with Jenny Fielding, Specialist Pelvic Health Physiotherapist
Returning to intimacy postnatally can bring about a host of different thoughts and feelings, and can feel like a looming cloud of expectation, fear and guilt.
It’s not uncommon to wonder
😬 “Will it hurt?”
😬 “Will it feel different for me or my partner?”
😬 “I’ve completely lost my sex drive!”
😬 “Will I ever feel in the mood again?”
😬 “I can’t even think about it, I just need to sleep!”
😬 “What about my scar?”
😬 “I feel more self conscious in my body and not sexy!”
Likewise for some couples, no longer being pregnant and celebrating the new addition to a family can spark a new wave of desire, connection and excitement for intimacy and their main question is:
😍 “How long do I have to wait?”
So what are the facts? What are the potential challenges? And how do we overcome them?
The general recommendation for post natal intimacy is to wait 6 weeks before penetrative sex. It’s important to ensure any stitches are healed (either vaginal or abdominal) and ideally that the lochia (post natal bleeding) has finished as well as be assured there is no sign of infection.
However, just like returning to post natal exercise – 6 weeks isn’t right for us all! If you’ve had a straightforward delivery, your stitches are healed, you have no symptoms or bleeding you may feel ready a touch sooner.
Likewise, for most women 6 weeks feels far too soon. Just like exercise, a graded return is optimal. Sex means something different to everyone, and a positive intimacy experience is far more than just the physical, requiring both body and mind to be on the same ‘page’.
So what can you expect?
Physically, you may notice discomfort or pain. This could be due to hormonal changes such as low oestrogen as a result of breastfeeding causing vaginal dryness. Other causes include muscular tightness in the pelvic floor muscles, your unique anatomy (some positions may be uncomfortable and need you to adapt), Pelvic Organ Prolapse (though you can absolutely have pain-free sex with POP), scar tissue restrictions (following perineal tearing, a caesarean section or other abdominal and gynaecological surgery), or muscular guarding due to fear of pain or linked to past pain experiences — a common physiological response of your body which causes significant muscle tightness. It may also be a result of infection or inflammation (such as an STI, UTI, allergic reaction, vaginal infection, endometriosis, to name a few) and so, it’s important to see a medical practitioner to help rule out a medical source.
What can you do?
1 / 8 Lubrication and vaginal moisturisers
Are a great starting point. The act of self touch to apply moisture can be great in reconnecting with your anatomy particularly if you have some trauma associated with your birth. Lubrication can help reduce friction from dryness or scar tissue. Experiment with oil-, water- or silicone-based products, but ensure the ingredient list is short, natural and avoids sugars, chemicals and scents.
2 / 8 Change sexual position or depth.
Sometimes a different position or a towel under your pelvis can alter your pelvic posture and make things more comfortable. The Ohnut, a wearable device designed to allow couples to control penetration, can be especially useful if you feel discomfort deeper inside.
3 / 8 Manage scar tissue.
Whether from vaginal tearing or a c-section, it is important to get things moving as these scar tissue restrictions can impact your soft tissue and pelvic floor muscles. Soft tissue massage and stretch techniques can help to de-sensitise these tissues and improve their flexibility aswell as make you feel more confident about touch.
4 / 8 Reconnect with your own anatomy.
Spend some time on self touch, re-learning your unique anatomy and feeling more confident with how everything feels. You can try this with the shower head, an intimacy toy or your self.
5 / 8 Remove the pressure and try non-penetrative sex.
Sometimes making this agreement with yourself and your partner beforehand gives you the freedom and control to explore, enjoy and help you feel more comfortable. As you remove the pressure and build the trust, your body and mind will be more receptive to physical touch. Even just a cuddle on the sofa can feel like a distant memory when you’re constantly holding a newborn, so carving out small moments to be intimate can help in the journey to reconnecting.
6 / 8 Consider topical oestrogen.
This medication works locally on the vaginal tissues and will improve lubrication and soft tissue elasticity. Sometimes when breastfeeding this may be prescribed. If you notice significant dryness discuss this treatment with your medical practitioner.
7 / 8 Get on top of your bladder and bowel habits.
Managing and treating constipation is particularly important as it can affect pelvic floor function. Emptying your bladder prior to sex can also alleviate anxiety surrounding leaking with intercourse.
8 / 8 Get help.
If you are experiencing symptoms such as discomfort, pain or if you have other concerns, do not suffer in silence – see a Pelvic Health Physiotherapist sooner rather than later !
Whilst physical considerations when it comes to sex are undoubtedly important, there is increasing understanding of the relevance of the relationship between our body and mind. Focusing on calming our nervous system can result in improvements in our physical symptoms and the ability for our body to achieve a heightened state of sensation.
1 / 4 Breathing exercises
Are a good place to start to reconnect with the body and calm the nervous system. Start with a few minutes of slow deep breath cycles prior to intimacy. The breath cycle should be longer on the exhale, for example a four-second inhale followed by a six-second exhale. Tapping into our breath cycles also utilises our diaphragm and can in turn influence our pelvic floor muscles. These systems work together and can promote pelvic floor relaxation.
2 / 4 Spend time away from the hustle and bustle of day to day life.
A walk in nature, a relaxed five minutes drinking your coffee or taking a moment to relish in your morning skincare routine are all examples of how we can shift our focus and bring about a sense of calm. Mum life is full on but these small moments can help us reconnect with ourselves.
3 / 4 Take it slow.
For the first time post-birth, it’s easy to rush to the “main event” and not give your mind or body a chance to get ready. Try to give yourself time (easier said than done when baby down for an unpredictable nap!). If it feels a bit uncomfortable, try slowing down and spending more time on foreplay.
4 / 4 Communicate.
Tell your partner how you feel, what your concerns are and why. Share what you both need, how that looks and what feels good, both emotionally and physically.
Whatever your struggles in the sex and intimacy space, know that help and support is available, whether in the form of pelvic physiotherapy, intimacy coaching, psychological support or learning how to be more mindful. You are not alone, there is no rush and there is a world of exhilarating, comfortable and satisfying sexual intimacy out there.
Jenny Fielding is a Specialist Pelvic Health Physiotherapist at Mint Wellbeing, Wimbledon. She specialises in the management of female health across all life stages from menstrual irregularities and pelvic pain, through pre- and post-natal to peri- and post-menopause. Her passion is to support women at various life stages and open up the conversation around women’s health topics, from the awkward to the unknown.
Are you dealing with pelvic floor issues – incontinence, prolapse or pain – impacting your movement, life and happiness? My signature 1-2-1 transformational programme Strong, Free & UPLiftedTM will help you regain trust in your body, get you back to fitness feeling strong physically AND mentally. Book in your free 30 min consult if you want to chat. I promise you I’ll let you know honestly if the programme is a good next step for you.