Sexual Intercourse in the Pre/Postnatal Period
Sexual Intercourse in the pre/postnatal period
By Emma Godden
Let's talk about sex.
In particular, sex during pregnancy and after having a baby.
You're certainly not alone if your sex life changes during pregnancy, or if you're feeling nervous about getting back into sexual intercourse after having a baby. After all, you experience a lot of changes during pregnancy, during birth and after giving birth. Hormonal changes, physical changes and emotional/social factors all play a part in how you feel about intercourse during pregnancy and after having a baby.
First, let's talk about how sexuality changes during pregnancy.
When you're pregnant, there is a huge increase in blood flow to the pelvic region (part of the reason many women experience haemorrhoids or vulval varicose veins during pregnancy). For some women, this leads to a heightened libido and more intense orgasms, and for other women they feel more sensitive around the vagina and sex is less enjoyable. Desire and arousal may also change in pregnancy due to nausea, discomfort, pelvic/back pain, perineal heaviness, incontinence, reduced cardiac ability and adjusting to body image. Physiotherapy can help with some of these symptoms.
Then baby comes along and there are a whole lot more changes.
Your oestrogen levels (which are high during pregnancy) plummet as soon as the placenta is delivered, resulting in less blood flow to the pelvic area. This can cause the vaginal walls to become drier, thinner, less elastic and more sensitive, contributing to discomfort with penetration.
Physically, there are a whole lot of changes that your body is adjusting to, and that's without even taking into account the effects of sleep deprivation and exhaustion of looking after a new baby. During a vaginal birth, the pelvic floor muscles stretch up to 2 ½ times their normal length, more than any other muscle in the body. This is amazing, but also means that these muscles need time to recover. You may also have a perineal tear, episiotomy or Caesarean scar which need time to heal.
What can I do in the early days postpartum to help prepare for getting back into having sex?
During the first 4-6 weeks, regardless of whether you had a Caesarean or vaginal birth, try to get as much horizontal rest as possible to allow your tissues to rest
Wearing compression around your abdomen and/or vulva can help your recovery. TPS stocks a range of compression options, such as tubigrip and SRC garments.
If you had a perineal tear or episiotomy, it may help to re-acquaint yourself with your new perineum – look with a mirror, try gentle self-touch and massage along the scar.
If you had a Caesarean birth, doing gentle scar massage can help.
See your physiotherapist when your baby is about 6 weeks old, for a thorough pelvic floor and abdominal muscle assessment
And then when you're feeling ready...
First, remember that intimacy doesn't need to mean penile penetration. Pleasure and intimacy is so much more than penetrative sex. Communicating with your partner about ways to be intimate without having intercourse may help set expectations. Maybe this means some time exploring ''outercourse'' rather than intercourse – kissing, cuddling, massage, touching inner thighs and clitoral stimulation can be arousing and intimate.
It's important to be proactive about preventing pain with penetration. When you are feeling ready to have intercourse, warm up first with some foreplay to ensure good blood flow and optimal lubrication. The brain is a marvellous thing, and it learns to protect the body quickly. So, if the last time you had penetrative intercourse you felt pain, the next time you go to have intercourse the body remembers and anticipates pain and may subconsciously tense up as a means of protection. This makes penetration more difficult, which leads to more pain and exacerbates the cycle. It's likely that you will feel a little drier than usual, particularly if you are breastfeeding, so we always recommend to use a lubricant for the first time. Here at TPS we love Olive & Bee lubricant (but remember that oil-based lubricants and condoms don't go together).
Our physiotherapists can make a detailed assessment of your body and make individual recommendations which may help you achieve pain-free, pleasurable sex
This might involve:
Pelvic floor muscle training (often this includes teaching you how to relax your pelvic floor muscles)
Management of pelvic organ prolapse
Internal release of the pelvic floor muscles
Using a vaginal wand or dilators
Perineal scar massage
Talking to your GP/obstetrician about using vaginal oestrogen