I see many women post partum who express a variety of different feelings regarding sex after childbirth. Some women resume with no problems, while others experience pain, dissatisfaction or very low desire. For the women who experience issues with sex postpartum, they often feel they are the only ones. These women express frustration because they aren’t provided any clear guidelines as to what is common, why they have the problem or what they can do about it.
The World Health Organization describes
sexual health as, “a state of physical, emotional, mental and social well-being
related to sexuality; it is not merely the absence of disease, dysfunction or
infirmity” (1). The transition to parenthood comes with many changes that
impacts sexuality and this blog will explore these changes and the impacts on
sex.
Female sexual dysfunction affects approx 40%
of women postpartum (2). Under the sexual dysfunction umbrella are sexual pain
disorders, hypoactive sexual desire disorder and arousal and orgasmic disorders
(1), which in layman’s terms means painful sex, lack of desire and difficulty
becoming aroused or orgasming.
The most common reason for women to not
return to intercourse at 6 weeks postpartum is pain. They may experience pain
with penetration or an inability to penetrate due to muscle spasm. About 42% of
women will experience pain immediately following delivery and will reduce to
22% at 8 weeks and 10% at 12 weeks. One study of 796 first time moms revealed
that 62% experienced pain at 3 months, 31% at 6 months and 12% at 12 months.
Another study looked at the medical records
of 626 first time moms and found that women with second degree tearing were 80%
more likely to report painful intercourse than women with no or minimal tearing
and that women with third or fourth degree tearing were 270% more likely to
report pain at 3 months postpartum (1).
When it comes to tearing versus episiotomies,
one study found women had more pain with episiotomies and assisted vaginal
delivery versus tearing alone. FYI.. an assisted vaginal delivery may include
forceps, suction, vacuum (2). Specifically, 30% of 438 women experienced pain
at 8 weeks with assisted delivery versus 7% of women who gave birth naturally.
Other studies have found similar results where women with assisted delivery report
sexual pain at 8, 16 and 24 weeks post partum (1).
Low sexual desire is reported by about 53%
of women at 3 months compared to 37% at 6 months post partum (1). Most studies
find that desire improves over time and was mostly impacted by changes in body
image, mother’s mental health and the status of the martial relationship (1).
Many women report that the physical changes to their body following childbirth
makes them feel less attractive (3) and that they were anxious about the
looseness of their vagina (3).
Other factors reported by women are the
changes in priorities. Whenever they get spare time, they just want to relax
and read or sleep (3). The demands of the child often leave the mother fatigued
and desiring alone, quiet time versus engaging in sex (3). When women were
asked about their low desire, the most common reasons reported were, tiredness,
breast-feeding, lack of time and concerns over vaginal damage from delivery
(3).
Breast-feeding women versus
non-breastfeeding women appear to return to sex much later. One study of 25
first time moms found decreases in the levels of testosterone and
androstenedione, which are responsible for increased sex drive. This is
supported by another study of 576 women who reported low or no arousal during
the time of breastfeeding (1).
Another potential reason breast-feeding
changes sexual activity is that the breasts are no longer viewed as a sexual or
arousing area. Women find it difficult to associate breasts with sex when the
focus now is on nourishing the child (3).
For those women who do engage in sex, many
experience arousal and orgasmic changes. One study of 796 first time moms, 33%
reported difficulty reaching orgasm at 3 months and 23% at 6 months postpartum.
Orgasmic disorders were associated with perineal trauma, those who sustained
more trauma had more difficulty with sex (1). Other factors impacting arousal
and orgasm postpartum are the physical decrease in blood flow to the vaginal
region, negative experiences such as pain with intercourse, distractions,
sexual anxiety, tiredness and depression (1).
Some women admitted that they agreed to
have sex with partners, while experiencing no desire to have sex. Some women
would even pretend to be aroused and orgasm for the sake of their partner and
relationship (3).
What I hope you gain from this blog is a
better understanding of the factors that may be impacting your desire. I want
you to know that you are not alone and that there is help if you are willing to
talk about it and seek treatment. Pelvic floor physiotherapy is very helpful
for addressing the pain aspect of intercourse, while a psychotherapist may help
you work through all the thoughts and feelings you are having in this time of
transition.
Your family doctor or a Naturopathic doctor
may be able to provide you with other solutions centered on hormones, nutrition
and getting rest. If you are reaching out to your healthcare provider and they
don’t seem to be taking it seriously or offering solutions, then you need to
find another healthcare provider for a second opinion.
WE ARE LOOKING FOR FEEDBACK REGARDING PAINFUL SEXUAL EXPERIENCES. TOTALLY ANONYMOUS. PLEASE CONSIDER OUR SURVEY www.ecophysio.com/survey
The Pelvic Health Lady
References:
1.
Abdool, Z et al. 2009.
Postpartum female sexual function: A review. European Journal of Obstetrics
& Gynecology and Reproductive Biology doi: 10.1016/j.ejogrb.2009.04.014.
2.
Yeniel, A. O and E Petri. 2014.
Pregnancy, childbirth and sexual function: perceptions and facts. Int
Urogynecol J 25: 5-14.
3.
Olsson, Ann et al. 2005. Women’s
thoughts about sexual life after childbirth: focus group discussions with women
after childbirth. Scand J Caring 19: 381-387.
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