We meet many women who have recently had a baby who admit to feeling daunted by the idea of return to sexual activity. This can be the case regardless of whether you have had a vaginal or caesarean delivery. Hopefully this Blog will help you to realise that firstly you are not alone. Secondly, there are multiple factors at play and thirdly, there are things you can do to help yourself. If you feel that there is an issue, we want you to know that it is O.K to seek help.
We also want to acknowledge that things have changed for partners too! Partners want and need to understand these changes to help make sense of why sex may seem quite different for a while.
Let’s think about the issues:
Fatigue: We all know that new parents have normal sleep patterns disturbed. For some this may go on for some time. Exhaustion by the end of the day is real. It’s a simple fact that exhaustion and sex don’t go well together. When extremely tired, it is understandable that all we want to do is sleep!
Body image: Bodies have changed and weight may have changed. The area around vaginal entrance has changed; tummy muscles might feel non-existent; a caesarean scar might feel vulnerable. Where some women may feel great about the amazing changes and amazing task this body has done, others might not be so happy for a while…
Breast feeding: Women may now feel that this area that was sexual is now not very sexual at all as she meets the breast feeding needs of her baby. Although breasts usually increase in size, for some this is good, for others not so good. For some partners, breast changes might be arousing . But for some women, breasts have become a “no go” areas for sexual activity.
Vagina now feels loose: The pelvic floor and associated nerves and tissues stretch massively with a delivery, and they recover over time. This stretch is not matched anywhere else in the body (how amazing are women’s bodies??) But the result is, that for a while, everything in this area feels different. Sensation might be different and orgasm sensation might change.
Stitches and wound recovery: For those that have had bruising, swelling, painful stitches, or an episiotomy scar, there may be fear around recovery of the area. Women just feel worried that there will be pain or that healing might be disturbed. An abdominal caesarean scar may be sensitive or uncomfortable.
Hormonal changes:
Hormone changes do affect libido. We are hormonally set to have decreased desire for sex after the delivery of a baby. We think that nature actually did this to prevent another pregnancy too quickly….long before contraception was invented! Sex therapists explain that libido lessens so that a woman can focus one hundred percent on the baby and therefore be there to protect that baby from harm. So there are deep hormonal and instinctive reasons why sex drive diminishes after the birth.
Decreased oestrogen:
Whilst a woman is not having periods, her oestrogen levels are low and this can affect not only libido, but vaginal lubrication and sexual response. Vaginal dryness, once acknowledged, can be eased with appropriate lubricants. Vaginal oestrogen cream can be prescribed via your G.P. or pregnancy care provider.
Pelvic Pain:
Some women do return to sex and do experience discomfort or pain. This may be because the problem was there before. If pain was there before, it will not necessarily be fixed by a vaginal delivery and we would urge these women to seek help. Others may have new pain at the vaginal entrance, or deeper within vagina, or anywhere in the pelvis which affects sexual activity. Factors might be:
- scar tissue which is sensitive whether vaginal or caesarean scar
- pelvic floor muscles have become tense due to pelvic pain in pregnancy
- pelvic floor muscles are tense due to fear of bladder leakage
- pelvic floor is tense just through anxiety and fear of pain
- vaginal dryness due to hormonal change causes discomfort
- decreased arousal decreases lubrication response and hence discomfort
The most important message is that sex should not be painful or uncomfortable. If concerned, seek help.
What can I do to help myself?
Communication:
All of these issues need to be acknowledged and shared if possible with your partner. Partners are also experiencing the rollercoaster of change with arrival of a new baby: communication is a key.
For a while sex may well be very different, things that feel good may have changed and certain areas of the body might be “no go” for a while. Discuss this with your partner. Other areas might feel great. Work with what feels good.
Flexibility:
Have an open mind about sexual activity that doesn’t involve penetration so that you are keeping the intimacy in your relationship. Many will gain pleasure from simple massage to tired muscles rather than more direct sexual practice as before.
Remember also, that sex therapists will remind any of us that it is very normal, at any stage of life, not to feel like initiating sex. But if you agree to engage in some activity, arousal feeling may then follow. Following the birth of a new baby, partners may need to understand that sex may be quite different for a while for all the factors described here.
Timing:
Schedule time perhaps earlier in the day when the baby is sleeping. This becomes more difficult with older siblings but planning may be the key otherwise time may pass and suddenly you realise that intimacy has disappeared from your relationship. On the other hand, with a new baby and older siblings, look for those opportunities and moments and if sex crosses your mind, at least let your partner know!
Vaginal oestrogen creams:
Regarding hormonal change, we have already mentioned that you can safely use vaginal oestrogen after a delivery if the vagina is dry and uncomfortable. You will need to see a Doctor about this. The Doctor will give you a prescription if appropriate.
Relaxation:
If muscles are tense causing discomfort, you need to learn how to relax them. We can teach you. Usually the whole body needs relaxing too. Bring your partner to a session so you can learn what to do together.
Lubricants:
Lubricants may well be essential for a while. There are many available so to help you make a choice. Remember too that natural oils like almond oil or olive oil can be used. (A clear olive oil can be purchased from some pharmacies. It is called “olive oil B.P”.) Oil is great for massage, can double up as vaginal lubricant and its edible! Lubricants fall into 3 categories: oil based, water based and silicone. Look at what the ingredients are. How many additives and chemicals are there? If you like oil you can try oils as mentioned above. It is usually advised that oil based don’t work well with condoms. Water based are just that: lubricants made from thickened water. Depending on the product used to thicken, some are thinner, some are thicker, some are stickier: it takes time to find one that suits. Water based lubricants will after time dissipate on the skin and unless your own lubrication kicks in, you may notice that you need to keep re-applying. Silicone is a natural product that forms a lubricant liquid that does not dissipate into the skin so it provides the lubrication effect over a longer period of time. It can therefore be useful for intimate massage, as can the oils.
Pelvic Floor Exercise:
Pelvic floor exercise does improve muscles strength and tone. There is plenty of evidence that sexual response is improved with better pelvic floor strength. It may take time to get back to where you were before the delivery but it is vital to get this right and it will improve sexual sensation.
So if you are feeling alone….you’re not alone. Everything can be explained and solutions can be found. Make contact with Caroline Bender through this website or via caroline@pelvichealth.com.au
