Let’s not beat around the bush here: there are physical changes in a woman’s body after childbirth that can create challenges in regards to her sexuality, but there are also psycho-social changes like fatigue, body image, adjustment to alterations in social/family roles, and quality of partner relationship. The combination of all of these factors will result in changes to a new mother’s sexuality, some for the better and some for the worse. What’s important isn’t necessarily why these’s changes occur, but rather, how best to prepare yourself for the changes you and/or your partner will face postpartum.
After giving birth and waiting for the amount of time suggested by the healthcare provider (which may differ between c-section and vaginal birth), a woman may be unsure about how her body will react to re-visiting intercourse and other sexual acts while she is breastfeeding. Unfortunately, research on breastfeeding and sexuality has been limited in the past (likely on account of taboos), but thankfully we’re seeing changes and we are able to gather some data from the perspective of psychology, psychiatry, endocrinology, obstetrics, gynecology, nursing, and midwifery. These studies and educational resources are vital in working towards universal education for women post-birth.
In a study published in the British Journal of Obstetrics and Gynaecology, 83% of female participants experienced sexual problems in the first three months after their first delivery, but only 14% felt comfortable talking to their doctors about it. We find this to be positively tragic.
So, we can see that there’s a good possibility that sexuality will be affected post-birth. This said, with adequate understanding, communication, and education from healthcare providers, it will be much easier to resume sex post-baby.
What Will Change?
Postpartum vaginal dryness could be caused by postpartum thyroiditis, an inflammation of the thyroid gland. Your thyroid produces hormones that are vital to various bodily functions, including metabolism. The thyroid may produce too many or too few thyroid hormones when inflamed. However, thyroid function returns to normal within 12-18 months for 80% of women.
Estrogen and progesterone levels rise during pregnancy and instead of being discarded, the uterine lining develops into a placenta. The placenta also begins producing estrogen and progesterone. After giving birth, the levels of both hormones decline drastically. Your body dials down estrogen further while nursing because estrogen can interfere with milk production. Estrogen is important to sexual arousal because it boosts the flow of blood to the genitals and increases vaginal lubrication. Postpartum vaginal dryness is very common and can make sex uncomfortable or even painful. Vaginal dryness or dyspareunia can last as long as a mother is breastfeeding.
When a woman breastfeeds these hormone levels stay very low, and don’t rise and fall like they would normally during her monthly cycle; this suppresses her ovulation, and could mean no period. “But even regular breastfeeding suppresses ovulation only for a limited time for many women, with quite a lot of breastfeeding women returning to their menstrual periods 3-6 months post-delivery and others experiencing period suppression for the duration,” says Debby Herbenick, Professor, and Director, the Center for Sexual Health Promotion at Indiana University.
What can you do about dryness? Using a vaginal moisturizer is a great option for women who are experiencing ongoing discomfort due to vaginal dryness or are experiencing painful intercourse and looking for the ability to be spontaneous, day or night. Unlike a vaginal lubricant, a vaginal moisturizer can be applied regularly and at least 2 hours prior to sex, rather than right before as you would with a lubricant. A vaginal moisturizer aims to replenish vaginal moisture and relieve ongoing discomfort experienced with vaginal dryness, whereas a lubricant should be used just for sexual activity- with a partner or by yourself.
What else is happening? Prolactin stays incredibly high to maintain milk production, as long as suckling continues. Prolactin is elevated as a result of lactation and helps contribute to the suppression of ovarian function, but this is connected with suppression of androgen secretion, making arousal difficult. Low levels of estrogen can result in a decrease in vaginal lubrication, which may impair physiological sexual arousal. Oxytocin remains elevated in a woman while breastfeeding and can cause the contraction of milk ejection. Oxytocin is released during labor to help with the pain of contractions; it is also linked to uterine contracts during orgasm and milk eject reflex (MER). Oxytocin is also released while breastfeeding and leaves a woman relaxed and connected to her baby; this makes it easy to orgasm during sex or breastfeeding.
It also might be easier to reach orgasm. If a woman orgasms while breastfeeding her baby, it can cause a feeling of uneasiness to an uninformed, new mother but is perfectly okay, and not a sexual arousal phenomenon.
But it’s not just hormones
These physical factors could be adding to psychological implications such as anxiety or self-consciousness and, in turn, preventing arousal. It’s important to talk to your partner about how you are feeling mentally and physically about starting to be sexual again. Practice open communication about it being perfectly normal for sex practices to stay the same after having a baby, but also be aware that frequency and satisfaction may be altered and can go back after time.
This openness can help ease anxiety and help with adjustments to your relationship post-baby. Methods to help with lower desire or frequency issues are: using foreplay (or a better word: love-play) to help with arousal. Touching, kissing, and stroking are each important things in helping slowly build a sexual response.
What could happen during post-pregnancy sex? Milk Ejection Reflex (MER) may happen. If a woman is worried about potential milk coming out during sexual activity, there are many things she can do. She may breastfeed before engaging in sexual activity, as emptying the breast will reduce in MER. She can use her or her partner’s hands to press down on her breasts during or right before an orgasm to help obstruct milk ejaculation, or she may choose to wear her bra.
Increased sensitivity to breast stimulation can occur and is different for each woman. Some women may enjoy it, and some may find it painful. Techniques for combatting overly sensitive breasts are making the breasts a “hands off” area, slowly cupping rather than grabbing or kneading, or staying away from the nipple area. Communication is key. Use your words and tell your partner how everything is feeling (good or bad.)
As well, remember cuddling, kissing, and closeness. Try bathing together or mutual stimulation, for example. Incorporating potential breast milk ejaculation into sexual activity is an option, as well. Sexual positions that allow for shallow penetration and/or giving the woman control may be a great way to explore what is possible and what feels good in the beginning stages of getting back into a sexual routine.
Oh, and on top of all of the changes your body is going through, there are situational factors that will change your sex life. A major one? Sleep (or lack thereof). “The newborn period (which is usually considered about 3 months) is associated with true sleep deprivation. Where a baby sleeps also impacts how and where couples have sex. Medical organizations recommend room-sharing for 6-12 months with a baby, that’s a lot of time with an infant in the same room. Some couples feel inhibited by this; others don’t,” says Debby Herbenick.
Health Provider PSA
It’s important for healthcare providers to explain more than just the recommended time to wait prior to resuming intercourse and sexual activity. Sex is an important part of our health (mentally and physically) and should be treated as such.
To ease health care providers into an education of these not-so-talked-about subjects, it’s important to start with the knowledge that sexuality is complex and should be individualized. The healthcare provider should keep in mind that if they cannot answer a patient’s questions, they should seek out the right place to direct them and provide a referral.
Most people just need reassurance and a sense of open communication.
Openness to communication is a key point that many healthcare providers may be lacking. When communication has been opened, the healthcare provider should start with facts then move onto topics with less sensitivity, and finally to the more open conversations based on the level of comfort and response that the patient is showing.
A woman’s partner should be included, whether physically present or not, and assumptions of heterosexuality should be avoided. It’s important for the healthcare provider to remain composed, relaxed, and nonjudgmental while speaking with the patient. It is ideal to have these discussions in a separated space, but if a single room is not available, ensuring confidentiality and privacy is important.
Sex should be an easier topic to talk about than it currently is. Starting with open communication and education from healthcare providers is the first step that needs to be taken in order for women to have an ease back into sexual activities post-pregnancy or while breastfeeding (if they choose to do so).