Our therapist Andrew,  mentioned sex in his last blog post, found here  .  In it, he discusses “lack of sex” as a “universal theme” that he hears from new dads.  This got me thinking about all the times we hear about lack of sex in the postpartum period, often as part of a joke or punchline.  The line usually ends with something like this, “yep, we have a _____ month old baby, so basically sex is non-existent”. 

But, beyond that kind of “sigh, this is my life now” comment, we don’t often hear the actual details as to why that may be.  Why does sex change so much for couples after a baby is born?  And, maybe more importantly, why aren’t the reasons talked about more?  Again, in my never-ending quest to tackle the stigmatized issues behind all things reproductive, I’ll try to tackle that issue today.

The simple answer is, there are several reasons why sex (and by sex I am specifically referring to intercourse) drops off in the postpartum period. 

“You want to put your what where?!?  There is NO way that is happening after what my body has been through.  Ouch.” 

This first reason is the most common reason behind lack of sex, especially in the first few months when a new parent’s body is healing.  Studies have found that, after delivery, about 9 in 10 folks find sex painful the first time, and about ¼ of them are still experiencing painful sex 18 months later.  The clinical term for this is dyspareunia (yep, there’s a word for it, because it’s that common).  What many folks are surprised by (I know I was), is that this pain can happen whether a baby was born vaginally or by cesarean (C-Section).

Believe it or not, pregnancy and delivery changes things about your body.  Like, really changes things.  With a vaginal delivery, there can be some physical trauma (tearing, for example, either naturally or through an episiotomy, where a cut is made by the medical provider to help baby come out) that takes some time to heal.  And, even after healing, there can be some residual scar tissue that makes sex difficult and/or painful. 

With a C-Section there are also physical changes.  This is certainly not talked about enough.  I work in an OB practice, and I had NO IDEA that a C-Section could alter things and effect sex.  In fact, when I was grieving the fact that I would have to have a cesarean for a pesky placenta previa, I thought that would be the one benefit.  But nope, turns out that, in fact, studies have shown that people who have C-Sections actually experience more pain in the postpartum period than those who delivered vaginally.   Medical providers believe this pain to be caused by adhesions that can form from the surgery.

Exclusively Breastfeeding = Painful Sex

This cause for painful sex was the most surprising for me, and probably even less talked about than any other reason.  Turns out, exclusively breastfeeding can make sexual intercourse a real pain in the vag (ha, see what I did there?).

Let me break this down for you.

Breastfeeding significantly lowers a person’s level of estrogen.   This decrease in estrogen is nature’s little way of helping us focus on the breastfeeding bambino, rather than producing another one too soon (i.e., it limits fertility).

For the sake of this post, let’s call estrogen “the happy sex hormone”.  Estrogen is what causesa) elasticity in the vagina, something absolutely necessary for sexual intercourse, and b) lubrication and blood flow to the vagina.  Again.  Necessary.  So when those things are gone?  OUCH. 

Some breastfeeding people appear to have more difficulty with this than others.  Here’s another term I’d never heard before having a baby – Lactation Atrophic Vaginitis.  Lovely, isn’t it?

Unfortunately, for many breastfeeding folks that estrogen level doesn’t go up again until after the person has their first postpartum period.  Another option can be making an appointment with your OB/GYN to discuss the possibility of applying a small amount of topical estrogen cream, which has been found to help.  However, there are risks associated with that, including reintroducing fertility and potentially diminishing milk supply.  Sigh.  Can’t anything just be easy?

“I’m just so, so, so, tired.”

Here’s another common reason.  Having a baby is EXHAUSTING.  There are no ways to prepare you for how exhausting until you’re actually going through it.  My husband says he literally does not remember the first few months of our son’s life, since he was essentially walking around in a sleep deprived fog.  Even when you’re working hard to make sure you get at least 6 hours of sleep in 24 hours (which is highly recommended, since routinely slipping below that can be dangerous), that sleep is usually disrupted.  Which means that you’re still walking around exhausted all the time. 

And, when you’re exhausted, it’s pretty understandable to pick sleep over sex.  Sweet, sweet, sleep.  Sleep that almost feels orgasmic when you’re that sleep deprived. 

Abuse

Research shows that postpartum folks who are the victims of intimate partner violence experience higher rates of dyspareunia.    And, that same research shows that 1 in 8 postpartum people were reporting abuse.   So, not a rare occurrence.  The exact cause of that increase in pain is unknown, but likely has to do with emotional response to abuse and/or sexual coercion. 

Ok, so I’m not a freak for having painful sex after having a baby.  But what do I DO about it?

1.       LUBE.  Lots and lots of lube.

For those that feel they can (and want to) have intercourse after having a baby, using extra lube can be super helpful.  That’s what it’s there for, folks.  Use it. Other things that can help; taking an over-the-counter pain reliever, making sure your bladder is empty, or taking a warm bath before sex can help.  Orgasms before sex can help too, as they can relax your muscles and get blood flowing to your vagina.  (And yes, I’m giving you permission to show this to your partner.)

2.       TALK ABOUT IT. 

Many folks are afraid to bring this topic up with their OB/GYN.  If you don’t talk about it, they can’t help.  So do!  That’s what they’re there for folks!  They will likely then want to perform a pelvic exam or an ultrasound to try to figure out more information.  Sex is not an embarrassing or shameful thing.  In fact, it’s integral to most healthy intimate relationships.  To be fair, painful sex should not just be on the patient to discuss.  OB/GYNs should be better at bringing this topic up at visits.  In addition, they should be screening more for intimate partner violence (and knowing how to help patients when they do admit to it), because most folks won’t bring abuse up unless they’re given a safe space to talk about it.

And, while we’re on the topic, talk about sex with your partner too.  Chances are, they’re noticing that they’re not having sex.  Which brings me to my next point.

3.       Sex does not just have to be “intercourse”. 

While the body heals, and until you’re ready (physically and emotionally), you and your partner may want to explore other forms of “sex” in order to keep that intimacy thriving.  This can mean pretty much anything, from hand holding and cuddling to mutual masturbation or oral sex.  One of the best ways to explore this is to communicate about it with your partner.  Saying something like, “Hey, I know I haven’t been comfortable with sex yet.  Let’s talk about other ways that we can connect.”  I find that many of my clients are afraid to even kiss their partners, because they don’t want that to seem like an initiation of sexual intercourse.  But completely losing any intimacy can cause real problems in a relationship.

4.       Schedule Intimacy.

That’s right.  Whether we’re talking about cuddling or actual intercourse, once you have a baby, you pretty much have to pencil that shit into your day-planner.  Gone are the days of lazy, “oh, we just woke up at 11am, let me roll over and have sex with my sleepy partner and then go out to a delicious brunch that we can afford because all of our money is not going to a tiny and adorable social terrorist”.  Even if your body HAS recovered, you may be too tired or “touched out” to feel like having sex.  So, schedule it! 

-          When baby is napping- nap time is during the day, and people tend to have at least a LITTLE more energy during the day.  So put aside the laundry and get busy.

-          Get a babysitter- even if it’s literally just for sex.  Drop the kiddo off at grandpa’s house, if you have that option, or a dear friend, or a babysitter, and go home for sexy time.

-          Put down the remote.  So often, it’s easy at the end of a long day after the baby is FINALLY asleep to want to just tune out for a bit.  I get that.  But try to factor in a little intimacy first, and then watch that episode of Scandal (or whatever).  Or, even better, watch something sexy to get you in the mood.

5.       Treatment

Sometimes painful intercourse has to be treated.  There are many different ways to treat dyspareunia.  For damage done during vaginal or cesarean deliveries, your doctor may recommend pelvic floor physical therapy.  Pregnancy and childbirth can damage the pelvic muscles, which is a bummer.  BUT, lucky for us, there are physical therapists out there that actually specialize in that area of the body!  Yay!  That looks like actual in-clinic therapy, as well as learning exercises to use at home to re-strengthen those muscles.  Pelvic PT can also help with other pesky side-effects of pregnancy and delivery, such as what I call the “sneezle” (i.e., when you sneeze and dribble pee at the same time.  So sexy.)

As mentioned above, for lactation related pain, an estrogen cream or even birth control with estrogen can be useful.

Finally, talking to a clinical therapist who specializes in sexual pain can be helpful, especially when pain is related to an emotional or psychological factor, such as a history of abuse or trauma. 

 

Have any of you experienced painful intercourse after childbirth?  What did you do about it?  Is there anything you wish you’d known or done differently?  Let us know in the comments section below!

 

Ariel is a therapist at Porch Light Counseling who specializes in fertility, pregnancy and postpartum counseling. 

4 Comments