Lowdown on resuming intimacy after childbirth

One of the most intriguing things about working with women is the ease with which rapport is established once they feel comfortable with the topic at hand and do not feel judged for having a difference of opinion.

These discussions happen in any setting and hence in many instances, being a gynaecologist means occasionally having to clarify medical issues outside the office.

In one such instance, the very interesting conversation of when to resume sexual activity after childbirth came up. Opinions around the table were expressed with utmost humour, but reflected the reality that it is not a topic that is often discussed in the doctor’s office.

One of us, a mother of one, was absolutely dumbfounded by what she was hearing and remained quiet for a long time.

When she finally spoke, her surprise was genuine. She could not understand how one would wait for weeks to resume sex. She had undergone a normal delivery and in less than a week, it was business as usual for her.

So what is deemed the correct time to resume sexual intercourse after birth? There are no hard and fast rules except that one needs to wait for lochea (the bleeding that occurs after delivery) to dry up. The rest is quite subjective.

Lucy* had a normal delivery for her first child. She had a fairly easy time, with a short labour and a relatively small baby born at 2.7 kg. She did not need an episiotomy (a cut made by the doctor or midwife to increase the vaginal outlet to ease delivery of the baby) and she did not sustain any tears in the peri-vaginal area.

After birth, she recovered fairly quickly and within two weeks she had stopped bleeding. By the third week, she comfortably had her first sexual encounter and other than the unruly breast milk splashing all over, she did not complain.

Seven years later when her second baby came, things were different. She had an uneventful pregnancy but at birth, her delivery was complicated.

Her baby weighed four kilos and she had shoulder dystocia, a complication where the baby’s head is out but the shoulders get stuck in the pelvis, putting the baby at risk of suffocating.

The response by the medical team was swift and aggressive. Lucy got an episiotomy and a fair amount of bruising. Despite healing well afterwards, she was scared of sexual intercourse because she thought she would be in pain. It took a lot of counselling and reassurance to resume a normal sex life.

SEX WITHOUT PAIN

Resumption of sex is dependent on a triad of good physical, mental and psychological states. The body has a great capacity to heal after birth. The episiotomy or tears heal in three to six weeks, and in the same time, the lochea will dry up.

The uterus will have shrunk back to its pre-pregnancy size by six weeks. Physically, a woman should be able to safely engage in sex without pain. Painful intercourse requires review by the doctor to ascertain and treat the cause.

Apart from genital tract wellness, overall body wellness is also important. As the hormones settle down, the toll of taking care of a newborn comes in, causing chronic fatigue.

Some mothers may have battled complications such as high blood pressure, diabetes and anaemia during pregnancy that they are still recovering from. Others may have delivered by Caesarean section and will be nursing wounds, both externally and internally.

The mental state must never be overlooked. Post-partum blues are fairly common though grossly under-diagnosed. This interferes with the function of the woman as a whole, from the swinging moods, to feelings of inadequacy as a mother or lack of affection for her baby, to sexual hypofunction.

In the extreme spectrum, postpartum psychosis will strongly disable a new mother to the point of needing hospitalisation.

Perhaps the psychological state is the most under-appreciated. A positive sexual encounter is heavily dependent on a woman’s psychological state.

Her environment is vital in determining how she feels. A mother who feels supported and appreciated in her new role, having peace of mind and without social pressure, is more likely to be well adjusted and hence more responsive.

However, some mothers may be alone, battling the crying baby with a terrible case of colic, without help. Others may have lack a partner to shoulder the responsibility with, while others may be worried about financial pressures. With such an unsettled mind, sex is the last thing on their mind.

All in all, good health is not only just physical but also sexual. It is a component of postpartum care that must not be ignored. It is the pillar upon which contraceptives are discussed and offered. The woman needs to be reassured that it is all right to have a healthy sex life and her partner needs to understand the situation so as to be supportive.

While at it, let us not forget the mums who are not breastfeeding for various reasons; their fertility resumes earlier and they will require contraceptives earlier to avoid getting pregnant weeks after birth.