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Patient perspective: Moms have sex too

Five things I wish my provider had told me about postpartum sex.

by Jena Crable

published 05/07/21

This Mother’s Day I’m celebrating being a mom by leaving my kids with my husband and getting a couple’s massage with my best friend, who just become a new mom. While we discussed our lady date, she told me she was medically cleared for sex. I asked her, “But what did your provider say that means?” Nope, she had no idea.

My husband and I attempted to have penetrative, vaginal sex somewhere between six and eight weeks postpartum after my first baby, when my C-section stitches felt healed and I had been medically “cleared.” I never labored with that breech baby, so I assumed my medical clearance was about my stitches; I wasn’t given any clear guidance about postpartum sex to disabuse this idea. I was paying attention to my incision and was instead overwhelmed by the searing pain that came from my vagina. I couldn’t understand what was causing it and I literally screamed. We called off the whole attempt while I sat sobbing, wondering what was happening and if whatever it was would last forever. I worried that something had moved out of place from my pregnancy or had been cut and sewn together incorrectly during my C-section. I was afraid, thinking this incredible pain was my new normal. I had to learn on my own what it was – my vagina had temporarily become the Sahara Desert from my postpartum, lactating hormones. Afterwards I confirmed this with friends who had discovered the same thing in the same unfortunate way. Here’s what I wish I had known about postpartum sex:

1. Postpartum hormones will override sexy fun time hormones. This means two noticeable changes brought on by low estrogen: a lack of interest in sex (though honestly, I didn’t blame my hormones when I was so tired all the time) and VERY significant vaginal dryness. This is the time to invest in and utilize whatever kind of lube you prefer for your sexual activities. While lactating means lower estrogen levels, even if you’re not nursing in the early postpartum days those changing, crashing hormones can create very painful vaginal dryness. What would have been AMAZING is if my provider had just handed me some lube samples, explained that I might need it and why. This would have prepared me mentally and normalized using lube.

2. Do some self-exploration before you resume sexual activities. Before you involve a partner, it can be helpful to have some “me time” to see what does or doesn’t feel good to you: does penetration feel good, or are there sensitive spots you want to avoid? I had some hard spots from stiches in my perineum after my second baby was born by VBAC. I thought I was ready that round –I knew that my vagina would be dry and that I needed time to ease into my body – but I still wasn’t told to do some reconnaissance to see what moved around during healing and how this would feel during sex. This hard spot meant some creativity in positions, and wondering again: is this a change that will this last forever?

3. Postpartum boobs are different! Postpartum nipples can be VERY sensitive. This is a double-edged situation, and you’ll need to figure out if that sensitivity means greenlight to sexual stimulation or if they’re only a food source and can’t be touched. Also, it’s true, your boobs can leak milk during sex. This one was a stranger adjustment, as it started with an association between feeding my baby, sex, and seeing my milk that I needed time to undo. Milk release during sex or with orgasm makes sense: oxytocin is also one of the two hormones involved in lactation. To minimize leaking, you can pump a bit, or just throw down a towel to catch the leaks.

4. Take your time. A postpartum body looks and feels different than both a pregnancy and pre-baby body, and I needed time to see this body as a sexy body, with skin that felt like mine. The physical differences and changes from carrying and birthing a human, however they exit, are real too. As hard as it is, try to allow some extra time for sex. I needed more time to get my head in the game to have sex, to get into the swing of sex while it was underway and to orgasm, as I needed more and/or different positioning and stimulation (and back to point one, LUBE!). I think this was a mix of being so tired I wanted to be sleeping and not sexing, my hormones also saying no thank you to sex, and physical changes to my body from pregnancy. Getting used to a postpartum body as a sexual body is about both emotional comfort and physical healing, and this is a place for grace.

5. If something doesn’t feel right or isn’t enjoyable, there is a solution. I started leaking urine after my first baby when I sneezed, even though I had a C-section. I didn’t address it, even when it was more pronounced after my second baby, hearing from older women that peeing and sneezing go together like peanut butter and jelly after a couple of births. This isn’t true! Pelvic floor issues can show up with leaking, or with things not quite feeling right during sex, or a mix of both. During sex, you may notice: pain or discomfort where it wasn’t before; realizing it takes more or different stimulation to have an orgasm; or as in my case, feeling like I was going to pee myself during sex (which is a terrible feeling, and makes it hard to get in the game when I’m worrying the whole time that I’ll start peeing). This is treatable, and if I had known to look out for the signs during sex as well, I may have addressed it sooner. There’s a level of acceptance I have for peeing my pants a bit when I laugh that I don’t have for not being able to enjoy myself during sex.

These things could have been addressed by my otherwise excellent care team. Just knowing what to expect and prepare for would have made a big difference in my sex life, and my mental health, which was tenuous in the first year after each baby. I could have adjusted faster, spent less time worrying, and sought a pelvic floor physical therapist much sooner.

This Mother’s Day, if you’re wondering what to get a new mom in your life, just help her out and get her a starter pack of lube. She’ll thank you later.

Self-reflection questions:

  • In my practice, what do I consider when someone is “medically cleared” to have sex? Physical health? Mental health and readiness for partnered sex? Birth control? Others?
  • What guidance do I give about what to expect when returning to sex? Do I talk to postpartum patients about sexual pleasure?
  • Do I find myself defending the providers in this article? Do I see myself in these providers?
Jena Crable is a working mother of three young children in Washington, DC. Using her desire to do work that has a positive social impact as her guide and always wanting a challenge, she has specialized in fields including direct advocacy, communications, and campaigns. Most recently she followed her heart into postpartum support, lactation care, and babywearing. If you're looking for her, check the playgrounds of Northwest DC for the mom double fisting coffee while chasing kids, or stealing a minute to herself in Rock Creek Park.
read more about:patient perspective,Sexual Health,postpartum
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