When is it safe to have sexual intercourse after childbirth?
Wait until postpartum bleeding (lochia) after childbirth stops—this can take up to 6 weeks after delivery. Some experts recommend waiting four weeks or until your first gynecological visit before resuming sexual intercourse. The reason is that the wound in the uterus, created when the placenta detached, is still healing. If you have sexual intercourse before the bleeding stops, you risk infection (NCT 2012) or further bleeding. If you have stitches (e.g., from a cesarean section, perineal tears, or episiotomy), it’s recommended to wait at least 6 weeks or until the tissue has healed before having sexual intercourse.
Don’t forget about your own feelings—only resume sexual activity when you feel ready, not before.
When after childbirth should you start having sexual intercourse?
Since everyone is different, there is no universal norm or timeframe for when you should be ready for sexual intercourse after childbirth (FSRH 2009). The most important thing is to wait until you are physically and emotionally ready (FSRH 2009).
Research shows that a small number of couples resume sexual intercourse within the first month after childbirth, while about half wait at least six weeks, as do most women who had perineal tears or episiotomies (Woranitat and Taneepanichskul, 2007). The vast majority of couples try sexual intercourse again within three months after childbirth, though some couples wait up to six months (FSRH 2009, McDonald and Brown 2013, Leeman and Rogers, 2012, Lurie et al, 2013).
If you both feel ready for sexual intercourse before your first postpartum checkup around six weeks after childbirth, you can try (Macdonald and Brown 2013). Some doctors suggest trying sexual intercourse before your first postpartum checkup if you both feel ready (based on the criteria mentioned above), so you can describe any issues during the exam—but make sure to use appropriate protection (NICE 2006: 14).
If you’re not ready for sexual intercourse yet, continue with kissing and touching—physical closeness is very important. Try to do this even if you’re tired and overwhelmed with the baby. Returning to sexual intercourse will be less difficult and feel more natural as a result.
In the first four to six weeks after childbirth, vaginal lubrication decreases due to lower estrogen levels in your body (which is why using a water-based lubricant is recommended). Low libido in the first weeks or even months after childbirth is common. In the first six weeks after childbirth, you’ll likely be exhausted, experiencing pain, and possibly feeling overwhelmed. Your body after childbirth needs time to recover.
It’s important to think about contraception when you resume sexual intercourse. Even if you’re still breastfeeding and your period hasn’t returned, you can still get pregnant.
Why don’t I want sexual intercourse after childbirth?
It’s very common for women not to want sexual intercourse for several weeks or even months after childbirth. Here are some reasons, circumstances, and factors that influence this:
– lack of sleep, fatigue, and the demanding new role—you’ve become a mother. If you’re breastfeeding, the hormone prolactin can reduce your desire for sexual intercourse (Lawrence et al, 2012).
– feelings of sadness and postpartum depression reduce the desire for sexual intercourse (Johannes et al, 2009).
– pain and stiffness from perineal tears during childbirth, episiotomy, or stitches (Rådestad et al 2008; Handa, 2006). In these cases, it’s completely normal to need more time before wanting sexual intercourse again. Give your body time to recover—let’s not forget that a cesarean section is a surgical procedure. Stiffness usually subsides relatively quickly, but pain from stitches or perineal tears can last longer. The stitches and surrounding area can be sore for several days or even weeks (Andrews et al. 2008, Macarthur and Macarthur 2004). Let the wound heal before attempting sexual intercourse.
– even if you didn’t have an episiotomy or perineal tears, bruising and increased sensitivity in the perineal area can persist for some time.
– if you had a cesarean section, the tissue will heal by the time the stitches are removed. If you still feel sensitive, try to find positions with your partner that don’t put pressure on the incision site (NCT 2012).
– if you have discomfort in or around your abdomen, you can place a blanket or pillow between you and your partner to avoid direct contact on sensitive areas. In these cases, a sexual position with the woman on top is recommended.
– your perception of your own body may have changed after childbirth. Some women feel that pregnancy and childbirth have changed their body so much that they need more time before feeling like themselves again. Other women perceive the changes pregnancy brought to their body as very positive, while others struggle with them (NCT 2012). All of these feelings are understandable and normal.
– many women worry that they’re no longer attractive to their partner after childbirth, but when they share their concerns, they realize this isn’t the case.
My partner wants sexual intercourse, but I’m not ready. What now?
The most important thing is to talk about it. Share how you feel. If you don’t want sexual intercourse yet but your partner does, he may feel rejected. However, you shouldn’t feel pressured into sexual intercourse just to please him. Sexual intercourse should be a pleasure, not a burden.
Sexual intercourse doesn’t necessarily mean penetration. Stimulation through touch can be very pleasant. In these moments, kind words, acts of tenderness, affection, and expressing emotions are very important. This will help you both prepare for sexual intercourse.
It’s not uncommon for your partner to be unsure whether he wants to have sexual intercourse after witnessing and seeing childbirth. He may be worried about causing you additional pain and may be uncertain about his own feelings. That’s why mutual honesty and conversation are so important.
Tips and self-help strategies for easing sexual intercourse after childbirth
– Start by trying simple forms of intimacy, such as caressing, tenderness, etc., so you gradually get used to sexual touch.
– Take it slowly. Enjoy each other’s bodies, don’t skip foreplay, and don’t rush into expectations about penetration.
– If you’re worried, tense, or concerned that it will hurt, you won’t become aroused (Brauer et al, 2007). As a result, sexual intercourse can be painful because your vagina won’t be adequately lubricated and relaxed.
– Try using a lubricant if your perineal area is still sensitive, as this affects comfort during sexual intercourse. Don’t use oil-based lubricants if you’re using condoms, as this can cause the condom to leak. Applying lubricant will also help with vaginal dryness, which is common if you’re breastfeeding (NCT 2012).
– Don’t rush. Sexual intercourse should happen “naturally”—you should both feel ready and aroused. Try positions that don’t put pressure on your sensitive areas. A sexual position with the woman on top is recommended, as this allows you to control the speed and depth of penetration.
– if you’re overly sensitive or sexual intercourse is uncomfortable, ask your partner to pause for a few moments.
– if fatigue is a major issue, try having sexual intercourse when the baby is sleeping. The baby will usually wake up at the most “inconvenient” time, but take it with a smile and wait for the next opportunity. Be patient—it will get easier once the baby starts sleeping through the night.
– it’s recommended to do pelvic floor exercises, as this restores vaginal muscle tone, which will also increase pleasure during sexual intercourse (Citak et al 2010).
– eat natural, quality food, drink plenty of fluids, and rest whenever you can. Caring for a baby is demanding and requires a lot of energy. This means you’ll also need to take care of yourself.
Problems with sexual intercourse after childbirth
When sexual intercourse after childbirth is painful, especially in later stages and despite a gentle and careful approach, talk to your doctor or gynecologist. The way a perineal tear or episiotomy is stitched can sometimes cause prolonged discomfort, which may require additional surgical intervention.
Vaginal discharge with an unpleasant odor may indicate an infection that requires medical attention. If after four weeks you’re still losing blood from your vagina or notice a sudden increase in blood loss, consult your doctor (NICE 2006: 9).
It’s important to seek help as soon as possible. Talk to your doctor, who can then refer you for a specialist examination. Sometimes something as simple as a conversation is enough, without needing further treatment (Lawrence et al, 2012)
If you’re not ready for sexual intercourse after childbirth, take your time. You need it to physically and emotionally adjust to the demands of caring for a baby, and sexual intercourse should happen spontaneously, when you’re ready and want it. Over time, sexual intercourse will be as it was before your baby came into the world.
