By Fiona McMahon, DPT

Edited by Amy Stein, DPT

It’s cliché to say the arrival of a new child is one of life’s most joyful events. It certainly can be. It can also be one of life’s most stressful events. According to the Homes and Rahe Stress Scale, pregnancy is one of life’s most stressful events falling just after having an ill family member. Sexual difficulties and arrival of a new family member are ranked just after pregnancy. It is little wonder that among the joy and excitement that comes along with a new baby, there is also stress and anxiety. Childbirth can have a profound effect on a couple’s sexual intimacy. Understanding a little bit about the physical and emotional factors that can affect post pregnancy sexuality can go a long way to reducing stress and beginning to start a new sexual relationship with your partner after the arrival of your child.

The causes of sexual dysfunction postpartum can be multifactorial and varied. They can occur simply because of the sleep deprivation and lifestyle upheaval a new baby can bring to a family dynamic. They can be hormonal. They can also be caused by postpartum depression, which can have a profound effect on one’s sexual desire. There are also physical factors such as dyspareunia, the technical term for painful vaginal intercourse. Rarely one single factor is the culprit. Post pregnancy sexual dysfunction is usually caused by several factors acting in concert.

Dyspareunia or painful sexual intercourse is fairly common after the birth of a child. Between 4 and 58% of women experience painful intercourse after vaginal delivery. Painful sexual intercourse in women after the birth of their first child was examined by Chaychinda and Ungkanungedcha in a 2015 article in the Journal of Sexual Medicine. The authors of this study found no correlation between painful intercourse and the birth weight of the child, newborn head circumference, or whether or not the mother had a history of pre-pregnancy dyspareunia.

In another study by Signorello and colleagues, the relationship of sexual functioning after childbirth was compared to the degree of birth trauma experienced by the mother during delivery.  The authors of this study classified participants into groups that included, the intact group (no vaginal tearing or episiotomy), women with first degree perineal tearing (tears to the vaginal mucosa only), second degree tearing (tears extending to the perineum and perineal muscles), third degree tearing (involving the external anal sphincter), and fourth degree tearing (involving the anal sphincter and surrounding rectal mucosa). The authors of this study found that women who do not experience any tearing or episiotomy tended to be younger and heavier.  Signorello found that all women, regardless of degree of birth trauma, resumed intercourse by 6 months after the delivery of their child. Most of the women experienced pain when they resumed sexual intercourse with the degree of pain dependent on the degree of perineal tearing. Dyspareunia was found in 33% of the intact group, 48% of the second-degree group, and 68% of the third and fourth degree group. The study also found that degree of birth trauma and maternal age were independent predictors of return to sexual functioning.

Overall sexual functioning after childbirth was examined by Khajehi and colleagues in an article to appear in the Journal of Sexual Medicine this year. In this study, overall sexual functioning was examined after childbirth. Khajehi found evidence supporting the work by Signorello that most women do not return to sexual functioning until 6 months after childbirth. Factors that influence return to sexual intercourse included return of genitals to pre-childbirth state, whether or not there is prolonged lochia (bleeding after childbirth) and perineal pain.

The authors also cited research that women having their first baby are more likely to experience sexual dysfunction than those who have already had a child, with sexual dysfunction significantly higher in women who had just given birth to their first baby at 8 and 16 weeks after delivery. The authors also looked at emotional factors that can affect return to sexuality and cited research that, emotional disturbance, fear of another baby, and well-being of the newborn as well as relationship dissatisfaction are correlated with sexual dysfunction, regardless of the sexual orientation of the couple.

New moms are not to be blamed for any type of sexual dysfunction following childbirth. In our society words like “frigid” get thrown around to describe women who cannot or do not want to engage in sex. It is important to remember that your body has gone through a tremendous change and produced something truly incredible. It is okay to allow yourself some time to recover and to return to sex slowly.

The Mayo Clinic has proposed some guidelines on return to sexual function after childbirth. They advise that new mothers wait 4-6 weeks after delivery to have sex regardless of whether they delivered vaginally or by c-section. Using a personal lubricant can help reduce pain and is particularly helpful because hormonal fluctuations can leave the vagina dry and tender, especially in breastfeeding mothers.

Physical exercise can be key in managing stress, improving body image, and helping to normalize sleeping patterns, which can all contribute to sexual dysfunction after pregnancy. Try to get 150 minutes of moderate exercise in a week to improve overall health. It does not all have to be at once, but adding in short 10-minute bouts of exercise in the morning or at lunch can easily add up to the 150-minute recommendation over the course of a week.

If you are not experiencing any pain or discomfort and you have not noticed any changes in bladder and bowel function, then you can do specific exercises for your vagina to increase blood flow and pleasure during sex. Pelvic floor exercises (Kegels) are contractions of your pelvic floor muscles. You perform Kegels by squeezing and drawing up your rectum and your vagina, like you were trying to stop gas or the flow of urine. If you were sitting on a hard chair while performing a correct Kegel you can actually feel the area between your vagina and anus lift up off of the chair. The best part of Kegels is you can do them anywhere and no one knows you are actually doing them! Keep your Kegels to a contraction of about 1-2 seconds and start off slow building to 100-200 contractions broken up over the course of the day. If you feel any pain with the exercises or notice any changes in bladder or bowel health, then stop doing the Kegels. This could be an indication that certain pelvic floor muscles are in spasm or there may be scar tissue that is causing the discomfort, and it is recommended to see a pelvic floor physical therapist.

Remember to take it slow to returning to sex. Start off with kissing and light touching. If anything hurts it is perfectly okay to put it on the back burner and return to it later. Be willing to explore. You might actually come up with new activities to add to your repertoire while you are waiting to recover. If you find that you are still troubled by sexual dysfunction months after childbirth, consider seeing a pelvic floor physical therapist for guidance in your recover. A pelvic floor physical therapist will be able to loosen and free up scar tissue, and treat any tightness and/or weakness, and teach you about more gentle sexual positions and activities to help you return to full sexual function. Just like any other injury, the sooner the problem is identified and treatment begins, the better; however, most conditions can be relieved many years, or even decades, later.

Sources

Chayachinda C, Titapant V, Ungkanungedcha A. Dyspareunia and sexual dysfunction after vaginal delivery in thai primiparous women with episiotomy. J Sex Med. 2015;12:1275-82

Khajehei M, Doherty M, Tilley M et al. Prevalence and Risk Factors of Sexual Dysfucntion ln Postpartum Australian Women. J Sex Med. 2015 [Epub ahead of print]

Mayo Clinic Staff. Sex after pregnancy: set your own timeline.[accessed May 2015] http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/sex-after-pregnancy/art-20045669

Signorello L, Harlow B, Chekos Am, et al. Postpartum sexual functioning and its relationship to  perineal trauma: A retrospective cohort study of primiparous women. Am J Obstet Gynecol 2001; 184: 881-90