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Expectations of Sex After Childbirth, According to an OB-GYN

Childbirth takes a toll on the body, and knowing when to return to sexual activity can be challenging. An OB-GYN tells Healthnews how long you should wait, what to expect, and how to reduce discomfort.

Getting pregnant and giving birth is often a beautiful, meaningful experience, but it also takes a serious toll on the body that requires a significant recovery period.

In fact, recent research suggests that pregnancy may actually accelerate biological aging, and many individuals report post-birth complications, including urinary incontinence, low back pain, and pain during or after sex.

The latter symptom, according to a recent study, is the most common, and it can be particularly distressing for those eager to return to regular sexual activity not long after childbirth.

According to OB-GYN Tiffany Pham, M.D., a medical advisor at Flo Health, most medical providers will recommend that you wait to have sex until you have been examined and cleared by a medical provider in your postpartum period, typically around four to six weeks following birth. If you experienced any vaginal or perineal tears during birth that were repaired, she says your medical provider will need to examine that area to ensure that it has healed properly before attempting sex.

Even those who had a c-section will need to be examined around four to six weeks after giving birth to ensure the incisions have healed properly.

“While many people will generally get the ‘go-ahead’ from your medical provider around this time frame, this does not necessarily mean you have to jump straight into it,” Pham tells Healthnews. “There is no specific timeline that you have to follow when it comes to resuming sex after childbirth. You may feel more comfortable waiting for a longer period of time beyond the six weeks — this is entirely up to you to decide for yourself and you should not feel pressured to resume sex before you are ready to do so.”

Is it normal for sex to hurt after giving birth?

While experiencing some pain during or after sex is common, Pham says we should try to avoid normalizing pain with sex following childbirth.

This is because each individual’s experience may be affected by their delivery experience, their medical conditions or complications, whether they are breastfeeding, or if they experienced some type of trauma or tear to the pelvic floor muscles or perineum (the area between the opening of the vagina and the opening of the anus) during birth.

Still, data show that roughly 85% of people may experience some degree of pain with sex during their first sexual encounter following childbirth. One study that looked at the severity of pain with the initial sexual encounter after childbirth found that 14% felt no pain at all, approximately 65% of people experienced a mild to uncomfortable degree of discomfort, 13% of people experienced moderate amounts of pain, and 6% had severely distressing pain.

This research suggests that roughly 40% of people experience some degree of pain or discomfort with sex during the first six months postpartum — pain which decreases with time.

Those who experience pain with sex prior to getting pregnant, or in pregnancy, may have a higher risk of experiencing pain with sex in their postpartum period, she explains.

“This knowledge should help empower people to seek help from their medical provider if they continue to experience pain well into their postpartum period or if they have certain risk factors that may increase their chances of painful intercourse after delivery,” Pham says.

How can you make sex more comfortable after childbirth?

While pain is common, there are ways to make it more comfortable. Pham suggests using vaginal lubricants to help reduce discomfort, especially with penetrative sex.

You can also build up to penetration, starting with other methods such as foreplay, oral sex, masturbation, use of sex toys, role play, and more, she says.

“Communicate with your partner to set expectations or discuss alternatives if penetrative sex may be uncomfortable or painful,” she says.

You may also choose to explore different positions that allow you to be more in control of the degree or depth of penetration, allowing you to choose your own pace and follow your comfort level.

How soon can you get pregnant after giving birth?

It’s important to note that whenever you begin having sex post-childbirth, you can technically get pregnant. As a result, Pham says it’s recommended that you start some form of contraception, whether it be hormonal or non-hormonal, immediately after childbirth.

The research shows that it’s highly inadvisable to get pregnant within six months of delivery due to the higher risk of poor pregnancy outcomes for both mom and baby, she says. Generally, it’s advised for there to be a 12-18 month period between pregnancies.

“That being said, even if you are breastfeeding or pumping, you should not rely on that as an effective method of birth control,” she says. “Using a hormonal or non-hormonal form of contraception is recommended even with breastfeeding to provide more effective birth control during this time frame.”

When it comes to the type of contraception you should choose, this mostly depends on your own health and medical issues.

For example, if you are breastfeeding or pumping, your medical provider may not recommend an estrogen-containing hormonal contraceptive due to the theoretical risk of lowering your breast milk volume. But Pham says more recent data suggests that this impact on breast milk production is not significant, and if using a combined hormonal contraceptive (containing both estrogen and progestin hormones) is beneficial for you in particular, you can still consider this as an option.

Intrauterine devices (IUDs), on the other hand, can be inserted immediately after birth up to 48 hours following delivery. Beyond this time frame, it is recommended that you wait until four to six weeks postpartum to have an IUD inserted.

“This is because the IUD has a higher chance of being expelled from the uterus if it is placed prior to four to six weeks after giving birth,” Pham says.

Progestin-only contraceptive pills or the implant can also be started following delivery.

When it comes to hormonal contraceptives containing both estrogen and progestin, Pham says it’s recommended to wait at least four to six weeks after delivery before starting them.

“Pregnancy and the postpartum period can increase your risk of developing blood clots, and combined hormonal contraceptives containing both estrogen and progestin also have the potential to increase your risk of blood clots,” she says. “Therefore, if you choose this particular method for contraception, it is recommended that you wait for a few weeks after delivery before initiating these medications.”

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