Redefining Intimacy: Six Tips for Sex After Birth
Dr. Margaret Archer, PT, DPT, shares six tips for returning to intimacy and sex after birth for postpartum women and couples from her perspective as a pelvic floor physical therapist. From lubricants to lactation support, there is nothing about postpartum sex considered TMI here!
Returning to sex and intimacy after having a baby is an area many women may feel scared or nervous. You may be concerned about pain, how it will feel, or you may have no desire and wonder if your libido will ever return. “Sex after birth” has continued to be a topic that many postpartum women have questions regarding, and there are often conflicting, vague or dismissive answers provided by healthcare professionals and Google searches. (Yes, as moms, we all know that we tend to “Google” these types of questions while soothing a fussy baby at 2 a.m.! 🤣)
As a pelvic floor physical therapist and mom myself, there is no such thing as TMI in my practice, and we are going to talk about both relational and practical tips today for rekindling intimacy and planning for postpartum sex.
While an important question for sure - “When can I have sex after birth?” - this common query does not even begin to touch all the questions that I know many new moms have or the intimacy issues that many struggle with after having a baby. But, don’t worry. Let’s get past that six-week postpartum visit and the oh-so-important medical “clearance” to what really matters: HOW and WHEN will your sex life feel satisfying again?
Six Tips for Sex After Birth
While you might want to breeze past some of these tips for postpartum sex, I would encourage you to pause and read through them all. After birth, your body IS different, as is your heart. You may find that you are meeting a new version of yourself in more ways than one after birth, and integrating all of those changes might just be part of your intimacy journey.
So, without further ado:
1. Redefine Intimacy and Sex During the Postpartum Period
First, we must recognize that sex and intimacy are not the same thing, and that intimacy can mean many different things to women in different seasons of life. Intimacy could be holding hands with your spouse while going on a walk with the kids, a passionate kiss shared on a date night, or it could be scheduling sex during naptime even if you never “scheduled” sex before.
And, remember, you and your partner can be intimate…without engaging in penetrative sex, and that’s OKAY if that is what you need.
We also must recognize that what intimacy means will likely evolve over different life stages and in different seasons. This is completely normal and expected! What women desire when it comes to sex and intimacy can be unique and evolving during the early postpartum journey and will usually continue to evolve over the course of each of our motherhood journeys.
During the postpartum period (and especially in the first year or so after birth) women often experience hormone fluctuations, bodily changes, and stressors of various kinds that can impact desire, arousal, and enjoyment. These stressors include but are not limited to:
sleep deprivation
birth trauma
professional and personal role changes and/or identity crisis
family dynamic shifts
feeding and health complications with baby
postpartum mood disorders
So, perhaps, PAUSE right now and allow yourself to journal or process through in whatever way you find helpful about what “intimacy” means to you. This reflection process might spark (quite literally 😉) your ability to communicate about AND then experience intimacy with your partner after having a baby.
2. Communicate Clearly, Honestly and Vulnerably With Your Partner
Now that you have given yourself the opportunity to pause and reflect on what intimacy means to you right now, the next step before jumping into the physical aspects of postpartum sex is to have clear, honest, and vulnerable conversations with your partner about expectations and desires. These conversations are meant to be two-way streets (before anyone is between the sheets!), as it is not just new moms that have questions about postpartum sex - partners often do as well!
Discuss how you both are feeling and what your desired outcomes are when it comes to returning to sex and intimacy. While these discussions might be more complex if you have never had these conversations together about intimacy, communication about sex after birth is crucial to your relationship especially in the postpartum season. It’s easy for all of us as new parents to get lost in communication just about the baby or other life stressors: “Where are the bottle lids?” “Have you set up childcare for that school holiday when daycare is closed?” “How are we handling night feedings?”
But, when considering when and how you want to return to sex after birth, prioritize open conversation with your partner about sex and intimacy, and recognize that your desires and your partner’s desires will change over time, so continued communication and intentionality are necessary!
3. Receive Medical Clearance Before Returning to Sex After Birth
This is perhaps the step that we all hear the most about, but that doesn’t mean that we can bypass it. It is vital to be cleared by your medical provider before postpartum sex. You want to ensure that if you have any sutures either from vaginal tearing or if you had a C-section birth, that your doctor or midwife indicates that you have appropriate wound closure and healing.
However, even once cleared, you do not need to immediately jump into bed after your postpartum appointment (unless you want to!). Many moms would benefit from a pelvic floor evaluation and then therapy appointments to support pelvic floor muscles and weakened core muscles that were strained by pregnancy and birth. While not always a normal part of perinatal women’s health care in the United States, many other countries consider pelvic floor therapy a routine part of postpartum medical care.
If you think that you might need pelvic floor PT support, then discuss your concerns with your healthcare team. Many insurance providers even cover pelvic floor rehabilitation, so make sure to research your options and coverage.
4. Keep a Lubricant Readily Available for Postpartum Sex
Yes, I am going there today! Let’s talk about lube.
Whether you gave birth vaginally or via a C-section (or “belly birth” as some midwives refer to cesarean section), you may experience changes to your pelvic floor and its function during the postpartum season. It is common for women to experience vaginal dryness in the months/years after giving birth, especially if lactating. (The lower estrogen levels required for milk production can exacerbate vaginal dryness plus other hormonal shifts.)
Because of this, you will likely want to have a lubricant that you enjoy utilizing during foreplay and penetrative intercourse. Somatic Sex Educator and Doula Kiana Reeves noted in her interview with The EveryMom that, “Postpartum sex is a sexual league of it’s own….If and when you’re ready to start engaging in sex again postpartum…the extra moisturizing and comforting effects of silicone or oil-based lubes can be nice starting points.”
For Lube Suggestions:
Read The EveryMom’s full article for more product details and reviews of some of their recommended lubricants for TTC, pregnancy, and postpartum sex.
5. Consider Wearing a Bra If You Are Concerned About a Milk Let Down
If you are lactating, you may want to consider wearing a bra to allow for increased support of your breasts, and/or you may want to use additional nursing pads as some women get a milk let down during orgasm. (Don’t be surprised or concerned if you are a first time parent and this happens! Milk let down during sex/intimacy is a normal physical response for many lactating women and nothing to be worried about. A bra or nursing pads are only tools if they make you feel more comfortable - not necessities.)
Nursing bras have come a long way in comfort and style, and you will feel sexiest in whatever makes you feel comfortable - whether that is an oversized t-shirt or lacy bralette! If you are looking for a place to start, this article by The Mom Edit is a great place to start!
If engorgement or breast tenderness are issues, then it might be helpful to nurse or pump prior if your breasts are full. You may also want to try new/different positions during sex that put less pressure on your breasts if they are particularly sensitive.
Lastly, early on, for some women their breasts are tender and may need to just be “off limits” for intimacy at the time. Make sure that if your breasts or any other areas of your body are “off limits” for intimacy that you communicate that with your partner. Again, all back to communication!
6. Seek Support If You Experience Pain During Postpartum Sex
Finally, if you are experiencing pain with sex and intimacy, please know that you are not alone. 10-20% of U.S. women experience pain with sex, but while pain is common, it is not normal. You do not have to live with painful sex.
We encourage you to seek collaborative care from an inter-disciplinary team, which could include medical providers, mental health providers and pelvic floor therapists to help address the root causes of your pain and help you get to the sex life that you are wanting!
The Center for Postpartum Family Health offers counseling and support for new mothers and their families, including sex therapy and postpartum mental wellness support. Reach out to our client care team to schedule a consult with one of our licensed therapists today.
Dr. Margaret Archer, PT, DPT & Arrow Physio
Dr. Margaret graduated from Medical University of South Carolina in Charleston, SC in 2013 and has been practicing physical therapy in the Houston area since. She worked in neurologic rehabilitation for 8 years and became passionate about the pelvic PT prior to and during her pregnancy and postpartum journey.
In her free time, Dr. Margaret enjoys time spent with her husband, son and dog. She loves to travel and is always up for a hike in the woods or exploring a reef while scuba diving. She loves to exercise and enjoys fitness classes! She is very active in her church and with her husband, enjoys hosting people in their home!
Arrow Physio Approach
Arrow Physio provides concierge pelvic floor physical therapy services in the Greater Houston area. Dr. Margaret knows as a working mom that services and prioritizing time to do so is challenging. Because of that, she does home visits and virtual visits! She treats a wide range of conditions from pelvic/hip/back pain, pain with intercourse, bladder/bowel dysfunction, core weakness and helping support women through pregnancy and postpartum.
Dr. Margaret believes that physical therapy is not just about treating injuries, but about empowering her clients to take control of their own health and well-being. She prioritizes education and takes fitness forward in her treatment to help her clients achieve long-term results. She wants to partner with you to reach your goals and help you be unstoppable.
You can reach Dr. Margaret at margaret@arrow-physio.com
Additional article source: Hill DA, Taylor CA. Dyspareunia in Women. Am Fam Physician. 2021 May 15;103(10):597-604. PMID: 33983001.