The Postpartum Sex Issue We Need To Talk About

My Ob/Gyn has a great head of hair for a man his age, I remember thinking as I looked down between my legs, my feet in the stirrups at my six-week postpartum checkup. Random things go through your head when your breasts are swollen and leaky, you haven’t slept much, and even though your sweet little twin babies are on the outside of your body now, you’re still not exactly sure where they end and you begin. The doctor stood up and pressed gently on my C-section scar, a discreet six inches that would be hidden by my bikini bottom, I was told. “Things are looking fine,” he said, snapping off his gloves and speaking to my face instead of my labia. “You’re good to go for intercourse. Just make sure you use birth control.”

My first thought was, “Are you fucking kidding me?” And my second thought was, “You’re kidding me, right?” But I didn’t say that. Instead, I snorted and kind of zombie-nodded, and got dressed. It took everything I had just to get my clothes back on and make my way back home to my little kiddos, whose basic physical needs for sustenance, sleep, and warmth mirrored my own. The idea of having any kind of sex was as remote to me as, well, ever wearing a bikini again.

In my case, it wasn’t only that I hadn’t slept more than 2.5 hours in a row since they made their debut, or that I was all “touched out,” as it’s called when you’re nursing or cuddling a little one all day and just can’t have another person near your body. It was that my pregnancy hadn’t been blissful and glowy, with me serenely pondering the miracle of life while enjoying the pregnancy cravings my foetuses inspired. I’d had unrelenting morning sickness, heartburn, and anxiety, the latter of which continued long after they were born. My experience of pregnancy (not to scare you!) was that an occupying force was in control of my body. Once I had it back, I simply wasn’t ready to share my body with anyone whose life didn’t depend on it. And my husband’s life certainly didn’t depend on it.

Still, I remember feeling vaguely guilty and loserish after my Ob/Gyn gave me the thumbs-up for intercourse. My vagina was up for the challenge, but the rest of me sure wasn’t. Should I be? I wondered.

There are so many “shoulds” surrounding new motherhood, and like many first-timers, I measured myself against those ideals. I should feel that breastfeeding was a transcendent experience (it was fine); I should instinctively know what my baby wants (there weren’t many possibilities, and I still blew it sometimes); and I should instantly feel this unshakable bond of love that would give me the strength to lift cars off my children should the situation call for it (the love was there, for sure, but any strength I had I used to lug my breast pump to work when I went back). Was not being up for intimacy on the doctor-approved timetable just another way I was falling short in this new role I chose for myself?

It wasn’t, but I had no way of knowing that my reaction to the thought of intercourse six weeks after delivery was much more the norm than I imagined. How could I have? My mum friends and I discussed baby poop colour and the challenges of pumping milk in an open workspace, not sex. As for my doctor, he was focused on what was between my legs, and not between my ears. In my new mum haze, I didn’t quite process that he was issuing a physical all-clear for vaginal intercourse — not a recommendation that I hop to it.

The truth is, despite the fact that the six-week mark is when doctors generally give the go-ahead for postpartum sex, many, if not most, women* seem to feel as I did about getting back into it at the time of their postpartum checkup. In an ongoing study in Ireland, which has the same six-week checkup recommendation as we have in the U.S., women were asked three months after delivery if they’d resumed some form of sexual activity, and 22% still hadn’t. A good chunk had given it a go at five to eight weeks (47%), citing reasons such as “wanting to check if everything still worked” and “because I knew he wanted to have sex,” according to Deirdre O’Malley, the clinical midwife and PhD candidate conducting the research — not necessarily because they had a sexual itch they needed to scratch.

Some women I spoke to reported that it was much, much longer until they had intercourse again, and experts say that’s common. “Maybe it isn’t until a year or a year-plus that some women are really feeling ready,” says Jennifer Conti, MD, an Ob/Gyn and clinical assistant professor at Stanford University. “It’s a huge change your body goes through.” It might be safe to have intercourse at six weeks, she says, but your body may not be asking for it or any kind of sexual contact (never mind your brain). “There are also a lot of emotional factors that go into readiness, and it’s different for every single woman,” Dr. Conti says.

Let me back up for a sec. For all of you non-mums (and mums who didn’t give birth), here’s the deal with the four- to six-week post-delivery exam: If you haven’t had any other issues since giving birth, this is the next time you see your Ob/Gyn. The doctor does a comprehensive physical, including a pelvic exam, to make sure your nether regions are healing properly from any birth-related trauma. If you had a Caesarian, as I did, the doctor will make sure your scar isn’t infected, and you can discuss any abdominal discomfort or other symptoms, such as incontinence or pelvic pain. You can also ask questions you may have about breastfeeding, exercise, and if you’ll ever play the violin again. Then you’ll get the a-okay for intercourse, if you are in fact a-okay. If you’re not already on birth control, you’ll discuss that, too, because yes, you can ovulate very soon after giving birth, even if you’re nursing.

“In general, the traditional six-week rule for sex after vaginal delivery is more about safety and healing, and not so much about when a woman will or should feel ready to have sex,” Dr. Conti says. Your Ob/Gyn is looking to see that any tearing of the vaginal or perineum is healed, that your cervix has closed back up (that usually happens quickly), and that your uterus has shrunk back down to size, she says. “The six-week recommendation is to decrease the risk of infection.”

Here’s what your six-week appointment will probably not look like: you and your Ob/Gyn kicking back on giant beanbag chairs, enjoying a mug of herbal tea and having a long, nuanced chat about your emotional well-being, your relationship with your partner, your new role as a parent, and how that might affect your desire to have sex. You also probably won’t talk about any concerns about your vagina being stretched out, or worries about whether your partner will still even want to have intercourse after recording the miraculous event on his iPhone. You probably won’t hear that some of your go-to sexual positions won’t feel like they used to or might even hurt, or that the stress of having a newborn may make you despise the guy who knocked you up (if you were impregnated by a male partner, that is).

There are loads of reasons why these conversations are not likely to take place. “Those visits tend to be short, and those [deeper] discussions take a lot of time,” says Hilda Hutcherson, MD, professor of obstetrics and gynaecology at Columbia University College of Physicians and Surgeons. Plus, “many physicians don’t feel comfortable with discussions about sex,” and many women don’t feel comfortable bringing it up, she says. Dr. Conti says that doctors aren’t given much training in medical school around issues of sexuality, particularly women’s sexuality. “What we know about it is still sort of surfacing — it’s only been over the last couple of decades that we are truly coming to understand female sexuality,” she says.

The result is that many new mums leave that six-week visit with only a vague idea of what to expect sexually — and feeling as if resuming sexual activity is another item on their new mum to-do list.

That was the case with Chris (names and identifying details have been changed for privacy), a mum in Madison, WI, who had her first baby by C-section at 27. She had intercourse again when her son was around 7 weeks old. “I felt pressure — not from my husband, but I felt like I was supposed to,” she says. “Some of my friends said they were so excited to be having sex again that part of me probably felt, well, what’s wrong with me that I’m not excited?” Chris says her desire was almost zero, sex hurt a lot at first, and she had to wear a bra. “Or else milk would squirt all over him. He was not into that, although I’m sure there’s a market for it,” she says. She did enjoy the feeling of closeness with her husband that came with having intercourse, though, so they consciously pursued intimacy. With lots of lube and practice, things felt physically normal after around eight months. (With her second child, a vaginal delivery, it took about a year for her to feel into it again.)

Part of the pressure Chris felt, she says, had to do with the “body after baby” cultural craziness we’re all bombarded with. “The media plays up the models and actresses who have a baby, and two weeks later are looking like sexpots,” Dr. Hutcherson says. “So the average woman is thinking two weeks later she should be looking like that, projecting that sexuality, and feeling sexy — that she should want to be jumping [her partner’s] bones.”

While some women are up for bones-jumping earlier than six weeks (15%, according to the aforementioned study), “I had four children and it never happened that way for me,” Dr. Hutcherson says. “The last thing on my mind was having sex.” Still, on top of being exhausted from taking care of a baby, maybe not being physically your old self, and getting used to this new role of mum, women have to deal with this pressure, too. “They see these images and feel they have to be that way, or there is something wrong with them, and their male counterpart is feeling the same way — that they should be coming around. Women are getting squeezed from all sides,” Dr. Hutcherson says.

This expectation, that we’re supposed to snap back into pre-partum modes of sexuality right away, squares perfectly with the having-it-all myth: Women need to be the ideal mums, available to our bosses 24/7 during our maternity leaves (if we even have them), and actively want to put a penis or something else in the exact spot where we just pushed out a baby — all while we’ve got a few other things to think about.

While none of the women I spoke with said that their partners directly pressured them, some had internalised the “I should want to more” feeling, because they didn’t want to disappoint them. Janette, 30, who has been with her wife Amy since they were in high school together and whose youngest child is 6 months old, says Amy missed sex a lot more than she did — which may have had a little something to do with the fact that Janette had done all the heavy lifting. She’d either been pregnant or nursing their two young children for three straight years, working freelance all the while. “Amy would joke about it, but she’d say, ‘Okay, isn’t it time to go see the doctor yet?’” Janette, of Charlottesville, VA, says, adding there were a lot of winks and nudges and unsolicited “you-look-beautiful-todays,” which Janette experienced as hints. “I was like, ‘Aren’t you a woman? Aren’t you supposed to be better than this?’ Amy was being self-mocking, but she was definitely ready.”

Janette, however, was not, and when they have sex now — less frequently than Amy would like, but more often than Janette would prefer — it’s because Janette wants to keep that part of her marriage intact. “It’s not unpleasurable in the moment, but it’s not what I’d choose to be doing on a particular Tuesday night,” she says. Plus, “My quota of physical touching is always being met by kids who are like koalas on my body,” she says. “I have to consciously remember to touch her, too! I’m trying to drop some breadcrumbs so we can find a path back to each other in that way once they are older.”

Taryn, a mum of two from Atlanta, says she had compromise sex for some of the same reasons. “We had a lot of conversations about it,” Taryn says. She had her first of two babies vaginally at 27, three years ago, and she didn’t get her good-to-go at six weeks, because she’d had minor tearing and a polyp had formed on her stitches. That had to be treated, so it was more than four months before any vaginal action was even safe, and then she had what Dr. Conti calls “sandpaper vagina” (which is vaginal dryness, and it’s common in breastfeeding mums for hormonal reasons). Taryn also had some scar tissue, which added to the discomfort.

“For my husband, sex is a big part of how he expresses his love, so I’d say, ‘It’s not that I don’t love you, but right now my body isn’t telling me that I need this,’” she says. He got it intellectually, but he still felt a bit rejected. When they finally did have intercourse again at around five months, “It was definitely a use-a-lot-of-lube-suffer-through-it kind of thing,” she said. “It was kind of painful — it is fun to be close to your partner and to have intimacy, but no, it’s not fun to do that.” When she stopped nursing at around a year, and her cycle returned to normal (and her daughter started sleeping through the night), her desire came back and sex was good again.

While Taryn says she didn’t actively want to have sex like before, she did miss being the kind of person who did. “I felt like, why can’t it just be fun again? Why is it so hard?” she says. Other women say they have sex around the six-week mark, sometimes before they feel a physical urge, because they don’t want to surrender the sexual part of their identity. “It was kind of like, We should do this,” says Caitlin, 30, who had a relatively easy pregnancy and delivery, and initiated sex as soon as her doctor said it was okay. “For some women, maternal identity is something they crave and want, but I never felt that way,” she says. “I can’t talk to you all day about kids, so for me, I think it was to reassert that I had an identity that is not just ‘mum.’”

Part of it, too, was that Caitlin wondered if what she felt — or rather, didn’t feel, as her desire was at zero — was normal. “I had one colleague who was like, ‘I was so horny after I gave birth!’ and I was like, What the hell could she possibly be talking about? But you benchmark yourself against other people’s stories, and that was one more data point. Of course, we’re all different,” she says.

The desire to know that sex would once again be fun, comfortable, and even spontaneous is another reason some women have it “even though they don’t feel ready physically or emotionally,” says Alison Huang, MD, an associate professor of medicine at the Women’s Health Clinical Research Centre at the University of California, San Francisco. “They may be anxious to reassure themselves that their sexual function will go back to what it once was.” Dr. Huang is the co-author of a study that found that, long-term, the number of children you have (after you’ve already had one) does not have a substantial impact on sexual function. Dr. Conti knows a woman for whom it took 18 months for her desire to return, and the fact that it was taking so long added to the stress she felt. “Women need to take their time,” she says. “Sexuality is such a complex thing.”

Clearly, understanding that there is no “normal” time to get back into sex after having a baby would go a long way in helping women feel good about their choices, their bodies, and their relationships, and the six-week doctor visit is one place that conversation can happen. “All medical schools have been having discussions about increasing the training and education of medical students about sex and sexuality,” Dr. Hutcherson says. She believes that the discussion about sex and sexuality should happen before people leave the hospital with their baby, in part to manage the expectations of both the new mum and her partner.

Ideally, the partner comes to the six-week checkup, as well as all of the preceding Ob/Gyn appointments, so they can understand what her body is going through (and has been through), and how her hormones are more geared to nursing than more procreating, which results in a temporarily depressed sex drive. “One of the main reasons we desire sex is to make a baby,” says Carol Rinkleib Ellison, PhD, a psychologist and author of Women’s Sexualities. “It’s perfectly normal not to desire sex because you’re not in the making-babies business right now.” (Of course, if doctors aren’t having more nuanced conversations with their patients about sexual desire, and women aren’t able to advocate for themselves in front of both their doctor and partner, having the partner present when a woman’s Ob/Gyn gives her the all-clear for sex may not be the best way to reduce the pressure she might feel.)

Caitlin says that if women were more open with one another about not just sex after delivery, but the whole experience of pregnancy and childbirth, that would have helped her. “Only one friend was like, ‘It’s going to be really awful afterwards — it’s going to get exponentially better, but it will take three weeks for you to feel like you can take a poop and not want to die,’” she says. “Our culture is so focused on birth and then infant care that we don’t talk much about what you feel like immediately postpartum.”

Having the couple on the same page about what to expect is also helpful, especially if communication between the parents isn’t the greatest. Dr. Conti says that patients sometimes come to her at six weeks and say that they’re not ready for sex but their partners are. “I have had women asking me to write a letter saying that she’s not able to have sex for two more weeks,” she says. After making sure that there’s no sexual coercion involved, she’ll do it. “It may not be medically indicated at that point, but for whatever reason, they don’t feel their partners will believe them. If I can give her whatever extra tools she needs to feel comfortable to take the extra time to prepare to return to sex, I’m fine to be the scapegoat.”

But more than convincing your partner, the most important thing, Dr. Rinkleib Ellison says, is to know within yourself that there’s nothing wrong with taking your time. “There’s this idea that somehow there’s a sexual ideal — we want to do so well in so many things that we want to ‘do well’ in sex, too,” she says. Lifting that pressure, she says, “has to do with acceptance of oneself and how you truly feel and what you truly want.” Rather than gritting your teeth and tolerating intercourse that’s uncomfortable, she and Dr. Hutcherson suggest finding some other way to be intimate, one that ideally brings your partner some joy and lets them know you still care about them, and brings you some sense of closeness, if that’s what you want. “Sex isn’t about intercourse. The real success lives in expressing loving feelings through your sexuality,” Dr. Rinkleib Ellison says.

The bottom line? “Take your time. I think there’s power in giving women permission and making sure they hear that,” Dr. Conti says.