Your Ultimate Guide To Postpartum Sex

Just as you may be looking forward to that first sweet sip of rosé or the familiar (and completely delicious) taste of smoked salmon, you might also be thinking about intimacy with your partner after giving birth.

However, returning to sexual activity after birth is an intimidating thought for a lot of birthers. So, before you jump the gun and get back between the sheets, follow our guide to postpartum sex, in which we will discuss:

• When you can have postpartum sex;

• If pain and bleeding during sex after birth is normal;

• How postpartum sex can differ between types of birth;

• After birth sex drive; and

• Tips on how to ease back into sex postpartum.

So, when can you have postpartum sex?

The time period following childbirth, also known as the fourth trimester, comes with many physical and emotional changes for the birther and partner involved. One component that should be taken into consideration with patience is returning to sexual activity after giving birth. 

The American College of Obstetrics and Gynecology does not have a set timeline recommended to individuals returning to sex postpartum, but most experts recommend waiting at least six weeks postpartum to return to intercourse. A routine doctor visit usually occurs at the six week mark, where the doctor will check for tissue healing, screen for postpartum depression, and discuss unresolved complications. 

However, seeing a pelvic floor therapist six weeks postpartum is the best way to receive a thorough assessment regarding muscle coordination, strength, and tissue integrity for successful return to postpartum sex and other routine activities during the fourth trimester. 

Additional major components of postpartum life that will play a role in the birther’s timeline of returning to sex including pain, fatigue, libido, and stress. All of these components are easily overlooked, and once they rear their head in the adjustment of postpartum life, it can feel debilitating and pose considerable healing challenges for the birther.

Can you have sex 4 weeks postpartum or is that too early?

Tissue healing is unique to the individual. However, the highest risk for infection or injury postpartum is within the first two weeks after delivery. After two weeks postpartum it is possible to engage in sexual activity, but if any pain, bleeding, or unusual symptoms occur then sex should be discontinued and resumed once symptoms are resolved.

Is it normal to bleed after postpartum sex?

Light bleeding and discomfort is normal during postpartum sex if sexual activity occurs prior to six weeks, as scar tissue in the uterus and pelvic floor are still healing. However, heavy bleeding is never normal and can be an indication of unhealed tearing. Following six weeks postpartum, if bleeding or discomfort occurs during sex and has been cleared by a gynecologist, then a pelvic floor therapist should be sought for management and resolution of symptoms.

Is pain during postpartum sex normal?

Pain during sex after giving birth is common but not normal. Sex might feel different, but it should not be painful. There are many tools to help sex be a comfortable and enjoyable experience postpartum. If a birther is breastfeeding their infant, then vaginal dryness is likely to occur due to a drop in estrogen. Lubricant is your best friend in this situation, and please, don’t skimp!

How to make sex less painful after birth.

There are many avenues you can go down to make postpartum sex less painful. Sexual activity does not always have to be penetrative, and there are other ways to arouse yourself or your partner without penetration if you are still healing from giving birth or are not yet comfortable engaging in penetrative sex postpartum. 

Outercourse

If couples are seeking intimacy after birth, other forms of closeness can be practiced whilst healing from birth. Outercourse, or non-penetrative sex, is the act of sexual activity without penetration. This can involve writing love letters, wearing lingerie or revealing clothing, kissing, or engaging in any activity that couples find arousing. 

Internal tissue stretching

Lastly, internal tissue stretching prior to penetrative postpartum sex can be greatly beneficial to prep for a pleasurable experience. This can be done with a dildo, dilators, or use of fingers. Choosing a dildo with less curvature is ideal to start, such as the Prism or the Heart. Make sure to get clearance and guidance from a pelvic floor therapist before using dilators or self-stretching directly postpartum.

Postpartum sex after vaginal delivery vs cesarean section.

You might hear a common statement that “your pelvic floor is spared after a cesarean section”. This is actually not the case, as the uterus sits directly on top of the pelvic floor. While the baby grows and the uterus expands, so does the pelvic floor. So, after 9 months of expansion, the pelvic floor can experience over-stretching or straining of tissue and ligaments before delivery occurs. 

Additionally, scar tissue from the cesarean incision goes through seven layers of tissue before reaching the uterus. Ultimately, this scar tissue shares muscular insertion points with the pelvis and can have effects on sensation and healing in the pelvic floor when it comes to postpartum sex. 

In sum, it is not surprising that a study by Baud et al. found that comparison of pelvic floor dysfunction six years after uncomplicated vaginal versus elective cesarean deliveries found that post cesarean section birthers reporter high rates of genital pain and pain with intercourse by a significant margin.

But don’t let any of this scare you about your postpartum sex life! The good news is that tissue remolds, scar tissue heals, and if things are not healing quickly or optimally down there, a pelvic floor therapist can help.

Anal sex postpartum.

For the same reason your pelvic floor does not go unscathed from a cesarean delivery, neither does your rectum. Hemorrhoids and anal fissures are common occurrences during pregnancy and postpartum, and it is important to take the time to heal for the same six week period that you would vaginally when considering sex after giving birth.

In severe cases, a fistula can occur from prolonged labor or pushing and surgical intervention is required as part of the healing process, which will likely entail an additional month of healing beyond the six week period. Once the birther feels ready to resume anal sex, lubricant should be used generously.

Postpartum sex tips.

We’ve said it more than once and we’ll say it again: the number one rule for sex after birth is to use lubricant. Be generous with its use, not only with postpartum sex but with foreplay, too. Take it slow and allow for extra foreplay time - you won’t regret a longer arousal. 

Most importantly, keep an open mind. You went through a major process of growing and delivering a baby, it is completely normal for things to feel different. Embrace the change and use it to your advantage to explore new sensations and ways to be close with your partner during sex after birth.

Postpartum sex drive.

The postpartum period can feel downright exhausting for most individuals, so sex drive during this time may be different to what it was before giving birth. Go easy on yourself if your postpartum sex drive is not as strong initially as other priorities may take place before your sex life while you are caring for a newborn. 

Remember that this is a temporary time, and your sex life after birth can come back with a roaring desire once your hormones have re-established a rhythm. Estrogen levels are frequently lower in birthers postpartum due to breastfeeding, which requires production of prolactin, a hormone known to suppress estrogen production. Having estrogen in the body increases vaginal lubrication and sexual desire. Once breastfeeding subsides, it is common to notice an increased desire to engage in sexual activity.

If you have any concerns about returning to sex postpartum, use this guide to calm your nerves and guide you through your fourth trimester when returning to intimacy. The great news is that resources are readily available to make your postpartum sex life more comfortable.

Claire is a pelvic floor therapist with a distinct specialty certification in pelvic rehabilitation (PRPC). She is the private clinic owner of Rooted Pelvic Health & Hand Therapy in Sun Valley, Idaho. She treats all gender diversities for pelvic floor-related conditions including sexual dysfunction, gynecological cancer recovery, and chronic pelvic pain. Claire's mission is to improve overall function and quality of life with lasting results for her clients. As a contributing writer to Pepper Together, Claire seeks to provide education about a subject that deserves more attention. She hopes that by spreading the word about pelvic floor conditions she can break the stigma about conversations around sex, and provide simple solutions to improve sexual intimacy.