I, for one, was totally unprepared for the strange and sometimes alarming but benign grunting noises that came from my little one, all night long. And as much as I braced myself for stretch marks and a deflated postpartum belly, that first warm shower after giving birth was a bit of a shock. (I’ll never forget reaching down to wash and yelling in shock and awe at the swollen, stitched-up sight that reminded me of a balloon animal.)
Something else I was not anticipating: all of the issues that came along with postpartum sex.
Most of us have heard that you can have sex again roughly four to six weeks after childbirth. But you may not know where that advice stems from.
Traditionally, new parents in the U.S. have a comprehensive postpartum checkup around four to six weeks (but possibly sooner) after delivery, where the doctor will check whether the cervix has closed, examine vaginal tears and/or the C-section incision, check to see whether any areas that required stitches are healing properly, and examine the breasts. You also typically discuss birth control options and pregnancy spacing for parents who may want more biological children, as March of Dimes explains.
At a four- or six-week checkup, you may be cleared to have intercourse again. The cervix generally doesn’t close fully for around six weeks, so up until that point, there’s the risk of introducing bacteria into the uterus and ending up with an infection, Pari Ghodsi, M.D., a board-certified ob/gyn based in Los Angeles, tells SELF. In addition, stitches to repair vaginal tears could open up, and, if you had a C-section, “pressure of someone on top of you could lead to uterine rupture,” Dr. Ghodsi says. So, waiting this long to have penetrative sex helps to ensure you don’t experience these complications.
But it’s important to note that the postpartum checkup isn’t necessarily for the purpose of assessing sexual readiness, Sofia Jawed-Wessel, Ph.D., assistant professor in the School of Health and Kinesiology at the University of Nebraska-Omaha who studies the sexual health of women and couples as they transition into parenthood, tells SELF. “It is a follow-up appointment after a person’s body has experienced significant physical and hormonal changes,” she says. “A woman was pregnant and now she is not, and it is important for her medical team to see how she is doing after a vaginal or cesarean birth.”
Just because most people are cleared for sex by six weeks, that doesn’t mean that you should start having sex again, that it’s the norm, or that it’s even going to be enjoyable at first.
After giving birth to my first child, I got the go-ahead to have sex again at my six-week appointment. My body was still recovering from pregnancy and birth, and I was tired and sore, but I had this feeling that if six weeks was generally when people were doing it, it made sense for me and my partner to give it a shot. So we tried. Then, as I cringed in discomfort and pain, I was convinced that we would never try again.
The reality is that at six weeks (or even way later) post-birth, it may not go well, regardless of whether you had a vaginal delivery or a C-section, says Jawed-Wessel.
She explains that the cervix can remain sensitive even after it has returned to its typical dilation. Vaginal tears and abrasions may be healed and stitches may have dissolved, but the tear sites are usually still tender or sore, she adds, and fresh scar tissue can have difficulty stretching.
It also takes time for the body to adjust to hormonal changes after pregnancy, especially while breastfeeding, Dr. Ghodsi says. These hormone changes mainly affect lubrication and should be temporary, she explains, but dryness can last as long as you breastfeed.
So, ultimately, while some women may be surprised or bothered if and when the first few times are painful, that’s very normal, Dr. Ghodsi says. She’s “not recommending that new moms go through a lot of pain,” but she says it can actually be helpful to try to work through it if it’s tolerable, using a water-based lubricant, in order to help scar tissues stretch and ultimately make sex more comfortable again.
But even though on some level I understood that sex at six weeks was (of course) not a requirement by any means, why did that six-week mark still feel like it came with some amount of pressure or weightiness attached to it?
When I spoke with other new moms about this, I heard a lot of variations on the same theme: Some felt this pressure to be intimate again as soon as possible, but their bodies or minds weren’t quite there yet.
For Rosie, sex was painful even with lubricant, she tells SELF. “It wasn’t until about 11 months [postpartum] that all the pain finally disappeared, and now I wish I’d asked more questions and looked into physical therapy, as 11 months was a really long time to endure painful sex,” she says. “I would definitely approach recovery differently next time around if I had similar issues.”
Physical pain and discomfort aren’t the only factors that impact postpartum sex. New moms can have “fatigue, anxiety about penetration, and overall just need time to adjust to the new family member,” Jawed-Wessel says. “I think that we as a culture expect new parents to get right back into their pre-pregnancy routines, but there is no going back—a completely new routine must be figured out, and that routine is likely going to change from month to month when a newborn is changing so rapidly.”
I personally recall not being in the mood most of the time after both of my kids were born because I was exhausted, distracted by postpartum OCD, and spent so much time breastfeeding, rocking, and comforting my baby that additional physical contact wasn’t a priority for me.
This isn’t necessarily a bad thing, it’s just a new norm. “Life is just different now and it takes time to adapt to these changes,” Jawed-Wessel says. “When you throw in other common challenges like postpartum anxiety and postpartum depression, all of this can be quite a challenge, and sex is likely not a priority and that’s ok.”
The importance of having a considerate partner can’t be understated either. Cultural expectations can add to the pressure to have sex after birth, along with assumptions around how often “normal” couples have sex. But that pressure can also come from an eager partner, and that can be a tough situation even if they’re kind and supportive, let alone situations involving inconsiderate partners. “I think if partners of new mothers had a better understanding of what to expect and what was typical, many new mothers would feel less pressure to bounce back,” Jawed-Wessel says.
My spouse was supportive, as were partners of other moms I spoke with, but not everyone is so fortunate. So the six-week mark can cause added strife. Mary*, who describes her partner as coming off as impatient waiting to get back into their sex life, tells SELF that she felt as if she gave into pressure. “It was awful,” she says.
She recounts having “lost” herself in trying to be what she was supposed to be, due to her marriage being in a tough spot and her husband’s professional difficulties. Leading up to sex after baby, she didn’t want to say no, but she ended up having a panic attack. She wishes that she knew at the time that enthusiastic consent is as important as the go-ahead from an M.D. There’s a “great deal of pressure on women to be sexual, and this whole time frame guideline and physical go-ahead puts even more pressure on,” Mary says.
In cases like these, it doesn’t hurt to have an ally, someone who can help walk both you and your partner through the challenges of postpartum sex and explain how a mother might be feeling physically and emotionally even beyond six weeks—a doctor, nurse, doula, or family member who has been through it. “My midwife sat me down at my six-week [appointment] and said, ‘Tell your husband that he does not have the green light for anything, that it’s super common to have zero sex drive while breastfeeding, and if he has any issues with that he can talk to me,’” Emily, who says her husband had a hard time waiting, tells SELF. “I could have cried, I was so relieved to have someone on my side.”
Communication can go a long way between couples with a new baby when it comes to, well, everything—and it’s no different with sex.
“Both partners need to be open with each other about their fears, concerns, and desires in the face of a changing sexual relationship as to avoid any misunderstandings,” Dr. Conti says.
Most new parents want their partner to know they are attracted to and love them, and that they look forward to intimacy, Jawed-Wessel explains. “But sometimes in the chaos of new parenthood our wires get crossed and we forget to communicate these thoughts in a sensitive way,” she continues, meaning “without pressure to engage in sexual behaviors and while validating feelings of disappointment all at once.”
Don’t forget that “penetrative sex is not the only way for [couples] to be intimate, sexual, or show affection,” Jawed-Wessel says. “If penetration is causing pain [and/or] anxiety, take it off the table entirely and explore each other’s pleasure in different ways that don’t include penetration.” Removing the expectation of orgasm entirely may also help take the pressure off enough for couples to just enjoy touching one another for however long they want to, so long that it’s comfortable, she adds.
Keep in mind that postpartum care doesn’t boil down neatly into just one appointment, and it doesn’t hurt to reach out to your care provider if you have questions or if something doesn’t feel right, even after your checkup; I personally wish I had reached out when I thought the pain meant that we should just give up on sex.
The American College of Obstetricians and Gynecologists (ACOG) is actually pushing to transform the traditional six-week visit and replace it with an ongoing process that improves “communication across the transition from inpatient to outpatient settings” and improves postpartum care that’s currently “fragmented among maternal and pediatric health care providers,” according to an ACOG committee opinion published in May.
Even with all the expert advice in the world, I can tell you from experience that navigating these waters can be tiring, fraught, and messy (literally), even with a respectful partner and decent communication. And that’s OK.
That sink full of dishes, the baby crying in the next room, leaking breasts, and just trying your best to squeeze in a four-minute shower are hardly prime ingredients for passion. My spouse never turned his nose up at physical intimacy post-baby, but I’ll be frank—when we welcomed our second baby in 2013, we counted finishing a single episode of our favorite TV show within three bleary-eyed nights a big, romantic success.
But we got through it. It’s not easy, but, as Jawed-Wessel says, postpartum intimacy is “absolutely something couples can figure out with some old-fashioned vulnerable conversation and better resources.”
*Name has been changed.