Sex after pregnancy

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Sex after pregnancy is often delayed for several weeks or months, and may be difficult and painful for women. Painful intercourse is the most common sexual activity-related complication after childbirth. [1] Since there are no guidelines on resuming sexual intercourse after childbirth, the postpartum patients are generally advised to resume sex when they feel comfortable to do so. [1] Injury to the perineum or surgical cuts (episiotomy) to the vagina during childbirth can cause sexual dysfunction. Sexual activity in the postpartum period other than sexual intercourse is possible sooner, but some women experience a prolonged loss of sexual desire after giving birth, [2] which may be associated with postnatal depression. Common issues that may last more than a year after birth are greater desire by the man than the woman, and a worsening of the woman's body image. [3] [4] [5]

Contents

Birth method and injuries

Women with damage or tears to their perineum resume sex later than women with an intact perineum, [1] [6] and women who needed perineal sutures report poorer sexual relations. [7] Perineal damage is also associated with painful sex. [8] Not all lacerations or trauma during childbirth cause decreased sexual function, but certain types of lacerations are associated with increased risk of sexual dysfunction. [9] Women who have an anal tear are less likely to have resumed sex after six months [10] and one year, [11] but they have normal sexual function 18 months later. [12]

Assisted vaginal delivery using suction or forceps is correlated with increases in the frequency or severity of painful sex, [8] the delay in resuming sex, and sexual problems. [13] Cesarean section may result in less painful sex during the first 3 months, [14] [15] [13] and there is no difference in sexual function or symptoms by six months. [14] [15] [16] Also, the women who delivered by cesarean section report greater sexual satisfaction relating to vaginal tone six years on. [17]

Delay before resuming sex

Many doctors recommend waiting four to six weeks before resuming sex, to allow the cervix to close, bleeding (known as lochia) to stop, and tears to heal. [18]

A study of women in Turkey found that 42% resumed sexual intercourse within six weeks of giving birth. [19] American and British studies found that at six weeks, 57% of women had resumed sexual intercourse, [20] 82–85% had by three months, [7] [20] and 89–90% had by six months. [10] [15] [20] Another American survey found that masturbation (74%) and oral sex (58%) were begun much more frequently within six weeks than vaginal penetration (34%). [21] Sexual intercourse was resumed by two-thirds of Ugandan women within six months of childbirth, [22] and among Chinese women 52% had resumed sex by two months and 95% had by six months. [16]

Sexual dysfunction

About half the men and women questioned eight months after childbirth in one British study described their sex life as ‘poor’ or ‘not very good’, [23] though another found that 70% of British women and 89% of Taiwanese women were satisfied with their sex life during the postnatal period. [24] Six months after giving birth, one quarter of American women said they had lower sexual sensation, satisfaction, and ability to reach orgasm, and 22% said that sex was painful. More than 80% of British women experienced sexual problems three months after giving birth, and nearly two-thirds at six months, compared to pre-pregnancy levels of 38%. [15] Of Ugandan women who had resumed sex within six months of giving birth, nearly two-thirds experienced vaginal pain and about a third had discharge or bleeding. [22]

Vaginal dryness may occur following giving birth for about three months due to hormonal changes, and breastfeeding women resume sexual intercourse later than those who do not breastfeed. [1] [25] Women who breast-feed are much more likely to report painful sex [8] [15] [20] [25] as well as reduced libido, both due to hormonal changes such as a reduction in levels of estrogen. [26] Women with major trauma reported less desire to be held, touched, or stroked by their partner. [7]

The risk of postpartum sexual dysfunction is increased in those with history of sexual dysfunction prior to pregnancy. [25]

Reduced libido

Having given birth within the previous year is associated with persistent low sexual desire. [27] More than a third of first-time mothers report a loss of libido at eight months, though only 1 in 7 of experienced mothers have a loss of libido. [23] Women often have a poor body image after giving birth. [4] [28] Women are often uncomfortable with their physical changes after birth, and often want sleep or to have time for themselves, which leads to a changed sexual pattern. Discordance of sexual desire with their partner is frequent. [4] [24] Another potential cause of low libido is postpartum depression; depressed women are less likely to have resumed sex at six months and more likely to report more sexual health problems. [29] Also, those with trauma during pregnancy are more likely to report reduced libido. [25]

Dissatisfaction with the sexual relationship a year after childbirth is associated with a lack of sex early in pregnancy as well as older ages of women, but not with factors relating to pregnancy or birth. [11]

In partners

A study of found that the sexual desire of partners is often low following the birth. Feelings of intimacy and sexual interest increased sexual desire in co-parents during postpartum period. In contrast, fatigue, stress, partner disinterest, and breastfeeding status decreased the sexual desire in this period. [21]

Risks

A fatal air embolism, when air enters the bloodstream, can occur due to sex shortly after childbirth before the placental bed has healed, particularly if the woman's knees are pressed against her chest, but this is rare. [30] [31] More common complications of having sex early after pregnancy are tears to incisions and infection of the uterus. [31]

Also, early resumption of sexual intercourse after childbirth may predispose patients to the risks associated with short interval pregnancy. [32] The patients who became pregnant within 18 months from the last childbirth are at an increased risk of adverse pregnancy outcomes. [32] To prevent such risks associated with short interval pregnancy, contraception is offered after childbirth. [32] [33]

Treatment

Only 15% of London women who had a postnatal sexual problem reported discussing it with a health professional. [15] In contrast, 59.4% of Ugandan women who had resumed sex and had a sexual problem sought medical assistance. [22] Performing pelvic floor muscle exercise appears to improve sexual function, [17] and painful sex and vaginal dryness can be reduced using different sexual positions and lubricants. [18] 83% of British and 60% of Taiwanese women thought they had sufficient information about sex during the postnatal period. [24]

An example of Implant (Implanon) Implanon 04.jpg
An example of Implant (Implanon)

Contraceptives are often offered immediately after childbirth. [33] This is to prevent unintended pregnancy and reduce the risk of abortion and short-interval pregnancy, which may increase the risk of preterm delivery and neonatal complications. [33]

Of the many reversible contraceptive measures, the Long-Acting Reversible Contraception (LARC) is the most effective with greater compliance by the patients. It can be easily placed by a physician in a short period of time, and no additional maintenance measures are required. [33]

An example of IUD (Mirena) Mirena IUD with hand.jpg
An example of IUD (Mirena)

LARC can be broken down into two different categories: Implant and Intrauterine device (IUD). Implant is a small rod containing the progestin hormone. It is placed in the upper arm and can be effective for 3 or more years. [34] No significant risks are associated with the use of implants during postpartum period, except for its theoretical effect on breastfeeding. The progesterone released from the implants are hypothesized to reduce the breast milk production, but such effect of exogenous progesterone during the postpartum period is yet to be proven. [33] IUD is a device that is placed within the uterus. IUD placement during postpartum period does not carry any significant risks if the patient does not have infection or hemorrhage at the time of delivery. [33] The two common forms of IUDs are copper IUD and Levonorgestrel (LNG) IUD. LNG IUD works by releasing progestin hormone, while the copper IUD does not involve hormone in its effect. [33] [34] As LNG IUD involves progesterone hormone, it carries the theoretical risk of reducing breastfeeding, like the implants. [33]

Combined hormonal contraceptives, including the birth control pills, increase the risk of blood clotting in postpartum patients. Moreover, it can also interfere with breastmilk production. [35] Thus, the patients are advised to avoid combined hormonal contraceptives for the first 3 weeks after childbirth if not breastfeeding and for 4 to 6 weeks if breastfeeding. [33] [35]

Another possible contraceptive measure after childbirth is depot-medroxyprogesterone acetate (DMPA), which is also commonly known as Depo Provera. It is a progestin injection that inhibits ovulation and thickens cervical mucus. The shot is safe to be administered immediately after childbirth. [36] However, the shot must be re-administered every 12 weeks. [32] Also, a backup contraception is recommended in the first 7 days of its use if the patient has started using it after 21 days from the childbirth or if the patient resumed menstrual cycle. [36]

After abortion

Sex after abortion is generally safe according to the National Health Service. [37]

See also

Related Research Articles

<span class="mw-page-title-main">Copper IUD</span> Birth control and emergency contraceptive device

A copper intrauterine device (IUD), also known as an intrauterine coil or copper coil or non-hormonal IUD, is a type of intrauterine device which contains copper. It is used for birth control and emergency contraception within five days of unprotected sex. It is one of the most effective forms of birth control with a one-year failure rate around 0.7%. The device is placed in the uterus and lasts up to twelve years. It may be used by women of all ages regardless of whether or not they have had children. Following removal, fertility quickly returns.

<span class="mw-page-title-main">Childbirth</span> Expulsion of a fetus from the pregnant mothers uterus

Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder experienced after childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The term dyspareunia covers both female dyspareunia and male dyspareunia, but many discussions that use the term without further specification concern the female type, which is more common than the male type. In females, the pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. Medically, dyspareunia is a pelvic floor dysfunction and is frequently underdiagnosed. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

<span class="mw-page-title-main">Episiotomy</span> Surgical incision of the perineum and the posterior vaginal wall

Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. This is usually performed during second stage of labor to quickly enlarge the aperture allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left, is performed under local anesthetic, and is sutured after delivery.

<span class="mw-page-title-main">Postpartum period</span> Time period beginning after the birth of a child and extending for about one month

The postpartum period begins after childbirth and is typically considered to last for six weeks. However, there are three distinct but continuous phases of the postnatal period; the acute phase, lasting for six to twelve hours after birth; the subacute phase, lasting six weeks; and the delayed phase, lasting up to six months. During the delayed phase, some changes to the genitourinary system take much longer to resolve and may result in conditions such as urinary incontinence. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most maternal and newborn deaths occur during this period.

<span class="mw-page-title-main">Hormonal intrauterine device</span> Intrauterine device

A hormonal intrauterine device (IUD), also known as an intrauterine system (IUS) with progestogen and sold under the brand name Mirena among others, is an intrauterine device that releases a progestogenic hormonal agent such as levonorgestrel into the uterus. It is used for birth control, heavy menstrual periods, and to prevent excessive build of the lining of the uterus in those on estrogen replacement therapy. It is one of the most effective forms of birth control with a one-year failure rate around 0.2%. The device is placed in the uterus and lasts three to eight years. Fertility often returns quickly following removal.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

<span class="mw-page-title-main">Lactational amenorrhea</span> Post-partum infertility due to breast feeding

Lactational amenorrhea, also called postpartum infertility, is the temporary postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding.

<span class="mw-page-title-main">Contraceptive vaginal ring</span>

A contraceptive vaginal ring is a type of hormonal insert that is placed in the vagina for the purpose of birth control. The rings themselves utilize a plastic polymer matrix that is inlaid or embedded with contraceptive drug. This drug, often one or two hormones, is absorbed directly through the bloodstream through the cells that line the vaginal wall. Some vaginal rings contain both an estrogen and a progestin, which are available in Europe and the United States. Other vaginal rings contain just progesterone. The progesterone-only ring is only available in Latin America, exclusively for postpartum breastfeeding parents.

<span class="mw-page-title-main">Comparison of birth control methods</span>

There are many methods of birth control that vary in requirements, side effects, and effectiveness. As the technology, education, and awareness about contraception has evolved, new contraception methods have been theorized and put in application. Although no method of birth control is ideal for every user, some methods remain more effective, affordable or intrusive than others. Outlined here are the different types of barrier methods, hormonal methods, various methods including spermicides, emergency contraceptives, and surgical methods and a comparison between them.

<span class="mw-page-title-main">Contraceptive implant</span> Implantable medical device used for birth control

A contraceptive implant is an implantable medical device used for the purpose of birth control. The implant may depend on the timed release of hormones to hinder ovulation or sperm development, the ability of copper to act as a natural spermicide within the uterus, or it may work using a non-hormonal, physical blocking mechanism. As with other contraceptives, a contraceptive implant is designed to prevent pregnancy, but it does not protect against sexually transmitted infections.

<span class="mw-page-title-main">Birth control</span> Method of preventing human pregnancy

Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unintended pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.

A postpartum disorder or puerperal disorder is a disease or condition which presents primarily during the days and weeks after childbirth called the postpartum period. The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. In the subacute postpartum period, 87% to 94% of women report at least one health problem. Long term health problems are reported by 31% of women.

Early postnatal hospital discharge generally refers to the postpartum hospital discharge of the mother and newborn within 48 hours. The duration of what is considered "early discharge" varies between countries from 12 to 72 hours due to the differences in average duration of hospital stay. The World Health Organisation (WHO) recommends healthy mothers and newborns following an uncomplicated vaginal delivery at a health facility to stay and receive care at the facility for at least 24 hours after delivery. This recommendation is based on findings which suggest that the first 24 hours after giving birth poses the greatest risks for both the mother and newborn.

<span class="mw-page-title-main">Intrauterine device</span> Form of birth control involving a device placed in the uterus

An intrauterine device (IUD), also known as intrauterine contraceptive device or coil, is a small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC). One study found that female family planning providers choose LARC methods more often (41.7%) than the general public (12.1%). Among birth control methods, IUDs, along with other contraceptive implants, result in the greatest satisfaction among users.

Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.

<span class="mw-page-title-main">Postpartum confinement</span> Cultural practice

Postpartum confinement is a traditional practice following childbirth. Those who follow these customs typically begin immediately after the birth, and the seclusion or special treatment lasts for a culturally variable length: typically for one month or 30 days, 26 days, up to 40 days, two months, or 100 days. This postnatal recuperation can include care practices in regards of "traditional health beliefs, taboos, rituals, and proscriptions." The practice used to be known as "lying-in", which, as the term suggests, centres on bed rest. In some cultures, it may be connected to taboos concerning impurity after childbirth.

The maternal mortality rate is 224 deaths per 100,000 births, which is the 23rd highest in the world. The mean age of mothers at birth is 19.3 years old, and the fertility rate is 5.72 children born per woman, which is the 7th highest in the world. The contraceptive rate is only 40.8%, and the birth rate is the 4th highest in the world at 42.13 births/1,000 population. Infectious disease is a key contributor to the poor health of the nation, and the risk is very high for diseases such as protozoal and bacterial diarrhea, hepatitis A, typhoid fever, malaria, dengue fever, schistosomiasis, and rabies. The adult prevalence rate of HIV/AIDS is 12.37%, which is the 7th highest in the world.

The postpartum physiological changes are those expected changes that occur in the woman's body after childbirth, in the postpartum period. These changes mark the beginning of the return of pre-pregnancy physiology and of breastfeeding. Most of the time these postnatal changes are normal and can be managed with medication and comfort measures, but in a few situations complications may develop. Postpartum physiological changes may be different for women delivering by cesarean section. Other postpartum changes, may indicate developing complications such as, postpartum bleeding, engorged breasts, postpartum infections.

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