Getting Back to Sex Post Baby.
Well this one’s going to be a fun post isn’t it! This is a hugely important topic that so few people talk about, I thought I’d share my personal experience and some of the research that applies to postpartum sex.
A few things I’ d like to clear up before we get to it. Sex comes in many MANY different forms. It doesn't just have to be sex with a male partner. I’d also like to point out that solo sex is just as valid as sex with a partner. I think a lot of emphasis is put on women returning to having sex with a male partner. Of course if this is a personal goal it’s very appropriate. Some women don’t have this goal or even if they do the different victories along the way can be forgotten. Looking at the vulva, Self touch, using a small vibrator, receiving oral sex, increasing the size of a dilator, orgasm, increased sensation. All of these milestones are valid on the road to our end goals whatever they may be. Side note, that was a small list of physical goals. Sex with a partner in whatever form runs somewhat deeper than “the physical” doesn’t it? Building those connections again with someone is what makes goal setting around sex so incredibly important and not as easy as “have you tried using lube?!” Shall we begin…?
And then we were three, note the tired eyes.
The photo above was taken 10 days after Theodora was born, we both look a little tired! I was sore everywhere and still healing from my surgery. I can only speak personally of my experience getting back to having sex with my husband after giving birth vaginally and sustaining a 3b tear (pop back and have a read of “Perineal Tears the Research”, I document my experience and the research there, it’s a hoot- promise.) So there I was breastfeeding through six bouts of mastitis trying to heal, exercise, eat well, drink enough water, keep my baby alive, walk the dog and oh yes- my husband! Anybody who knows Jonjo would say he’s super laid back and supportive. In short he’s wonderful and I’m lucky to be married to him, no he’s not writing this. That said y’know how long it was before I let him anywhere near me without his clothes on…? Nine months. That’s right 9 months. For some ladies it’s longer and for other ladies it’s a few weeks. Everybody’s different and there’s no right or wrong, no definition of “normal”.
So sticking with the personal theme -why 9 months? Well truth be told I just had absolutely no desire whatsoever to have any kind of intimacy with anybody. I’d been poked and prodded by so many people I just wanted to be left alone. I remember so well the lovely Obstetric Reg coming into the room after I’d had Theodora. We’ll call him Bob, he explained what my midwife thought about the tear and gained my consent for a digital rectal exam. The Royal Collage of Obstetricians and Gynaecologists (RCOG 2015) have written an accessible document on the management of third and fourth degree tears, I’ll pop the link in the references. Bob kindly suggested I use the gas and air for the examination as it was going to be pretty vigorous to fully assess the situation. He was not wrong. I was then taken to surgery. So you see I was feeling somewhat touched out in the genital region. Van Brummen et al. 2006 actually writes, At 1 year after childbirth, women with OASI’s are less sexually active than women without it. OASI’s being an Obstetric Anal Sphincter Injury (a grade 3a/b/c-4 perineal tear), not that Britpop band from the 90’s.
My hormones were at a constant rave and didn’t really settle until I completely stopped breastfeeding at 15 months. They calmed significantly when my daughter weaned at 6 months but I was still feeding 4+ times a day. I was heavily influenced by a lack of oestrogen in my system, lack of sleep, lack of time and to be blunt not really feeling like myself. I lost the weight I put on through pregnancy by 5 months but just felt a little out of sorts and not athletically myself until the 9 month mark. I’m not embarrassed to admit I like to look good in my pants, my body confidence had quite a wobble after having my daughter. I’ve described this in previous posts. Looking at myself in the mirror immediately after having Theodora and the following months I didn’t recognise my own reflection. Bits wobbled that didn’t move before and my boobs- well! My nipples were SO sore I had to hold back the tears when I showered because the water touching them was agony! Things improved in time, the soreness when I realise I was allergic to lanosil (I know, what are the chances) and my body confidence improved with rehabilitation and a graded return to Crossfit. around the 5 month mark.
So what about the other 4 months I hear you ask. Well I’d fallen off the horse in terms of not having sex for quite some time and to be frank I was slightly nervy about getting back on. I knew I’d healed well from the surgery, was doing my pelvic floor exercises daily (for life) and had no real concerns but I was just a bit scared for lots of reasons. Scared of possible pain, what if I didn’t like it? What if I couldn’t do it? Would it feel the same? What if my husband thought it was terrible? The endless worry. I don’t think these sorts of feelings are exclusive to me. I know lots of ladies who share the same thoughts. Then again I know lots of ladies who had no concerns. Everybody is different. With the levelling out of my hormones, Theodora’s sleep improving and excellent bits of advice from friends “just get a bit pissed and go for it,” (not medical advice,) I slowly felt more like myself. I think my husband was getting out of the shower one evening and I said “you look nice”- he almost fell over with shock. I think this was when I knew my libido was returning which for me was half the battle.
The day Theodora turned 5 months old and I returned to some adult PE at CrossFit Exmouth.
Trying to find the research for postpartum sex is well.. a difficult job! There isn’t a lot out there unsurprisingly. The little research that is out there is very much centred around OASI’s. I did read one study which I found outdated on multiple fronts specifically the method of data collection which I chat about a bit later. It’s research none the less. Van Brummen et al 2006 found an important prognostic factor for dissatisfaction with the sexual relationship 1 year postpartum was not being sexually active in early pregnancy. As in, how much sex were you having when you were pregnant. Interesting isn’t it?! This study was based on a questionnaire, the The Maudsley Marital Questionnaire (MMQ-S). Please note the below photo of the paper to validate this questionnaire as an outcome measure, it’s from 1983. Ancient (in research years, not people years obvs). Which leads me onto the second finding of Van Brummen’s research. Dissatisfaction with the sexual relationship 1 year after childbirth, assessed with the MMQ-S scale is associated with an older maternal age at delivery. Research isn’t there to be friendly I guess, but OUCH! At a spritely 33 when I had Theodora I find the link with older maternal age an interesting one.
As I said research on the topic is scarce which makes this post a little more heavy on the personal experience front. What I will reiterate is the importance of seeking help from the right healthcare professionals. It’s not just a case of covering yourself in lube and having half a bottle of Oyster Bay. There can be multiple factors affecting someone’s ability to have sex. Physical health, mental health, hormone levels, stress, sleep deprivation, confidence, anxiety, the list could easily be longer. I know it’s just easier to not make the appointment and it can feel pretty embarrassing laying details of your sex life (or lack there of) bare to a healthcare professional. It might make you feel nervous or uncomfortable and I understand. I promise the professional sitting in front of you is there to help with the very issue you’re experiencing. It’s their job. Sex, like I keep saying is an activity of daily living. If you suddenly found one day after a physical event, say you ran a marathon, that you couldn’t walk down the stairs afterwards without pain. What would you do? You’d make an appointment to see a healthcare professional to examine what’s causing the pain and how best to treat it so you can resume your normal function of going up and down the stairs. So why do we have an issue with seeking help when it comes to sex after having a baby?!
I finally felt ready to discuss how I was feeling at around the 8 month mark with our local practice nurse who was fantastic. She did what I wish more healthcare professionals had the confidence to do. She very nonchalantly asked how my sex life was when I went for a routine smear test. She partially opened the door and invited the conversation in because at that point I hadn’t discussed my worries with anybody. She very kindly gave me some lube (I was already swimming in the stuff given my professional background,) and the reassurance that all was well when she examined me. Most importantly she gave me the confidence to go home and talk to my husband. Well wasn’t that a good idea! All those worries, niggles and insecurities I’d been merrily carrying around with me, had I actually shared them with the man who held my hand when I was giving birth- nope. Did it make the world of difference once I did- yes. I had to learn to trust my husband with my thoughts and insecurities and I had to reconnect with my body. I found using the Headspace app a really useful tool. Not that they have a section labelled “How To Have Sex Post Baby,” I just found their mindfulness and breathing exercises worked well with pelvic floor stretches to try and help me relax. As previously discussed in other posts a tight pelvic floor isn’t what we want. It’s funny, as I’m writing this I can’t believe I went through the experience I have. I see ladies all the time in clinic who have worries getting back to having sex again and I was one of them. I think that’s why I take such care to ask in clinic, once I’ve built a rapport with the person sitting opposite me and we’ve laughed at my laminated paper pelvic floor model.
I ask “have you resumed your normal level of sexual activity?”
More often than not ladies laugh and say “we’re trying, but babies don’t like to sleep at the right times do they?!” - We laugh some more and I wholeheartedly agree.
Then I’ll smile and ask “when baby is sleeping are you comfortable and happy having sex that you enjoy?”- Some ladies smile or laugh and say “oh yes all fine on that front!” And some ladies don’t smile they look how I looked in clinic a while ago. I’m encouraging you, potentially as someone seeking help, to be brave and say what’s on your mind. Remember, sex is an activity of daily living. If you can’t walk up the stairs and I’m your physio I want to hear about it. If you can’t have sex, and I’m your physio I want to hear about it!
Everybody’s journey back to having sexual relationships post baby is different. There is so much we can do to help as Women’s Health or Pelvic Health Physiotherapists. The treatment options are vast and vary from person to person. This is why I stress the importance of contacting your local Womens Health or Pelvic Health Physiotherapist and going for an assessment if you’re experiencing difficulty resuming your normal sexual activity. There are also some brilliant organisations full of useful information I’ll make a list below;
MASIC foundation supports women who’ve suffered serious injury during childbirth; https://masic.org.uk/about-masic/
The Birth Trauma Association; https://www.birthtraumaassociation.org.uk/
Pelvic Obstetric and Gynaecologists Physiotherapy (POGP); https://thepogp.co.uk/default.aspx
Vaginal changes after childbirth; https://www.nhs.uk/live-well/sexual-health/vagina-changes-after-childbirth/
If I’ve said it once I’ve said it a thousand times. Sex is an activity of daily living. It’s something you should be able to resume post baby when you feel ready. Having the expectation of enjoying your sex life post baby is not too much, selfish or an unreasonable request by any stretch of the imagination. Know that as you sit in clinic hundreds of other women are also sitting in clinic being brave and asking for help. I know this, they sit opposite me every day in my clinic and I know this because I was one of them. Big love V x
References
Rådestad I., Olsson A., Nissen E. & Rubertsson C. (2008) Tears in the vagina, perineum, sphincter ani, and rectum and first sexual intercourse after childbirth: a nationwide follow-up. Birth 35 (2), 98–106.
Royal College of Obstetricians and Gynaecologists. (2015) Third- and Fourth- degree perineal tears, Management(Green Top guideline no 29). Accessed on 10/06/21, found at; https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg29/
Van Brummen H. J., Bruinse H. W., van de Pol G., Heintz A. P. M. & van der Vaart C. H. (2006) Which factors determine the sexual function 1year after childbirth? BJOG: An International Journal of Obstetrics and Gynaecology 113 (8), 914–918.