Live embodied physical therapy

A topic thats rarely discussed… So let’s discuss it!

Because it’s a shame that new parents are left in the dark about what to expect when returning to sex and intimacy after pregnancy/birth. I love to provide a safe and open space for my patients to discuss these topics freely. Most people crave this type of support an \d info, so hopefully these tips are helpful!

Just a note before we dive in:
Sex and intimacy looks different for every person/couple. Due to the implications that pregnancy and birth have on your body, we’ll be discussing vaginal penetrative activities/intercourse.

Alright, let’s get to it.

The time frame is different for everyone.

There is no “normal time” to resume intercourse after you’ve had a baby. I hear people express feelings of guilt, that they aren’t getting back to sexual activity within a “normal time.” But the notion of “normal” when it comes to sexual relationships is a fallacy! There is no normal when it comes to this topic!

Technically, you want to wait until your vaginal tissue or cesarean scar is fully healed before getting back to it (usually 4-6 weeks). However, it’s very rare that birthing parents are considering sexual activity before this time. But, if you are interested in engaging, consider waiting until the 4 week mark or after your provider has cleared you, as risk for infection is highest in the first month after birth.

Whether you wait 6 weeks or 6 months, there is no time frame that’s considered normal.

It’s normal to not want it.

Want to know something interesting? After your placenta disconnects from your uterus, a massive hormonal shift happens in your body to stimulate lactation and bonding with your new babe. This shift means your estrogen level plummets, which can cause lots of physical, mental, and emotional changes… one of which is low libido. Another reason why there is no “normal” level of sexual activity after giving birth (or really in any time of life for that matter).

On top of hormonal landscape, other factors like fatigue due to sleep disruptions, postpartum blues/depression, identity shifts and physical changes can make it difficult for you to find your sexual-self again. So give yourself some grace and throw out the guilt. It’s not your fault you aren’t sex crazed… it’s biology. And honestly, it makes sense! Why would your brain want you to make another baby when you just spent a whole lot of energy making and birthing one!

If it helps, there’s evidence that suggests it can take 12-18 months before many birthing parents find sex pleasurable again.

If you’re feeling down due to a lack of sexual spark that you might have once had with your partner, don’t sweat it. There are a million ways to connect with your partner beyond sexy time. Try practicing different forms of intimacy, spending quality time alone, and practicing open communication.

It’s okay to feel nervous… but if you don’t want to engage, then don’t.

If you read the section above, you might understand the barriers to feeling excited for sexual intimacy. Again, it’s normal to have low libido and it’s also very normal to be nervous to get back into it. However, if you are dreading it and do not want to engage, don’t. (This is a good general rule for sex regardless of your situation). If this is how you feel, please be open with your partner and they likely would want to know how you’re feeling!

There are so many ways to show love and physical affection besides intercourse. Find things that make both of you feel loved and cherished. Here are a few examples:

1. Taking a morning or evening walk (with or without baby). Chat about your day, funny memories from the past, things you are excited for in the future.
2. Watch a movie or show that you both love. Hold hands, snuggle, or simply just sit together!
3. Treat yourself to a date. Spending time away from your baby can can feel hard, but spending time alone with your partner is so important. You could go to a local store you both love, a lunch spot you used to frequent, or a romantic restaurant that you’ve celebrated other milestones at.
4. Write a love note, or a note of appreciation.
5. Take baby for a drive while they nap. Grab a coffee or pastry and spend time chatting with your partner.
6. Practice other forms of intimate touch, like a loving hug, shoulder rub, hand holding, etc.
7. Plan something together… whether it’s a big trip for the next year, a small road trip, or a day trip. Taking time to plan a family event can help you feel connected and allow you to both look forward to something!
8. Explore each other’s language (the way in which you feel love and connection.). Here’s a quiz that determines yours. Discuss each of your results and implement daily ways to build your connection!
9. Be creative… I won’t get into dirty details here, but sex is more than just intercourse or penetration. Practicing and exploring other forms sexual activity can feel exciting and fulfilling without going the whole 9 yards. Again, only engage in sexual activity if you feel excited for it. But just know, penetrative intercourse is not the only option.

This list is absolutely not exhaustive! These are just options that can help both parties feel connected and loved. Again, sexual activity/intercourse is not the only option and should be avoided if one party is not wanting it. Remember- if you have low sexual desire, it’s normal for this time in your life!

Practice open communication.

Being open about sex and sexual desires can be very hard. If it’s easy for you, then great! But if it’s hard for you, then here are some tips to help broach the subject:

1. Chat over text message if you have difficulties speaking face-to-face about it.
2. If you aren’t sure about your sexual-self at the moment, that’s okay! Your mind and body has gone through a huge transformation. Start by writing down some of your feelings on sex, things that excite you, etc. Keep it private or show your partner.
3. Talk about your hold ups (if you have them), your feelings towards sexual activity at that moment, and anything you are worried about.
4. Talk to your partner about your ideal sexual experience. This doesn’t have to be a wild and crazy fantasy. Maybe it’s simple like soft music, candles, and a massage to start. Or maybe you are interested in using a new toy.
5. Ask your partner for their feelings and thoughts. Hear what they have to say about your sexual relationship and what they desire. You might be surprised to hear that you’re on the same page more than you realized.

Be sure to chat about these topics prior to engaging in intercourse… but also communicating during, and after! Once you practice open communication about sex, it gets easier and will help you feel connected!

Consider the physical nature of sex/penetration.

If your mind is there and you’re excited to get back to it, awesome! But don’t forget about the physical changes your body has endured.

1. Using good, quality lubricant is a must. Good Clean Love is friendly to postpartum vaginas (I don’t have an incentive to recommend them; I just genuinely like their products). Make sure to re-apply the lube every 5 minutes or as needed… water based lubes can absorb quickly!
2. Be mindful of the effects of lactation… Remember the point above about hormonal shifts? Well, that low estrogen is even more distinctive if your producing milk. In short, prolactin (hormone that stimulates milk production) suppresses the production of estrogen. Low estrogen can cause vaginal dryness and sensitivity. So… again, use lots of lube, try a vaginal moisturizer, or if those don’t work- contact your provider for a prescription for vaginal estrogen cream. Read more about this phenomenon by downloading our freebie on it!
3. If you’ve had stitches to repair a vaginal tear, be mindful of how that can effect intercourse. Sometimes, the scar tissue can get tight and cause pain. If the pain persists, hold off on intercourse and schedule an appointment with a trusted pelvic floor PT. Here is my PT practice if you are a SLC local.
4. If you’ve had a cesarean birth, you also want to consider your healing process. Wait for your incision to heal before engaging in intercourse. Even when it’s healed, it can still cause some issues. Be gentle and mindful of how your scar tissue feel during and after intercourse. If it’s an issue, visiting a pelvic floor PT is the best move!
5. Lastly, be sure to start slow and be gentle. Choose positions that are gentle and allow you to be in more control (side lying, being on top). Starting with rough, fast, deep penetration might not be the best move. This is where open communication is key. Direct your partner’s movements and keep them updated on how you’re feeling.

If you experience significant pain during your first attempt at intercourse… stop. It’s not helpful to continue and can actually cause some more complicated issues if you continue engaging in painful intercourse. Next, visit a pelvic floor PT or contact your provider. Continue engaging in other types of sex as long as they are not painful.

Be mindful of fertility.

This isn’t necessarily my scope of practice as a PT… but I still think it’s important!

You can get pregnant immediately after giving birth… even if your period hasn’t returned or your lactating. If you desire to prevent pregnancy, use a trusted birth control method.

Choosing when/if/how to add another child to your family is a deeply personal decision… so this is just objective information: But… Studies have shown that there are good reasons to wait 12-18 months between your last pregnancy and conception of a subsequent one. This gives your body time to recover and has shown to decrease pregnancy and birth complications.

Give yourself grace. Explore your sexual-self.

Sexuality and understanding your sexual-self is a deep topic. It’s different for everyone and can change considerably in different seasons of life. If you are still struggling to connect with this part of your identity, that’s okay! I often recommend this book when a patient of mine is struggling with connecting to their sexual identity.

If you have complicated feelings on sex and sexuality, you don’t have to face it alone. Seeking help from a postpartum mental health therapist or sex-specialized mental health therapist can be very helpful. Follow the links to find resources and a local provider!

This post is not exhaustive and might not encompass everyone’s experience, but I hope it’s helpful to at least get the conversation and personal thoughts started.

Please save it for later or send it to a friend who might be struggling. We are all doing our best out here. So, throw out the guilt, talk with your partner, and take it one day at a time!

Cheers to bodies doing amazingly difficult, magical things… and figuring out who we are in the aftermath.

Sam