You have your six week followup after giving birth and your provider clears you to return to normal activities. Yes, ALL activities. If your partner is in the room this is the point in the conversation when they may start to involuntarily smile.
Some women are excited and ready to have a deeper level of physical intimacy and connection with their partner again. Do not despair if this is not you as you are definitely not alone. The majority of new moms sex six weeks postpartum brings up feelings other than excitement. There are many reasons why you may not be ready to have sex at the six week postpartum mark and all are completely valid. At the six week postpartum mark, no matter how you delivered, you are still in the process of getting to know your new body, identity, and baby, while also navigating a changing relationship with your partner.
Physical Transformation
You may look in the mirror and not recognize yourself. Your body has changed drastically to accommodate a growing human and then birth that human into the world. There may be stretch marks, diastasis (which causes the lower abdominal “pooch”), excess weight, painful leaking breasts, and cracked nipples. Your pubic bone may have separated (pubic symphysis diastasis) which causes pain and instability in the pelvis. You may have urinary incontinence or (much less frequently) pass gas or stool involuntarily. And then there is the vagina and perineum. If you had a vaginal birth, especially if you experienced tearing or an episiotomy, although technically healed things may still not feel the same. Even after a cesarean birth, especially if you were fully dilated and pushing when you had the surgery, your pelvic floor may still not feel normal.
Any or all of these things may make you experience a complete lack of sexual desire or fear of having sex. You may feel physically recovered but have the need to get to know your new body and embrace yourself before inviting your partner to get to know your body again. I often reassure my patients that even though physically you can have intercourse as far as having healed, physiologically it may be a year before you feel like yourself completely again. Even then it involves acceptance of some things that will not go back to the way they were before because your body performed multiple miracles when you created, nourished, and birthed a new human into the world.
If you had vaginal tearing I recommend doing some perineal massage focusing specifically on the areas where you formed the scar. Massage with a natural oil such as coconut, almond, or olive oil can soften firm and tender scar tissue. This self touch can also help you feel more comfortable prior to your partner subsequently touching you in this sensitive area. Even if you did not experience tearing or had a cesarean birth, getting reacquainted with your own body before your partner does can be helpful both physically and emotionally. I also know that for many women because they had so much pain at first when healing in their mind they think that everything must look horrible and could never possibly be the same. I reassure my patients that the vagina is extremely forgiving and no matter how badly you tore, unless there were extenuating complications, by the six week mark I can barely even notice the scar. Get a mirror and look for yourself. And then be in awe of what you did and how your body was able to recover!
If you had a cesarean birth your scar will still be numb and tingly as if the skin was asleep. This improves over time and sensation will eventually return to normal. However, all of your internal layers are healed at this point and you do not have to worry about penetration damaging anything sunless you had complications and your doctor says you need to wait longer to have sex. Women who have had a cesarean birth, especially if they have had two or more cesarean sections, may notice that they have pain with deep penetration during intercourse or when using toys. This can be related to scar tissue formation inside of the abdomen. If the uterus becomes stuck to the front of your abdomen or other internal organs then when there is pressure on your cervix you can have a pulling, sharp, or aching pain.
Remember that even though you have been cleared for normal activity and do not need to return for an exam for a year you should still reach out to your provider at any point if you have any questions or concerns. If you have abdominal, pelvic, or vaginal pain after your six week visit, or are still having trouble with incontinence, always tell your obstetric provider. It may be helpful to see a pelvic floor physical therapist. These specialists are amazing and can help you strengthen your pelvic floor and desensitize you to pelvic pain. You can also work with a trainer who is certified in postpartum training. They will teach you how to safely strengthen your pelvic floor and your core muscles which have been stretched out to accommodate your baby.
If you are breastfeeding or pumping and are worried about painful or leaking breasts you can wear a bra while being intimate. You will leak milk with touch and orgasm, especially if you are engorged, so unless you want to make breastmilk part of the experience you may feel more comfortable keeping your breasts covered and having the breasts as empty as possible when being intimate with your partner.
Hormonal Changes
You may be getting all of the physical touch and intimacy you need from bonding with your new baby. Since human babies can not care for themselves, evolution encourages moms to care for their babies via a positive biochemical feedback that occurs when you connect with your baby. The more time you spend touching, caring for, and interacting with your baby the more your brain physically changes to reinforce the desire to bond with your baby. This is why some moms do not immediately fall in love with their baby, however the connection and desire to be near the baby grows quickly as more time is spent with the baby.
You also get a release of positive endorphins and love hormones such as oxytocin when you bond with your baby. Skin to skin, feeding, even just smelling or making eye contact with your baby triggers a response and a rush of love. So yes, you will fall in love with your baby and are naturally programmed to want to make them the center of your universe! It is also extremely normal to not crave a physical connection from your partner as you receive touch, intimacy, and a release of love hormones from bonding with your baby.
You also may just feel “touched out”. Your personal space is constantly invaded by the baby and so you may need a little more distance to reclaim your bodily autonomy when not with the baby. The best thing to do is just talk to your partner so they don’t feel disconnected, ignored, or left out of that special new bond you have created with your baby. Let them know you love them and want to spend time with them as a family. Remember that you are a great mom and these transitions are normal when you have an infant at home.
Another important hormonal factor plays into a lack of sex drive post baby. When your estrogen drops substantially postpartum you are physiologically in a state similar to menopause. Low estrogen means decreased sex drive. Your body knows it is not a good time to get pregnant again and you may even have hot flushes like you would when going through menopause. Besides being extremely bothersome and uncomfortable, sweating through your clothes and sheets does put moms in the mood for intimacy.
When the estrogen is low it is important to use a lubricant. It is normal to not show signs of physical arousal such as self lubricating when your estrogen is low. You should not take it personally and neither should your partner. Lack of self lubrication in a woman at any point in life, especially at a time associated with low estrogen, does not equate with a lack of desire. Use a silicone lubricant that is gentle on sensitive skin and does not have any additives that can irritate the vagina. This is important to decrease friction and pain with intercourse.
I always tell my patients that just because they are cleared to return to physical intimacy and sex does not mean that they will want to or should jump right back in. No matter how you delivered, when you do start having sex I always recommend going slow and gently at first to make sure you feel comfortable with any penetration. And do not forget there are many other ways to experience physical and emotional intimacy with your partner other than through penetrative intercourse. As women, our emotions are tied very closely to our ability to become physically aroused and enjoy sex. If you are scared or equate pain with sex it will be even harder the next time and you may recoil from the thought of having sex or even develop physical symptoms such as vaginismus where the muscles of the vagina involuntarily contract in anticipation of pain.
Survival Mode
Having a baby puts the parents into survival mode and initially we release high levels of stress hormones which help us survive the intense transition to being a parent and caring for a newborn. You may be so sleep deprived that sex is the last thing on your mind. Instead of spending time being intimate and re-connecting with your partner the most attractive option is to get a few extra minutes of rest. The postpartum period also puts a lot of stress on your relationship with your partner. When we are in survival mode and sleep deprived we are in a state of fight or flight and often can not even think rationally. If you are lucky, you and your partner formed a strong bond and developed excellent communication skills prior to the baby that help you get through this time with relative ease. Some couples become more united and stronger as they work together to care for the baby. Other couples become disconnected and struggle due to a lack of effective communication strategies necessary to navigate the earth shattering changes that have just occurred in their home and relationship.
There are countless other reasons why you may just not be ready to have sex at the six week postpartum mark, but just know that no matter what you are normal and part of the majority of women that I care for. Do not feel guilty, ashamed, or pressured to have sex. If you and your partner are struggling to connect and function as a new family, or if you feel there may be other factors such as postpartum depression, anxiety, or PTSD affecting you and your relationship, please speak up and ask for help. Therapists, support groups, and your obstetric care team are all so important throughout this transition. I often have moms tell me they do not have the time or energy for these interventions, however if the alternative is struggle, conflict, emotional distress, and feelings of isolation, getting emotional and mental support is the most valuable way you can spend your time and energy.
Please remember that although having a baby is very common and is considered a normal part of life it does not mean that it is not really hard. It involves a lot of new stressors that you personally and as a couple have never previously encountered. Treat yourself with grace. Do not judge yourself or feel guilty if you are not ready to embrace intimacy with your partner when your provider clears you for normal activities. And remember that you are not alone. There is a whole world of other mamas who have been where you are and a multitude of wonderful resources available to you. Take all of the time necessary and get the support you need to develop a healthy relationship with yourself and your partner post baby prior to reigniting your sex life!