If you’ve recently given birth, the words ‘postpartum sex’ can seem like an oxymoron. First of all, if you’re recovering from a Cesarean birth or perineal tear, you need time — not just to heal but to build confidence that sex or even touching that part of your body isn’t going to hurt. If you’re breast/chestfeeding, your body is intentionally limiting your production of estrogen, the main female hormone that supports sexual function. And then there are relationship factors to consider, like whether staring at your partner snoozing peacefully while you nurse in the middle of the night is filling you with libido-killing resentment.
Really, it makes perfect sense that 2 out of 3 new mothers report having low sexual desire and struggle to get aroused or have an orgasm. The question is: What, if anything, should you do about it? For answers, we turned to Origin PT Dr. Ashley Rawlins and Certified Sexual Health Educator Cindy Luquin, founder of Howl at the Womb.
First of all, why don’t we talk about postpartum sex more often?
Cindy: In many cultures and communities, talking about sex at all is still taboo. Talking about sex in relation to motherhood is even more taboo. We have this idea that reproduction and sexuality have to be completely separate and there can be shame attached to that. The Madonna/Whore dichotomy is often at the root of this sexual shame that conditions society to not address the sexual needs during motherhood especially for people with multiple marginalized identities (based on race/ethnicity, identity, age, etc.) This dichotomy assumes either sexual purity or amorality. However, you are a sexual being, and that doesn’t change because you are pregnant, postpartum, or in menopause. We need to talk more about this issue!
Ashley: There is so much confusion surrounding everything in the postpartum period, including your body and sex. You may know that you aren’t ready for sex, or maybe you tried and it hurt, but you’re not sure why or how to talk about it. Speaking with your healthcare provider should be a good place to start. Unfortunately, while 63% of OBGYNs report asking about sexual activities, less than half follow up with more questions, when a patient tells them about a problem. This is largely due to short visits that focus on healing and birth control options. The good news is that pelvic floor physical therapists are here for you — we will happily spend an entire discussing postpartum sex.
How do you know when it’s medically safe to have sex postpartum?
Ashley: Typically, your first postpartum visit with your healthcare provider is around the 6-week mark. Unless there were any complications with your healing, you will likely be given an “all clear” to resume normal activity, including sex with your partner. As a pelvic physical therapist, and a mom of 2, this 6-week “all clear” is a hard pill to swallow. SO MUCH is not back to normal by this point, both physically and emotionally. Full healing in the postpartum takes time, so if your body and your mind are telling you to hold off on sex, then that’s the right thing to do for you.
Why is low libido so common postpartum, and is it really something we need to fix?
Cindy: It is not a health problem to have low libido after childbirth. Especially if you are breastfeeding, you’re going to have a low sex drive because of elevated levels of prolactin. During breastfeeding prolactin is released creating a hormonal ripple effect in suppressing estrogen that is needed for ovulation and increases sex drive during the fertile window of the menstrual cycle. Estrogen is the hormone responsible that helps regulate your sexual response cycle — in other words, it gets your engine going. When estrogen is low, it’s going to lower your libido. This is a natural hormonal response.
Ashley: I completely agree. Having a baby changes us physically, emotionally, and it significantly affects our personal relationships. None of that needs ‘fixing.’ It’s more about discovering and acknowledging what’s changed and deciding what you need and want to feel good, from day to day and week to week. I think that what most everyone needs during this time is patience, understanding, education and a plan for self care. Depending on your goals and needs during this time, there are many modifiable factors that contribute to your sex drive, and creating a game plan with a trusted healthcare professional to address them is totally realistic.
What does it mean to be ‘touched out’?
Cindy: When your baby has been on you all day and night, you may have had all the physical closeness with another being that you can handle for that day. You just need to be you, alone, without touch. That’s being ‘touched out.’ And if your partner tries to be close to you when you’re feeling this way, it’s normal to have a very negative response, which can leave your partner feeling rejected. Communication is the answer. Explaining this phenomenon to your partner and letting them know when you’re feeling that way will help them understand that it’s not about your feelings for them. You just need space.
What should you do if you try to have postpartum sex and it hurts?
Ashley: It’s not uncommon! During pregnancy, the muscles, nerves, and connective tissues of your pelvic floor can become overworked as they support your baby for 10 months. And if you have a vaginal birth, they have to stretch to several times their normal length to accommodate a baby’s head. While your pelvic floor is absolutely up for these tasks, it does have its limits, and injury is not uncommon. Even after healing, your muscles may be tight, strained, or have scar tissue which can make postpartum sex uncomfortable or even impossible, due to pain. That’s when you need a pelvic physical therapist on your side. Your PT will examine all of the muscles and connective tissues that may be contributing to your symptoms, and find the right exercises, manual therapy techniques, tools, and resources that you need to get back to enjoying sex.
What if some penetration feels ok, but deep penetration is uncomfortable?
Ashley: If your physician examined you and gave you the green light for safely returning to sex, a number of other things could be causing pain with deeper penetration. With lower estrogen, your natural ability to produce lubrication is limited, so pain may be a result of thinner vaginal tissues, and less lubricated than usual. Pain or discomfort may also be a result of deeper scar tissue, muscle tension, change in the position of your pelvic organs, or insufficient arousal. During arousal, your vagina will actually lengthen and the uterus will raise, but if all the other factors are leaving you less aroused, deeper penetration can be uncomfortable. Communication with your partner is key, so change positions or stop if you’re having pain. There are helpful products available too such as the Ohnut, which can comfortably modify the depth of penetration. Whatever the cause, it’s always a good idea to check in with your OBGYN or pelvic health PT if your pain is sticking around, because it doesn’t have to stay this way.
How can we stay in touch with our sexuality even if we have low libido postpartum?
Cindy: Instead of looking at it as a negative or from a deficit mindset, see this as an opportunity to be true to yourself. There will be many times in life when what you want in terms of sexual pleasure will shift — getting to a place of peace with that and deciding what you do want is a very powerful thing. Sex doesn’t have to involve intercourse. This is a time to explore new sensations, while being very clear about what isn’t going to work for you. Sex toys, outercourse, masturbation could be possible options to explore. As the person who carried and birthed a child, you are the one in charge. Getting clear about your own sexual desires will improve your overall sexual health with you are having practicing solo or partnered sex. Being able to communicate with a partner, “I want to have fun and feel good with you, but there are some ways I don’t want to be touched” is truly powerful.
What if you don’t like the way your vulva looks postpartum?
Cindy: We have this idea that our vulva is supposed to look a certain way because of the media and beauty standards — and that our bodies aren’t supposed to transform over time. But every part of your body looks different from everyone else's and time changes everything. Your vulva is no exception. It’s one of a kind. It really only has one job to do, and that’s to help you feel good. Exploring with different sensations and types of sexual play to discover what makes your vulva feel amazing will help you develop a new relationship with it. A relationship that is positive and pleasurable.
Beyond setting boundaries and communicating with your partner, what can you do to make sure postpartum sex feels fantastic?
Ashley: If you weren’t using lubes before, they’re about to become your new best friend. Low estrogen during the postpartum period can leave the skin in your vagina and vulva dry — as in Sahara Desert dry. Estrogen also helps keep the blood flowing to your clitoris. Without adequate blood flow, you may have less sensation. This will all improve over time as your hormone levels go back to normal. Until then, there’s lube! There are so many good lube options out there, but keep your vagina happy by avoiding using any with heavy scents, flavors, anything that heats up, or anything that has ingredients like parabens or glycerins. Here’s a fun guide to help you choose!
Cindy: Yes, lube is going to be your best friend! Lubrication will heighten sensation. The feeling of wetness of your vulva is incredibly sensual and it makes things smoother and more pleasurable for you and your partner. I also encourage you to take time to use lube and other sex toys like a vibrator on your own to discover what is feeling good for you. That way you can tell your partner ahead of time what you want them to do or avoid doing. This conversation, where you set boundaries, is very important. You can say “I’m not ready for the kind of sex we used to have, but I’ll let you know what I am ready for.” Communicating effectively is going to help you have a thriving sex life postpartum. It’s how you strengthen your relationship and create safety for your body.