That’s why it’s important to ease back into this part of your life and educate yourself on what to expect. Here, we go over the recommended wait time, reasons why you might be experiencing painful sex, why it’s not at all uncommon to not want to have sex right away, and tips for when you are ready.
When Can You Have Sex?
According to the American College of Obstetricians and Gynecologists (ACOG), there is no set “waiting period” before a woman can have sex again after giving birth. Doctors have customarily recommended holding off on sex for four to six weeks after childbirth, but in truth, this advice is not evidence-based. The ACOG says the chances of bleeding or infection during sex are fairly small after about two weeks postpartum. The timeline can depend on the type of delivery. If you had a cesarean section, a return to sex hinges on recovery from major surgery. In this situation, clearance from your doctor is critical. “Almost immediately after giving birth, the vagina begins to heal itself from the trauma of vaginal delivery,” says Peter Rizk, MD, FRCOG, FACOG. Women’s bodies are very elastic and incredibly resilient, which Rizk says makes the speed at which it heals really remarkable, especially when third and fourth-degree tearing occurs. “This recommendation has more to do with when it’s likely safe to have sex, especially if a woman has perineum stitches,” he says. If you tore or had an episiotomy during vaginal birth, getting intimate needs to wait until that area is completely healed. And if you had a cesarean section, Rizk says the same six-week postpartum recommendation stands, but consider avoiding partner on-top positions such as missionary position to protect your healing scar. When in doubt, always check with your doctor. If it’s still days or weeks away from your six-week postpartum appointment, give them a call. They may have you come in early or help you decide if your body is recovered and ready for sex.
Painful Sex After Pregnancy
Getting the all-clear from your doctor to resume sex doesn’t necessarily mean everything will go as planned. If this is your first experience with post-pregnancy intimacy, don’t be surprised if you feel both physically and emotionally different than you did before childbirth. This is not at all unusual. According to a study published in BJOG, most women who resume sex by 12 months postpartum experience pain during their first vaginal sex encounter after childbirth. More specifically, dyspareunia or painful intercourse after childbirth was reported in 44% of women at three months postpartum, 43% at six months, and 28% at 12 months postpartum. Breastfeeding often delays ovulation and the return of menstruation, and leads to low estrogen levels. “A low-estrogen state means women will experience vaginal dryness and be producing less of their own natural lubricant,” says Heather Jeffcoat, DPT, owner of Femina Physical Therapy. That’s why she says lubrication is a must for postpartum women resuming intercourse. “Plus, you may have vaginal scar tissue from the delivery, which can also create pain with penetration,” Jeffcoat says. Jeffcoat also points out that you may have hip, pelvic, or low back pain resulting from childbirth or taking care of a newborn. And pain can be an additional deterrent to intimacy. Painful sex postpartum is a problem that often gets dismissed. If you are experiencing discomfort beyond what is expected, consider making an appointment with a pelvic floor physical therapist. They can address issues with scar tissue and muscle tension, make lubricant recommendations, and provide ideas for positions that may feel more comfortable.
Why You Might Not Want to Have Sex
A woman may not have the same sex drive even if the doctor clears her to have sex because she feels mentally and physically exhausted from birth and taking care of a newborn. The whole experience and life after birth can be extremely overwhelming. Adding sex to the mix may feel depleting rather than pleasurable while adjusting to motherhood. If the birth experience was difficult or even traumatic, you might fear getting pregnant again, says psychoanalyst Babita Spinelli, LP. It’s also not uncommon to fear the pain even before you experience it, which can cause many women to avoid having sex. Women are often hard on themselves in regard to how they look after giving birth. “The inner critic within is heightened, and it can impact feeling attractive, which results in feeling too self-conscious or unattractive to be intimate,” Spinelli says. This aspect can feel very shaming for a woman, and she may avoid sex rather than express her feelings or show herself some compassion. Another common reason for not wanting to have sex after pregnancy and childbirth is the possibility of getting pregnant again. If this is the case, talk to your doctor about forms of birth control so you can feel safe about not getting pregnant during intercourse.
Intimacy Tips
Once your body heals, and you feel emotionally ready to add intimacy back into your life, there are some things you can try to make the experience more positive and fulfilling.
Ease Into Sex
“The combination of delivery trauma and hormone fluctuations many women have while breastfeeding can cause vaginal tenderness and even noticeable dryness,” says Rizk. When having sex the first few times after having a baby, he recommends not rushing it. Instead, go slow and ease into it.
Prep Your Body Before Sex
Being physical with your partner is not a race you need to win the first time back in bed. In fact, Rizk says it might be helpful to start with a gentle perineal massage–like what you did to get ready for delivery–using a chemical-free lubricant, preferably one that’s pH balanced and paraben-free. “Proper lubrication using a pH balanced product can help make the experience so much more comfortable and can even help reduce post-sex inflammation,” he says.
Show Self-Compassion
Spinelli says the postpartum period is an important time to show yourself compassion and replace negative thoughts with self-love and kindness. “Understand that your body changes after having a child, but that you are still beautiful inside and out,” she says.
Communicate With Your Partner
When talking with your partner, Spinelli says it’s critical that you allow yourself to be vulnerable and honest about your fears and express how your partner can support you. “Don’t hesitate to express your needs to your partner,” she says. That said, try to have this conversation when you are both rested (at least somewhat rested) and ready to listen to each other.
Adopt a Healthy Timeline
To help ease both emotional and physical strain, Spinelli says to think about a timeline that works for you and share it with your partner. “Make room to hear their feelings and share yours so that you can both create a timeline that feels safe and attuned to how you’re feeling physically and mentally,” she explains.
Consider a Phased-In Approach
Intimacy is about more than just sex. That’s why Spinelli recommends exploring a “one step at a time” or phased-in approach. She suggests starting with some cuddling, and then move to gentle touching, and eventually foreplay and intercourse.
Take It Slow
In addition to taking a phased-in approach, Spinelli also stresses the importance of sharing with your partner that you may experience some pain and will need them to be gentle and take it slow. “Sharing this is not about rejecting them, but about what you are feeling mentally and physically,” she says. Vocalize if it hurts when having sex and if you need to pause.
Explore Ways to Make Yourself Feel Comfortable
Sex after pregnancy and childbirth may look and feel a lot different than it did before this major life event. Positions that used to feel good may now be painful. To help with this, Spinelli suggests exploring new ways to have sex. When you find positions that feel good, make sure to communicate that to your partner. If you’re experiencing tension or anxiety before having sex, she recommends asking your partner for a soothing massage, which can help you feel more relaxed. Consider “outercourse,” including mutual manual stimulation and oral pleasure, instead of intercourse.
Seek Couples or Individual Therapy
Although it may feel like there is no time to schedule professional help, Spinelli says you may find that just a couple of sessions with a therapist can help navigate this often uncomfortable space with your partner or help you to process all of the feelings and emotions which come up after giving birth, including the avoidance of physical intimacy.
A Word From Verywell
Becoming a parent is a major milestone. It’s also a big adjustment as you learn to care for a little one—often putting their needs before your own, all while you’re still recovering from pregnancy and childbirth. Finding ways to connect with your partner, both emotionally and physically may take some time during the postpartum period. Once your doctor has cleared you for having sex, it’s still up to you to decide when you are ready. And, it’s okay if this takes some time. Share your feelings with your partner and ask them to do the same. Use this time to connect emotionally, then learn new ways to connect physically.
