There seems to be no shortage of information available to the newly pregnant couple. Myriad books, blogs, and online articles cover just about everything you may wish to know about pregnancy, birth, and the postpartum period.
However, if you want to know what your sex life might be like after transitioning to parenthood, you may find a bit less information. There are certainly sitcom jokes about the death of one’s sex life and sexless marriages after children, as well as the rise of so-called “mommy porn” a la Fifty Shades of Grey and the like, but not too much in between.
Pregnancy itself, the enormous physical, emotional and hormonal changes that come along with it, and each couple’s unique pathway to get there influence sex during pregnancy and afterward. Dealing with infertility, miscarriage, pregnancy complications, or birth trauma can all provide complicating factors to sexuality after baby. As a sex therapist, I often field questions from clients about sex after baby or help couples and individuals who are experiencing sexual issues during this period of transition. Here are a few concerns that seem to surface.
What about sex during pregnancy?
Many couples express concern about having sex during pregnancy, wondering if it can endanger the growing fetus. These concerns can be exacerbated if there have been previous miscarriages or infertility issues, so I encourage clients to speak with their healthcare providers about their concerns to discuss what is safe to engage in during pregnancy.
Generally, sexual activity is safe for healthy pregnancies and is often pleasurable for couples if they understand the physical changes occurring. Many women experience physical changes such as breast tenderness or sensitivity, nausea, fatigue, and swelling or engorgement of vaginal tissue (due to increase blood flow to the pelvic region). Some women experience increased sexual desire and arousal, particularly during the second trimester, while others are significantly less interested in sex due to the impact of nausea and fatigue, or pregnancy complications.
It is important to maintain good communication between partners during this time, as desire may change (for both partners), and it is helpful to talk frequently about what feels good and what doesn’t. As pregnancy progresses, it may be necessary to change positions and be a bit more creative; breaking out of the “sexual script” that is usually followed can be fun and expand beyond penetrative sex. For example, in late pregnancy, rear entry and side-by-side positioning can be more comfortable for the pregnant partner if penetration is desired. If you are in a lesbian relationship and typically use vibrators or dildos for arousal or penetration, continue to discuss the comfort level of these as pregnancy progresses and physical changes occur.
What changes occur after birth?
During and shortly after childbirth, the woman’s body is flooded with what are known as attachment and security hormones, oxytocin and vasopressin. Oxytocin is also released during sexual arousal and is associated with the beginning of labor. Significant mood changes, crying spells, and feelings of being overwhelmed are normal after birth.
Physical discomfort is also experienced at times due to low estrogen and progesterone levels, so there may be vaginal dryness and thinning of the vaginal tissues, especially for nursing mothers. Healing from episiotomy or cesarean section can take time and cause soreness and difficulty with movement. Sleep deprivation can lead to significant fatigue, for both partners.
During the postpartum period, many women express that their bodies do not feel like their own. There are many physical changes, nursing women may express milk or leak, vaginal secretions and bleeding can continue for a while, and there is breast soreness associated with nursing and milk engorgement. The pelvic floor muscles, vagina, and cervix often feel different and are more relaxed, resulting in women stating things “feel different down there.”
Frequent nursing and holding the baby can result in touch overload. Partners may withdraw from physical touch, and hugs and cuddling may decrease during this period. When coupled with the additional stress and sleep deprivation of the postpartum period, this can lead to increased tension and conflict between partners.
Will I ever want sex again? I’m worried that I feel no desire at all.
When I talk to couples about resuming sex after baby, I talk most about expectations, time, and patience. First, we talk about keeping expectations reasonable. Given what we know about the changes that have occurred for both partners, physically and emotionally, couples can expect to have to communicate more, and both partners should be prepared for things to go differently than in the past. Arousal may take more time, certain positions and activities may be painful at first or less desired than before, and pleasure may be found in unexpected ways.
Couples that have struggled to talk openly about sex in the past may have more difficulty with the postpartum adjustment. Allow time for each partner to adjust to the changes, and try not to make sex a race for the “finish” of orgasm, for either partner, at least at first. This is a time for exploration of each other’s bodies in a new and perhaps more tender way. If one or both partners do not feel emotionally connected because of tension or conflict that is unresolved, it can be helpful to talk about those issues before attempting physical intimacy.
Women often are alarmed that they do not have any sexual desire during the postpartum period, and wonder if it will ever return. It is helpful to chat with your medical provider about when you are ready physically to resume sex, understanding that even when this is the case, you may not be emotionally ready or feel spontaneous desire. Much of this is due to the shift in focus to the role of mother/caregiver, and occurs in lesbian, gay, and heterosexual couples. It often also relates to fatigue and sleep deprivation and the lack of time to devote to being a couple. Continuing to connect physically in intimate but not specifically sexual ways is helpful during this time. Seeking breaks from caregiving is also helpful, if you have a support system that can be called upon to keep the baby for a few hours. Even escaping as a couple to a coffee shop for an hour can be restorative to the sense of self.
Will my body ever feel the same again?
Because of the many changes during pregnancy and childbirth, body image issues are particularly prevalent during the postpartum period, often compounding a decrease in desire for sexual activity. A woman may feel that the birth experience itself, or the way her body looks after birth, makes sexual activity undesirable for the partner as well, especially if she is not feeling particularly close to her partner. What is key here is making sure that partners are spending time together and sharing affirmations with each other, with both partners feeling loved and appreciated. I encourage new mothers to take a look at themselves in the mirror several times a week, and affirm what their body has done, the work of pregnancy, labor and delivery, and now feeding the baby as well (if breastfeeding). It can be helpful for partners to take part in this activity, and to affirm the continued desirability and sexiness of their partners’ body.
As for how these physical changes affect sex, be prepared that things may not feel the same. There are some simple solutions for some of the changes you may experience when you resume sexual activity after birth.
If breastfeeding, the breasts can leak or even squirt fluid if stimulated during sex. Nursing or pumping before sex can help. If you or your partner are uncomfortable with this, you may wish to focus on other parts of the body, which can be a fun exploration of other erotic zones you may not have discovered before. Breasts can be sensitive during this period, which is arousing for some women and a turnoff for others. Some women find wearing a nursing bra or tank top during sex can help with this issue.
The pelvic muscles have done amazing work during delivery, so it is expected that these muscles may feel stretched out or looser than before. With time these muscles will tighten, although some women report that “normal” remains different than before. Occasionally a bit of urine will leak during sexual activity after pregnancy. Kegels can help with both these issues, and are easy to do almost anywhere.
Any helpful specifics for sex after baby?
Once you have the go-ahead from your doctor to resume sexual activity, here are some specifics. Most couples want to feel secure about birth control, so this is an area you want to cover with your doctor during your postnatal checkups. Breastfeeding is not a reliable method of birth control, even if you haven’t resumed your menstrual cycle. Having birth control figured out can help both partners relax back into sexual activity.
Make sure to have plenty of lubricant on hand, even if you have not needed to use any in the past. Look for lubricants with minimal additives and natural ingredients, and try both water-based and silicone, remembering not to use silicone with silicone toys. Use liberally at first, more than you think you need.
Warm up together, maybe a nice bath or massage, and take your time. More foreplay and communication about what feels good is helpful here. Couples may need to experiment with the positions that feel best, often with new mother on top or side by side to put the least pressure on stitches. It helps for new mom to have more control over penetration, whether with penis or dildo. Start with a finger the first time out.
If there is pain, speak up! It is never a good idea to “push through the pain.” Let your partner know it’s happening, shift positions, take a break, add more lubrication. Some pain and irritation are expected, but if pain continues, seek assistance from your doctor; there may be scar tissue or delayed healing that needs to be addressed.
It’s been months, and sex just isn’t working. This is starting to be a real problem between us. What should we do?
Given all of the changes occurring, it is not unusual for couples to need more help with sexuality after having a baby. If you need help, it is best to find a couples counselor who is a trained sex therapist. A sex therapist is a licensed therapist who has had additional training in the areas of sexuality and sexual problems. Look for words such as sex-positive, LGBTQIA affirming, and evidence of additional training in sexuality when you are looking for a therapist. The gold standard for sex therapists is having been certified by AASECT, the American Association of Sexuality Educators, Counselors and Therapists. You can find an AASECT certified professional here.
If you cannot find an AASECT certified therapist in your area, ask questions about the additional training the therapist may have in the area of sexuality and about their approach to therapy to make sure you are both comfortable.
Some couples are concerned about what to expect from a sex therapist; after all, for many couples these are difficult issues to talk about openly. The therapist can help with this, and will likely take a full relationship and sexual history from both partners, as well as help you talk about the problems you have been having that bring you into therapy. The therapist may also suggest exercises for you to try at home, or refer you to other professionals, such as a urologist or pelvic floor specialist, depending on what sorts of issues you are having. Sex therapists do not touch you or expect you to touch each other in session; they are present to help you have conversations you need to have to improve your connection and sex life. Most sex therapists are also trained in couples counseling and can help with relationship issues that are getting in the way of better sex.
Nancy Owen, MA, LMHC, is a licensed mental health counselor with a private practice in Kirkland, Washington. She has over 25 years of experience and specializes in helping individuals and couples navigate conflict and life transitions, with a particular focus in sexual issues. For over ten years she has taught the Gottman course Bringing Baby Home and utilized those principles with couples and individuals navigating the transition to parenthood and the struggles the the postpartum period can bring.