Returning To Intimacy After Childbirth

Becoming a parent is full of contradictions: I love my baby, but I’m finding it hard. I’m enjoying nesting, but I miss my old life. I know there are 24 hours a day, but today feels like it’s lasted several decades…

And perhaps one of the most significant contradictions of all is how sex can be both the first and the last thing on your mind first, because you’re fretting about how and when to get your sex life back to normal, and last because – for various reasons – you’ve started to feel as sexy as a damp breast pad.

So, what problems might you face as a new mother worried about a return to intimacy with their partner, and what can you do about them?

Problem: I’m still recovering from a birth injury

Birth can be a joyous, happy and emotionally powerful experience, but it can also mean a slow and painful recovery for many women. Whether you delivered vaginally, by c- section, or had an intervention such as forceps or ventouse, you could be left with minor to severe tears, grazes or skin tags. Not only can this be very painful, but the physical and psychological impact of post-birth trauma, including vaginal and anal incontinence or difficulties passing wind or going to the toilet, can be incredibly profound. One study found that 53 per cent of women who had tears reported a negative impact on their bodies and sex, but this is likely to be much higher.

Our guidance:

Communication with your partner is critical. Share your fears and anxiety around your recovery and have a realistic conversation on how it might impact your intimate life. When you do feel ready, it might help to remember that sex is much more than vaginal sex. ‘Sex’ can be holding hands and kissing passionately or intimately touching each other for a few minutes.

At the right time, post-birth intimacy can be an opportunity to mix it up while your body recovers. You could try gentle foreplay, clitoral stimulation and ‘outercourse’ rather than intercourse. Use a lubricant to make it all a lot smoother and more fun. Sylk or YES are good options as they don’t contain harsh chemicals or substances which can alter bacterial growth or disrupt your vaginal pH.

Problem: I have little to no sex drive

You’re tired, you’re anxious, your oestrogen levels have plummeted, and there are not enough hours in the day. Being deprived of sleep can trigger hormonal changes, which make your libido go AWOL. If you’re breastfeeding, you’ll also be producing a hormone called prolactin, which helps milk production but can dampen desire. It can also dry out your vagina, making this even more tricky. Lastly, some women feel frumpy and functional in their new role as mothers or find the changes in their bodies make them feel self-conscious rather than sexy.

Our guidance:

Get as much rest as possible in the early postnatal period. Work on your sleep rather than sex first. Accept any offers of help from trusted people to help you rest and recover, night or day! Delegate some night feeds to your partner. If you’re breastfeeding exclusively, ask if they can handle the night-time nappy change and winding to give you some extra sleep. And crucially, don’t try to do much. Do you really need to take three buses across town with your buggy to go to an event you don’t even really want to go to?

Put your feet up or go for a local gentle walk with a friend instead, to avoid post-natal burnout and help you regain your mojo. Lastly, treat your body with loving care. Five minutes a day to massage your temples, do some gentle stretching, breath work or meditation can go a long way in helping you rebuild your confidence.

Problem: Sex is painful

Pelvic floor trauma (which occurs in almost 90 per cent of births) can cause women to feel a pulling or dragging feeling around the vagina and/or anus (the perineal area) which can cause pain when emptying your bladder, walking or during sex. If your baby’s birth involved an episiotomy or forceps, you may also have scar tissue which has built up in your vulval or vaginal area.

Our guidance:

Life is too short to put up with pain, and a specialist pelvic health physiotherapist can help. As part of your postnatal check and with your consent, a pelvic health physiotherapist will conduct an internal vaginal examination to assess the type of trauma your muscles have gone through, and tailor your treatments accordingly. This might include gentle manual therapy to release tension on the scar tissue or surrounding areas, manual sensory work, biofeedback, and breath work. These strategies can really help with the initial phases of returning back to sex.

Problem: I’m still recovering from birth trauma

If you’re still processing the psychological fallout of a traumatic birth, the idea of sex can seem frightening. If you do want to start it up again, you might find that anxiety causes your arousal to dip and your pelvic floor muscles to tense up. If sex is painful, then anxiety around it increases, and a vicious circle can ensue.

Our guidance:

Talking to a specialist pelvic health physiotherapist can really help. They are the best-placed health professionals to help you understand your postnatal presentation, will work with you to address any anxieties you have and help regain your confidence. Less time worrying about the unknown = more energy left to focus on your recovery

It can also be helpful to practice penetration on your own, using plenty of lubricant, to see how it feels. We show them how to use dilators, which come in various sizes and materials, and can be used inside and outside the vagina to help you build back up to sex.

If anxiety and pain continue, you might find treatment from a psychosexual councillor to be beneficial, as well as relevant trauma counselling if you can access it.

Problem: My partner and I are not getting on

They say they’re tired but you’re the one up most of the night. You spend hours pumping milk and they chuck it away without thinking. You think they’re living it up at work all day, they think you’re lounging around on the sofa. No wonder you two can’t connect. Research says the quality of a couple’s sex life is at its lowest during the first five years after having children. A sexual expression which was an important part of your identity as a couple might feel lost and gone forever. And you can’t imagine how it might return..

Our guidance:

When your limitless and free-range life has been replaced with the routine tasks and responsibilities that come with parenthood, your spontaneous desire (when you want to rip each other’s clothes off) is understandably reduced. But that’s ok! Even if you’re not ready for sex, you can work on connection. Don’t worry about what other couples are doing and think instead about what’s right for you (post-natal journeys will look different for everyone).

Do you have any time to hang out together and have fun? This is important even in the early days; Could you do something together like a new walking route, or a short, gentle yoga session at home? Offer a massage and get one in return, it might lead to a sleep, or some sex, either way it’s a step in the right direction..

At LETO, we hear all sorts of worries about how new mothers are feeling physically and mentally, and it’s our honour to help them reach a place of physical wellbeing; getting them back to strength and boosting their confidence in the meantime.  

It is essential to address any issues that occur postnatally to facilitate your recovery and prevent problems later in life why we believe a postnatal check with a specialist pelvic health physiotherapist must become the standard of care for all women. You can read about the LETO Postnatal Check here. The Squeezy App is also a great directory you can use to locate a pelvic health physiotherapist near you.