Nervous about sex after baby? The first time after pregnancy can be just as good as it was before. And if not, here are tips to manage the pain and help you feel better!
Sex is probably the last thing on a woman’s mind after giving birth. After pushing a baby the size of a watermelon out of your vagina, it’s difficult to picture anything ever going near that area again.
At some point in the postpartum period, perhaps when you are not dead tired from staying up all night with a newborn, sex may be on the table again. To ease your mind regarding what to expect when you have sex for the first time after giving birth, we consult Dr. Whitney Sippl, a Board Certified Women’s Clinical Specialist and Doctor of Physical Therapy. She helps answer the most common questions women have about intercourse after pregnancy and what to do if you have discomfort.
How Soon can I have Sex After Giving Birth?
Couples are usually told to wait 4-6 weeks after delivery before having sex, but it’s important for you to get the clearance from your healthcare provider before attempting. Whether you have a vaginal delivery or a C-section, you need to wait until your body is completely healed before intercourse.
Chances are, you are probably not up to having sex before the recommended 4-6 week, especially if you are breastfeeding. Postpartum triggers oxytocin as the new mom bonds and nurses her baby, and as a result, her estrogen levels become very low.
Hence, new moms may experience low libido and vaginal dryness, which makes intercourse undesirable. We will talk about how to address vaginal dryness below.
What will Sex Feel Like After Giving Birth?
For some people, sex is exactly the same after the baby as it was before.
For others, sex is better. For those who have had pain or tightness during sex pre-baby, giving birth may have eliminated their pain. Some people have better orgasms postpartum due to physical changes that their bodies went through during childbirth.
And for others, sex is worse. Some people now have pain with sex that wasn’t there before, or climax isn’t as easy or as good as it used to be.
How can we make Postpartum Sex Less Painful?
The first few attempts at intercourse post-baby may be uncomfortable, but it shouldn’t be painful or uncomfortable for long. If it is painful, then there are 3 main factors that could contribute to this:
Vaginal dryness is normal after having a baby and for some people, it can last for as long as they are producing milk and up to 3 months after they have stopped.
You can never have too much lubricant after having a baby, so if vaginal dryness is the issue, lube up and try to fit in a little extra foreplay. If you still have pain and you are using lube, then it could be one or both of the following issues.
Tight pelvic floor muscles:
Tight pelvic floor muscles can happen after vaginal birth or cesarean birth. After a vaginal birth, the muscles can reflexively contract and “guard” after being under an extreme stretch during birth. After a cesarean birth, the muscles around the pelvis, including the pelvic floor, can go into a spasm or a protective guarding mechanism after the trauma of surgery in the area.
We need to relax the tight muscles in order to fix the painful intercourse that is stemming from this. To do that, we can:
- Do manual trigger point release to the pelvic floor muscles (like what I do for my patients and then I teach them or their partners how to do it too)
- Use vaginal dilators (the “medical dildos” that are like the Russian dolls increasing in size) to help stretch your pelvic floor muscles.
- Do relaxation exercises for the pelvic floor (the opposite of kegels, so imagine the sit bones spreading apart, marble dropping, flower blooming, etc.) to retrain the muscles down to a normal resting tone.
Perineal scar tissue:
If you have had an episiotomy or any degree of tearing, there is scar tissue at the site of the tear. Scar tissue can become restricted or adhered and can cause pain. Treatment for this is manual mobilization or massaging of the scar tissue.
Feeling Loose After Having a Baby
Some people do feel loose after having a baby and they should also ideally be evaluated by a pelvic floor physical therapist.
Sometimes it is true that their muscles are weak and lax and we need to do strengthening exercises (like Kegels) to regain the tone.
Sometimes instead of necessarily saying they feel loose, some moms will complain that they feel “open”. They may have vaginal gaping where the vaginal opening is held open a bit. This can be due to scar tissue that is restricted and holding them open, muscles that are too tight and holding them open, or weakness and laxity of the muscles. In this case, I wouldn’t recommend doing Kegels until we know for sure that there isn’t any scar tissue or muscle tightness that is causing this sensation.
How do you do Kegel Exercises?
Your pelvic floor muscles may be weakened and stretched after a vaginal delivery. Kegel exercises can help strengthen and tone the muscles. It may be difficult to perform Kegel exercises right after delivery, so do what you can and work your way up.
- Gently tighten your pelvic floor muscles (imagine you are grasping and lifting a marble up with your muscles). Hold tight for 3-5 seconds.
- Relax the muscles.
- Repeat steps #1-2 five times to complete one set.
- Do 3 sets a day and repeat daily.
You can use the Elvie Trainer to strengthen and gain awareness of your pelvic floor muscles. It measures the force of your pelvic floor when you do a Kegel to ensure that you are doing the exercises correctly. The app also guides you through Kegel exercises with fun workout “games” and keeps track your progress and results.
Loss of Sensation After Birth
Decreased sensation after birth can be a bit tricky. Sometimes there could be nerve damage that can slowly regenerate to improve sensation again. Some people could have decreased sensation because the muscles are weak and lax (and therefore Kegels can help to improve sensation). Sometimes the hormonal changes can affect sensation along with the potential that mom might not be all that into sex for a while after baby (decreased libido), which can also affect sensation.
What if I can’t Climax After Giving Birth?
Some women might experience difficulty achieving orgasm postpartum. Here are some things that can help address the inability to climax postpartum:
You can split the pelvic floor into 3 different areas for Kegels:
Once you’ve mastered how to do a Kegel, you can target different areas of the pelvic floor to enhance awareness and control:
- Start with nodding the clitoris (contract the muscles to make the clitoris tip down and “nod”), close the vaginal opening, and then anal wink
- Anal wink, close vaginal opening, nod clitoris
- Anal wink, nod the clitoris, close vaginal opening
You can also play around with the force of the Kegel:
- Elevator Kegels: squeeze pelvic floor muscles slightly (to 1st floor), then squeeze a little harder (to 2nd floor), then squeeze as hard as you can (to 3rd floor), relax a little (to 2nd floor), relax a little more (to 1st floor), then fully relax, hold each squeeze for 2 seconds.
- Vaginal weights: these are small weights that you can insert like a tampon and walk around for 5-10 minutes with them in to gain endurance and strength of the pelvic floor.
Practice Kegels in different positions:
- Leaning back, leaning forward, leaning to the sides
- Leaning forward is a great position to start targeting the front muscles that stimulate the clitoris
- Try Kegels in different sex positions
Incorporate Kegels into sex by timing Kegels to see what feels best:
- Relax the muscles during penetration and Kegel as it comes out
- Or try the opposite by squeezing during penetration (like you’re pulling it deeper) and relaxing with movement out
Real Moms’ Experiences with Sex Postpartum
What is sex after birth really like? We asked moms to share their experiences with us.
I had pain with sex after I had my daughter and I was already a pelvic PT that treated this all the time, so I was surprised. I didn’t have any perineal tearing or trauma and had a very easy birth, so you wouldn’t necessarily expect that sex would be painful, but my muscles ended up tensing after birth without me realizing it until we tried sex and it was impossible.
Luckily for me, I knew exactly what was going on and how to treat it so I could do the manual pelvic floor work on myself, use the dilators, and do the pelvic floor relaxation exercises throughout the day to retrain my muscles to a normal tone and get back to pain-free sex.
For me, the first time having sex after giving birth was a mix of excitement and fear. Not nervousness, but actual fear of pain. I’d had an undisclosed number of stitches for many 2nd degree tears just 6 weeks earlier! At the same time, I missed that connection with my husband and was eager to resume our healthy sex life.
We decided the gentlest way to approach it was to use lube and go slow. I was the one in control so I could make sure to go at my own pace and not do anything that hurts. In the end, we were both surprised at how good (no, awesome) it was. It felt so good to temporarily forget about having a newborn and just be in the moment with my husband, enjoying each other.
My first birth was rough, as I imagine most first births are. I tore in several places, (that I didn’t know were possible to tear in,) and healing took a long time. I had my check-up at 8 weeks and even though the doctor gave me the go-ahead, I was not ready.
After 10 weeks, we attempted to have sex. As far as the thought of it, I imagined the worse and had myself so worked up about the potential pain. It wasn’t as bad as I thought it would be, although fairly uncomfortable. I cried due to the stress I had already built up about it, but the point is we made it through that first time! Each time after that was a little less uncomfortable.
After a second birth, (of twins,) I was much less afraid to get over that “first time” as I knew most of it was in my head.
I couldn’t even do it the first time! I made sure to have lots of foreplay and lube, but it was so freaking painful! It was like shoving a loonie in a slot that’s made for quarters. I made him go super slow into me, but the pain would flare up more and more the farther he went so finally I had to make him stop. It took several attempts like this to finally have sex. My gyno then explained to me that it is caused by all the granulated scar tissue caused by birth and all that happens down there!
It was awkward, staged, and I wanted to get into the act, but couldn’t.
My husband and I scheduled during the
We managed to get intimate, but couldn’t have sex. There was a mental block for us. I mean, the baby was RIGHT THERE! We stopped making out when we realized neither one of us wanted to move the intimacy along to the next step. “I’m sorry. She’s just right there. I can’t get into it.” His heartfelt apology was unnecessary. I was in the same place. We agreed to try again at another time.
The next night, we placed a visual barricade between us and the sleeping baby. I couldn’t focus. My mind was split between paying attention to him and paying attention to the baby. We finished and didn’t think to try again for a few more weeks in our own place.
To speak the truth, I was very apprehensive about having sex after my vaginal delivery. We couldn’t do it till the baby was 2 months old, because my hubby wanted me to be ready, both physically and mentally.
And when it did happen, we did it like first timers, very gently and carefully. It was truly discovering each other anew.
I couldn’t tolerate my hubby’s smell when I was pregnant, and suddenly he started smelling all delicious!!
Physically, I had a hard time getting aroused, and the foreplay kept going in and on because I did not “feel” ready. Mentally, I had to keep warding off thoughts of the baby waking up and crying, and whether he likes my changed body.
After making love my hubby said that he did not feel the pleasurable pressure as before, the vagina had enlarged so much. For me, everything else was just the same, except a minor tear at the episiotomy site.