After childbirth, sex may be the last thing on your mind. If you’re feeling up to it, follow your sex drive where it leads.

Sex after pregnancy happens. Honestly. But first, vaginal soreness and sheer exhaustion are likely to take a toll. Whether you’re in the mood or sex is the last thing on your mind, here’s what you need to know about sex after pregnancy.

After the baby is born, how soon can I have sex?

Whether you give birth vaginally or by C-section, your body will need time to heal. Many doctors recommend waiting six weeks before resuming intercourse. This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.

But the other important timeline is your own. Some women feel ready to resume sex within a few weeks of giving birth. Others need more time. Factors such as fatigue, postpartum blues and changes in body image may take a toll on your sex drive.

Will it hurt?

Your vagina may be dry and tender, especially if you’re breast-feeding. To ease any discomfort, take it slow. Start with cuddling, kissing or massage. Gradually build the intensity of stimulation. If vaginal dryness is a problem, use a lubricating cream or gel. Try different positions to take pressure off any sore areas and control penetration. Tell your partner what feels good — and what doesn’t.

If sex continues to be painful, consult your doctor. A low-dose estrogen cream applied to the vagina often helps. Rarely, complications of healing may require additional treatment.

Will it feel different?

After several vaginal deliveries, decreased muscle tone in the vagina may reduce pleasurable friction during sex — which can influence arousal. To tone your pelvic floor muscles, remember to do your Kegel exercises. Simply tighten your pelvic muscles as if you’re stopping your stream of urine. Try it for five seconds at a time, four or five times in a row. Repeat throughout the day.

What about birth control?

Unless you’re hoping to become pregnant right away, sex after pregnancy requires a reliable method of birth control — even if you’re breast-feeding. Barrier methods such as condoms and spermicides can be useful. If you prefer hormonal birth control, it’s important to select a method that doesn’t interfere with breast-feeding. Your postpartum checkup is a great time to ask your doctor about the options.

What if I’m too tired to have sex?

Caring for a newborn can be exhausting. If you’re too tired to have sex at bedtime, say so. But that doesn’t mean your sex life is over. You may prefer making love early in the morning or during your baby’s nap. Feed your baby first to extend the time you and your partner have together.

What if I’m not interested in sex?

That’s OK. There’s more to a sexual relationship than intercourse — especially when you’re adjusting to life with a new baby. If you’re not feeling sexy or you’re afraid sex will hurt, share your concerns with your partner. Until you’re ready to have sex, maintain intimacy in other ways. Spend time together without the baby, even if it’s just a few minutes in the morning and after the baby goes to sleep at night. Share short phone calls throughout the day or occasional soaks in the tub. Look for other ways to express affection.

If communicating with your partner doesn’t help, be alert for signs and symptoms of postpartum depression. If your mood is consistently low, you find little joy in life or you have trouble summoning the energy to start a new day, contact your doctor promptly.

What can I do to boost my sex drive?

Go easy on yourself. Set reasonable expectations as you adjust to parenthood. Appreciate the changes in your body. Eat healthy foods, and drink plenty of fluids. Exercise regularly. Rest as much as you can. Spend some time alone. Taking good care of yourself can go a long way toward keeping passion alive.

Will childbirth affect your sex life?

Yes, it certainly will! So please don’t expect that everything will instantly return to normal. Men are particularly likely to believe this; a lot of young blokes think that they’ll be able to have intercourse as soon as their partner gets home from hospital. But that just isn’t true.

You see, childbirth is a pretty traumatic process for a woman. Having a baby pass through her vagina is almost like having a small explosion go off inside her. The delicate vaginal tissues are inevitably strained, bruised and torn – and it takes some weeks for these injuries to heal up.

Furthermore, childbirth involves very considerable hormone changes hormone changes – as well as emotional stresses. Therefore, very, very few women feel rampagingly sexy until a long time after they have given birth.

Therefore, it’s important for both mother and father to realise that lovemaking may not go brilliantly in the first six months or so after Baby arrives. So be prepared - and be patient!

How soon can you resume having sex?

In general, a woman shouldn’t consider having full sex (ie intercourse) until after her postnatal check-up. This examination usually takes place about six weeks after the birth.

Even then, she may not feel ready to ‘go all the way’ - particularly if she has had stitches and the opening of her vagina is sore.

If you’re in any doubt about whether to resume sex, ask the doctor who does your postnatal examination for advice – particularly about using additional lubrication..

Can you go in for any other sexual activity before resuming intercourse?

Yes – and it can be a good way of ‘letting off steam’. Couples do often get very frustrated when they’re waiting to resume sexual intercourse. This applies particularly to men!

So, in the meantime, you can go in for loveplay - though there is one danger, which we’ll explain in a moment.

Can both of you go as far as the point of climax? Definitely! It will do the postnatal woman no harm at all to have orgasms if she wants to.

So, things you can do include:

• hand petting on the man by the woman - what’s often called a ‘hand job’.
• hand petting of the woman by the man - using his fingers to stimulate her clitoris. But he should not put his fingers inside until she has had her postnatal examination and the doctor has said that everything has healed up. So, just stick to stroking and rubbing the outside of her sex organs. It’s quite safe to pay plenty of attention to her clitoris, which is well away from the area where stitches are put in.
• oral sex performed on the man by the woman. This type of loveplay - termed ‘fellatio’- often proves a great boon to a male who is desperate for sexual release.
• mutual caressing of various other parts of each other’s bodies.

Is there anything we should avoid?

Yes. Please heed this important warning. You’ll note that in the section above we have not recommended oral sex performed by the man on the woman (ie ‘going down ‘ on her).

This activity - often termed ‘cunnilingus’ - is definitely off limits during the first few of months after childbirth.

Why? For two reasons:

• it could introduce infection into the vagina and womb.
• even more seriously, it has occasionally led to death. These tragedies have occurred because the man has (often accidentally) managed to blow air into the vagina. Air can very easily get into the blood vessels of the newly-delivered womb - and cause an often fatal illness called ‘air embolism’. Not long ago, the British newspapers reported an appalling case in which a man forced his wife into cunnilingus shortly after she came home from hospital, puffed air into her – and killed her.

Is it OK to handle the breasts after childbirth?

Yes, it is OK - provided the woman feels happy about it. But don’t go in for ‘boob play’ if she develops any kind of breast disorder, such as a nipple crack or an abscess.

Do feelings for the new baby affect your sex life?

Absolutely! You’ll find that a great deal of time has to be spent taking care of the new baby. Most new mothers - and plenty of new fathers too - feel exhausted because they are never able to get sufficient sleep. This may go on for months - or even a couple of years.

During this time, a man can feel as if his partner is pushing him away. He may think that she is lavishing all her attention on the baby and this may make him feel jealous, or left out.

After watching a partner go through pregnancy and birth, some men gain a new respect for the female body. These guys find it easier to articulate the emotions they feel about the new phase of their relationship and become more considerate of their partner’s changing needs.

But a few men who have been at the birth of their child are quite distressed by what they have seen. Indeed, some of them feel so guilty at the pain their partner has gone through that they are unable to even consider the idea of making love with her again. This is usually just a passing phase, but not always. And such a man should seek help from a counsellor to discuss his feelings.

To create and maintain a good atmosphere in the home, your relationship has to be one of trust and mutual respect. Both partners need to try to understand the other’s point of view. It is vital at this time that the couple can still do things together without the baby being involved so that they can enjoy the feelings they had for each other before they became parents.

We do urge new parents to take advantage of any offers of babysitting that come their way from fond grandparents, aunts, uncles and friends so they can go out together - or even just retire to bed for a sleep and perhaps a spot of sex!

What happens to the female sex drive after birth?

Most women don’t feel very keen on sex for at least a few weeks after childbirth and the main reason for this is simply exhaustion. If the delivery was long or difficult, the woman may also feel anxious about getting pregnant again.

Generally, women start getting their desire back within a couple of months of having a baby. If your libido doesn’t return, then you should seek help from a doctor. Female medics at family planning clinics are particularly good at helping to deal with this problem because they see it all the time.

What do you do when you want to resume sexual intercourse after the birth of your child?

When you’re both ready to have intercourse after the birth, you should begin gently. If possible, try and find a time of the day when you are not too worn out. Also, try to find a time when the baby is not likely to wake up - so you can have some peace and quiet.

Hormone changes and worry can lead to some women experiencing vaginal dryness for the first three months after giving birth. But you don’t take hormones for this. Instead, buy lubricants over the counter from a pharmacist. Try K-Y Jelly, Liquid Silk, or Pjur. Some condoms have a built-in lubricant that may help.

For the first few sex sessions after childbirth, it’s a good idea to choose a position in which the woman can control the pace and depth of penetration. A position with her on top, or one where both partners lie side-by-side facing each other, may be more comfortable.

Don’t forget contraception. It’s very easy to become pregnant again - far sooner than you intended. Try and decide on some form of family planning by the time your baby is four weeks old. If in doubt, ask the doctor at your postnatal examination about contraception.

What do you do if the woman doesn’t regain her interest in sex?

This is quite common. Please bear in mind that it could be a symptom of postnatal depression (PND). If the woman is at all depressed, she should see her GP.

Otherwise, the best thing is for the couple to get some counselling from an expert in sexual problems, for instance at:

• Relate
• Couple Counselling Scotland
• A Family Planning Clinic.

With commonsense advice, a loving couple can usually gets things sorted out – though it may take some months.

During 2005, certain new treatments for increasing female libido are due to come onto the market. They include:

• a testosterone (male hormone) gel.
• a testosterone skin patch.
• alprostadil gel (ALISTA) – a jelly intended for application to the clitoris and surrounding area.
• Eros – a vibrating suction device which is already available, but not on the NHS.

Unfortunately, Viagra and similar drugs have not so far been convincingly shown to help new mothers who are having difficulties with sex. However, in mid-2005, doctors from St Mary’s Hospital, London, published a very small series of cases in which women with poor libido seemed to be helped by using Viagra. But as this treatment is not licensed, it is not available from your GP.

Sex after baby: Do you really have to wait?

This question is very appropriate because many women are anxious to resume an active sex life after giving birth and are afraid to ask their care providers. about this issue.

You may be surprised to learn that the restrictions regarding resumption of sexual intercourse after birth are largely a result of “folk wisdom.” There are no research-based studies that show an ideal waiting time. Women should be given the freedom to chose when they wish to resume sex after birth.

It is observed that it takes approximately six weeks for the uterus to return to “normal” size after vaginal birth. So, early “authorities” felt that the proscription against intercourse should coincide with this landmark.

What we actually see in practice, however, is that some women are emotionally and physically ready for intercourse much earlier. Williams Obstetrics, a respected text, states: “following an uncomplicated delivery, a six-week abstinence from intercourse makes little sense. It can be safely resumed in as little as three weeks or when comfort can be maintained”.

From your description, it sounds as if you may be ready for intercourse far earlier than some other women. If you have had no tearing or episiotomy, and your lochia (bleeding) has changed from red to pink and is scant in amount, it is probably fine for you to resume sexual relations as soon as two weeks postpartum. I would advise this additional week to assure the healing and closure of the cervix.

You will want to protect yourself from another pregnancy by using a contraceptive method.

You should not resume sexual relations if you have any fever, malodorous discharge or red bleeding.

For some women, it takes much longer than six weeks until they are ready to make love. Advice should be provided to women based on individual variations.

A review entitled “Sexuality during Pregnancy and the Year Postpartum” was published in The Journal of Family Practice (1998) by J. Byrd et al. 47(4), 305-8. It reported that “there is little agreement in the findings of research on the resumption of sexual activity following childbirth”. They state that “at five to seven weeks postpartum, only 50 percent of women had resumed intercourse.” Numerous reasons have been suggested for the delay in resumption of vaginal intercourse after childbirth. The principal ones are: pain related to an episiotomy; vaginal bleeding or discharge; fatigue and discomfort related to inadequate lubrication of the vagina, due to low levels of estrogen in the postpartum period.

Women who have had a lengthy labor following a high risk pregnancy or women who have had a birth assisted by a vacuum extraction, forceps or cesarean, may not wish, nor perhaps should they, resume intercourse until 8 to 12 weeks postpartum, or perhaps even longer. Women who suffer extensive perineal tearing, or those with a large episiotomy or mediolateral episiotomy, may not be “comfortable” for several months after the birth.

Resuming intimacy after giving birth

After giving birth many women go through a period of adjustment to their “new” body. You may wonder if you will lose the weight you gained during pregnancy and if you will ever get your figure back again. It can be very helpful to see that you are still desired by your partner.

The postpartum period is a good time to explore being close to your partner without sexual intercourse. You both may be eagerly awaiting the opportunity to make love again, and this is an important time to approach each other with tenderness and continued communication.

You may find that you have little or no interest in sexual intercourse immediately following childbirth. When you are ready, you can resume sexual intercourse when your perineum is comfortable, the episiotomy has healed, and the lochia has stopped.

It is common to feel very dry and lack the vaginal lubrication that had been normal for you. This is due to the reduced estrogen after the delivery of the placenta. Prolactin and oxytocin can also interfere with lubrication if you are nursing. It is normal for vaginal dryness to last up to six months. You can apply a water-based vaginal lubricant, such as astroglide or liquid silk, to help make intimacy more pleasurable. If intercourse causes you discomfort, you may want to wait a little longer or find other sexual practices that you and your partner enjoy.

Because there is decreased tone in the perineal muscles you may notice less pleasurable friction during intercourse. You may find that your orgasms are less intense for the first few months. These are normal occurrences after giving birth. To help increase muscle tone, resume your Kegel exercises (perineal tightening) that you learned in childbirth class. Practice Kegel exercises at least 50 times every day, slowly increasing to 100 repetitions.

Because you are probably fatigued after giving birth, you may want to experiment with making love in the morning or afternoon, rather than at the end of a day when you are already too tired. If you are breastfeeding, nurse your baby prior to your lovemaking to help extend the time you and your partner have together.

While conception is highly unlikely in the postpartum period, when exclusive breastfeeding, if another pregnancy is not desired at this time, it would be wise to resume the use of contraceptives. Discuss your options with your care provider.