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Sexuality After Pregnancy

Probably the last thing on your mind right now is resuming sexual relations. Many women express the feeling that sex at this time is too painful and too much to cope with. They need to rest, get enough sleep and get back into a routine before they start thinking about sex again.

Resuming sexual relations can be a little difficult. You may be concerned about pain. That's natural. The best thing you can do for yourself is to take it easy and go slowly. Don't have sexual intercourse until you feel ready. Share your feelings and concerns with your partner.

Your sex drive, and that of your partner, can be affected by stress, emotions and fatigue. In fact, there are physical reasons you may not feel like having sex, including your changing estrogen level, which can cause vaginal dryness and irritation. You are probably still bleeding, too. If you had an episiotomy, that may add to your discomfort. And with all the changes your body has gone through, you just may not feel sexy right now. That's OK.

In the past, we advised a woman to wait at least 6 weeks before having intercourse. Today, we tell a woman to let her body be her guide, but 6 weeks is still a good suggestion. You probably won't feel like it anyway until then. If you feel no pain or discomfort and your episiotomy is healed, you can resume sexual relations when you feel up to it. Be sure bleeding has stopped. For most women, this is at least 4 to 6 weeks after delivery. Talk to your partner to make sure he isn't expecting to resume relations with you 1 or 2 weeks after delivery when you're thinking it will be 4 to 6 weeks.

When you do decide to have sex again, you can take some steps to make the experience more enjoyable for both of you. Try the following.

• Be sure you are healed enough to have sexual intercourse. If you aren't sure, call your doctor for advice.
• Use lots of lubricant to relieve vaginal dryness and to avoid irritation from friction (avoid petroleum jelly if you use condoms).
• If you use the woman-on-top position, you can control the amount of penetration.
• Foreplay can add pleasure to your sexual experience.
• Don't focus on your body and the way it looks; if your partner says you're attractive, believe him.
• Remember, there are alternatives to sexual intercourse. Kissing and caressing can be great turn-ons.

When you decide to have intercourse, take precautions if you don't want to get pregnant again immediately. You can become pregnant before you have a menstrual period. Read the section on birth control that follows, and be sure to discuss birth control options with your doctor.

If you used a diaphragm or cervical cap before pregnancy, you need to be refitted after the birth. The size of a woman's cervix often changes after she has a baby, so these devices might not fit correctly or work effectively after baby's birth. Birth Control After Pregnancy
Contraception after the birth of your baby can be important, so you probably want to consider all your options. Most women begin ovulating 6 to 8 weeks after birth if they are not breastfeeding. (Breastfeeding may delay ovulation and menstrual periods for a few months, but you ovulate before you have a period.) If you have unprotected sex when you ovulate, you could get pregnant again.

We know breastfeeding protects you against pregnancy to some degree, but breastfeeding is not an effective method of birth control by itself! If you breastfeed, it's important to consider birth-control methods if you don't want to get pregnant.

If you don't want to have another baby very soon, it's important to discuss birth-control options with your partner and your doctor in the hospital or at your 6-week postpartum checkup.

Contraception if You Breastfeed
Consider using some kind of contraception if you don't want a surprise pregnancy. There are many to choose from, even if you breastfeed. If you want to use a method that doesn't require seeing your doctor to get a prescription or require an in-office procedure, condoms and spermicidal foams and gels are available. However, these methods may not be as reliable as those prescribed by your doctor.

More-reliable contraception choices for a nursing mom include:

• diaphragms
• birth-control pills, called minipills (they contain the hormone progesterone and are safe for a nursing mom and her baby)
• Depo-Provera, a hormone injection given every 3 months
• an IUD (intrauterine device)
• once-a-month birth-control injection
• Norplant, small rods containing a hormone (progesterone) placed in the arm just under the skin

If you don't use some method of contraception while breastfeeding, you're living dangerously. Most women don't have periods while they are nursing during the first 6 months, but that is not always the case. And the longer you nurse, the greater the possibility you could ovulate and get pregnant. It's a mistake to think not having a period means you can't get pregnant!

Contraception if You Bottlefeed
Contraceptive choices for the bottlefeeding mom are the same as those listed above, with one exception. If you bottlefeed, use regular birth-control pills rather than the minipill.

Discuss your options with your physician while you are still in the hospital or at your 6-week postpartum visit. Make your selection after considering all your choices.

You can become pregnant again before you have a menstrual period. Most women begin ovulating 6 to 8 weeks after their baby is born, if they're not breastfeeding. When you have your first period, you have already ovulated!

Putting it all in Perspective
The concerns we've discussed in this article are ones women face each day. Most of them are temporary and won't interfere much with life with your new baby. The key to dealing with something during your recovery period is to relax. Any of these situations is more easily dealt with if you don't add your own stress to it.