with fingers and or different objects and textures every day. It is done with increasing tension and pressure until the sensitivity to touch has gone.
Sometimes scar tissue or the area surrounding it can contract or develop into excessive scar tissue (hypertrophic or keloid scar). It can result in reduced elasticity as well as possibly reducing the size of the introitus (entrance to the vagina). Scar massage is meant to help with the mobility and elasticity around the area it does not always help with the excessive scar tissue formation.
See our ‘Perneal Massage’ section to learn how to do perineal scar massage and desensitisation.
HOW TO HELP WITH TENDER AND/OR LEAKING BREASTS
Breast feeding makes your breasts tender and leaky. For some women they can find leaking breasts embarrassing while others do not mind. During breast stimulation and orgasm you generally release oxytocin, the same hormone that triggers the let down reflex. This can result in the breasts leaking or even spraying milk.
If you find this uncomfortable or embarrassing there are certain things to try, but the first and foremost thing should be to discuss this with your partner.
Other tips include:
- pump or nurse before sex to reduce the feeling of being too full
- wear a nursing bra or lingerie with nursing pad to help ease the feeling of heaviness and help absorb the leakage
- trying different positions to find which feels most comfortable – for example straddling your partner in a seated position with your breasts gently pressed against them for support
