Sex after pregnancy: Set your own timeline

Changes in your body and lifestyle after childbirth might make the thought of sex less than exciting. Soreness, lack of sleep and caring for an infant can all take a toll. But with time, most people do decide that they want to have sex again.

Whether you're in the mood or you feel as though you'd rather wait, here's what you need to know about sex after pregnancy.

After the baby is born, how soon can I have sex?

There's no required waiting period before you can have sex after childbirth. But a typical recommendation is to wait to have sex until after you've had a medical appointment with your healthcare professional to check your health following childbirth. That's true for both vaginal deliveries and C-sections.

The risk of developing a health concern related to giving birth is highest during the first two weeks after delivery. But waiting longer than that to have sex gives your body more time to heal. Before you have sex, make sure any vaginal tears have healed and that you're using birth control if you don't want to get pregnant again.

Common symptoms after birth that may make sex difficult or unpleasant right away include:

• Discharge from the vagina.
• Vaginal tears.
• Vaginal dryness.
• Pain.
• Low sexual desire.

If you had a vaginal tear that needed surgery to repair, your healthcare professional might suggest that you have a medical exam to check that the tear has healed before you have sex. Or your care professional may suggest you wait longer to have sex.

Will it hurt?

Hormone changes in your body might make your vagina feel dry and sore. That can be especially true if you're breastfeeding. Those changes might make sex uncomfortable.

You may have some pain during sex if you've had scar tissue develop after childbirth. It may be painful if you're still healing from a tear in your vagina or in the area between your vagina and anus. Sex also might be painful if you had an episiotomy. That's a cut made in the tissue between the vagina and the anus during childbirth.

To make sex more comfortable:

• Ease pain. Take steps to lessen pain before you have sex. For example, take a warm bath, take pain-relieving medicine and be sure your bladder is empty. If you notice a burning feeling after sex, put ice wrapped in a towel on the area that's uncomfortable.
• Use lubricant. This can be helpful if you have vaginal dryness. It's common for people who haven't needed lubricant before to need it for a while after a baby is born.
• Experiment. Talk with your partner about doing something other than vaginal intercourse, such as massage, oral sex or mutual masturbation. Tell your partner what feels good and what doesn't.
• Take your time. Try not to rush it. Give yourself plenty of time for sex. And find a time when you're feeling rested and relaxed.

If sex continues to be painful, make an appointment with your healthcare professional to talk about treatment that can help.

Will it feel different?

Pregnancy, labor and delivery can stretch or injure the pelvic floor muscles. Those muscles support the uterus, bladder, small intestine and rectum. Damage to that area may affect how sex feels. Toning your pelvic floor muscles with Kegel exercises may help.

To do Kegels, imagine you are sitting on a marble and tighten your pelvic muscles as if you're lifting the marble. Try it for three seconds at a time. Then relax for a count of three. Work up to doing the exercise 10 to 15 times in a row, at least three times a day.

Many people also benefit from pelvic floor physical therapy after a baby is born. Ask a member of your care team if it might be helpful for you.

What about birth control?

If you don't want to get pregnant again, always use reliable birth control.

If it's less than six months after you've given birth, you're only breastfeeding your baby and your period hasn't started again, then breastfeeding might offer a small amount of protection from pregnancy. But research suggests that the birth control effect of breastfeeding isn't the same for everyone. So don't rely on breastfeeding for birth control.

To lower the risk of pregnancy health concerns and other health problems, some research suggests waiting at least 18 months between the end of one pregnancy and the beginning of the next. If you want more children, talk to your healthcare professional about pregnancy spacing. If possible, have that conversation before your baby is born.

Birth control choices right after a baby is born include:

• A contraceptive implant, such as etonogestrel (Nexplanon).
• A copper or hormonal intrauterine device (IUD).
• Progestin-only birth control, such as the injection medroxyprogesterone (Depo-Provera) or the minipill norethindrone (Camila, Emzahh, others).
• Permanent birth control, such as tubal sterilization, where the fallopian tubes are partially or fully removed, or vasectomy, where the tubes that carry sperm are cut and sealed.

Birth control methods that contain both estrogen and progestin — such as combined birth control pills — pose a higher risk of blood clots shortly after delivery. For otherwise healthy people, it's OK to begin using combined birth control pills and other types of combined hormonal birth control one month after childbirth.

Birth control methods that contain both estrogen and progestin have traditionally been thought to lower the milk supply of people who are breastfeeding. But more recent research suggests that this form of birth control does not have as significant of an effect on milk supply when it's started after the supply is well established.

Talk to your healthcare professional about your birth control choices. Start that conversation before the baby is born, as some kinds of birth control can be provided at the time of delivery. Others can be given before you leave the hospital.

What if I'm not interested in sex?

There's more to intimacy than sex, especially when you're getting used to life with a new baby. If you're not feeling sexy or you're afraid sex will hurt, talk to your partner. Until you're ready to have sex, you may want to try to connect and show affection for one another in other ways. For example, spend focused time together without the baby, even if it's just a few minutes in the morning or after the baby goes to sleep.

If you're struggling after childbirth, watch for symptoms of postpartum depression. They may include:

• A depressed mood that lasts. This may involve feeling sad or hopeless and crying often.
• Little interest in daily life, including caring for your baby.
• Thoughts of harming yourself or others.
• Worrying a lot or feeling much more anxious or irritable than usual.
• Sleep problems.
• Changes in appetite.
• Feelings of guilt, shame or failure.
• Problems concentrating.
• Often feeling very tired.

If you think you might have postpartum depression, talk to your healthcare professional. Getting treatment for postpartum depression right away can make it easier to recover.

Remember, taking good care of yourself can go a long way toward keeping passion alive.