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
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.