Having sex with your partner after having a baby can lead to anxious and exciting feelings. Dr. Dana Elborno (@thegirlgyno), OBGYN in Chicago, answers the most frequently asked questions from new moms about having sex after giving birth. Keep reading to learn more!

Dr. Dana Elborno, OBGYN in Chicago (@thegirlgyno), answers the most frequently asked questions from new moms about having sex for the first time after giving birth.

First time sex after baby can be a mixture of anxiety inducing and exciting feelings and I would say both of those things are common. Patients often describe to me being excited to getting back to some aspects of their normal pre-baby life and relationship, but also being worried – commonly about their body looking and feeling different, lactating breasts and anticipating pain. I often share with patients that women commonly have mixed feelings about sex after baby and that is not only normal, but expected. I reassure them that we are here to help them along the way and with a few tips hopefully make it less intimidating, enjoyable and fun!

What are normal things to expect and feel the first time having sex after baby?

Dryness and discomfort can be common. Delivery and breastfeeding drop estrogen levels, so your vaginal tissue can definitely be drier than pre-baby, which in addition to any delivery related tears can contribute to discomfort during penetration.

To prevent this, use a lot of lubrication. I personally recommend silicone based lubricants like Uberlube. Not only does it come in a beautiful glass bottle, but it is superior to water-based lubricants because it stays slippery longer and unlike oil-based lubricants, is condom friendly. You literally cannot use too much. If you are not needing condoms for birth control, you can definitely try coconut oil, which a long time favored solution by all of us millennials for most things in life and turns out – this is no exception.

I would also encourage women to explore vaginal penetration with fingers or a petite vibrator on your own (I like this one because it’s slim which is a good shape when you are especially hesitant about penetration). This, I think is helpful for a million reasons. One, it helps you gauge if you are ready and may help you build up to vaginal penetration with your partner. Two, it helps you rebuild your sense of self as a sexual person post baby. Yes, your boobs may be lactating and your body may look and feel different to you, but you are still you.

The process of claiming this body as your own, even as a more beautiful, sexy and stronger version of yourself for the experience you just went through I think is an important step in healing postpartum. Three, if there is anything particularly painful- it’s probably better to find out in a more controlled setting, so you can discuss with your doctor before getting back in the saddle, so to speak.

Knowing yourself – both what feels good to you or causes discomfort is key in order to communicate to your partner what your body is craving in this new phase/stage of postpartum healing.

What feelings are NOT normal?

Sharp pain, intense cramping and heavy bright red bleeding with penetration are among the symptoms I would say are absolutely not normal and need further evaluation.

What’s the best sex position that won’t be as painful?

Any position which gives you more control of depth of penetration and speed are ideal. For heterosexual partners, you being on top either facing your partner or facing away while your partner is lying down or sitting in a chair are great for this. Honestly though, as long as you are communicating about what feels good and what you need – any position is great for heterosexual or same sex partners.

Why does it hurt to have vaginal intercourse after a vaginal birth? 

This is likely related to healing after vaginal trauma and due to dryness related to the drop in hormones post delivery and with breastfeeding.

After a baby is delivered vaginally, there is commonly a tear in the perineal muscles. These muscles support the opening of the vagina. The body’s natural response is to form a scar where the tissues have torn.  Sometimes that scar tissue can become weakened, restricted or painful, resulting in painful sex.  Inflammation around sutures called granulation tissue and regrowth of nerves in the area also can make the opening of the vagina more sensitive.

I think the other thing to keep in mind is that our central nervous system has a well-defined defense mechanism to force our muscles to flex in response to pain – think pulling your hand away from a hot stove. In response to pain during delivery, some women’s pelvic floor muscles can develop a similar reflex and essentially get overly activated/tight. Some women can have a hard time learning how to relax their pelvic floor which can definitely make vaginal penetration more painful.

Does it hurt to have sex after a c-section too?

It absolutely can. All of the above can definitely apply- sometimes moreso, as your abdominal wall can definitely get a work out with sex and depending on how you are healing post c-section incision, that can add another layer to discomfort with sex.

What can I do if it’s uncomfortable?

Try the common fixes like extra lubrication, positions that give you more control, extra foreplay, etc. If the discomfort is not improving- see your doctor. They will assess for granulation tissue, excess scarring, infection, etc.

She/He will likely refer you to pelvic floor physical therapy, which can genuinely be life-changing to help you reclaim and rehabilitate your pelvic floor!  This will help you both to relax muscles that are overly tight, strengthen muscles that were weakened or stretched out by pregnancy and labor and help release any scar tissue to help you return to intimacy and exercise comfortably and with full bladder and bowel control.

They achieve this through external and internal vaginal physical therapy, which I know sounds weird, but trust us on this one. All pelvic floor physical therapists are highly trained professionals who truly understand the big picture of how your pelvic bones, joints, connective tissue and muscles all need to communicate with each other to maintain sexual function. It is truly instrumental in helping treat many forms of sexual dysfunction post baby. Pelvic floor physical therapy is also instrumental as first line therapy to treat post baby urinary incontinence, fecal/flatal incontinence or vaginal prolapse.

I also occasionally recommend vaginal dilators (see below) in addition to physical therapy. Vaginal dilators are essentially a set of tubes that come in a pack ranging from small to large that women can use to practice vaginal insertion. These can be helpful to help introduce penetration in successively increasing size when the vaginal muscles are overly tight or contracting with attempts at insertion.

My favorite medical vaginal dilators are She-ology (great silicone option that comes in graduated sizes), Dr. Laura Berman’s basics dilators set (graduated sizes and vibrates for $22!), and this vaginal dilator set that comes with a training guide and videos and is made by a pelvic floor physical therapist so it’s super helpful to anyone intimidated by the process and wants extra guidance on how and what to do at home.  I also really like this vibrator because it’s long and slim (good shape when you are especially hesitant about penetration). Make sure you are using a lot of lubricant!

Is it normal to pee when I stand up after having a baby?

Around 10-30% of women after a delivery will experience some kind of leaking of urine when they cough/laugh/sneeze/have sex/stand from a seated position or run. This is called stress urinary incontinence. Interestingly, this occurs in women both with cesarean sections and vaginal deliveries at nearly similar rates (only 8% more likely in women after vaginal deliveries.) It tends to get better with time and can definitely improve with pelvic floor exercises, so yet another reason to see pelvic floor physical therapy if it is bothering you.

There are also surgical fixes for it, but we typically do not consider them in women who are still planning to carry more babies.

Will it feel different for my partner to have intercourse after having a baby?

I can say as a gynecologist, I see around 20 vaginas/day and have seen 1000s of vaginas at this point. Genuinely, most times, I cannot tell just by looking or examining if someone has or has not had a vaginal delivery in the past. The vagina has an incredible ability to expand for delivery and contract back to a pre-pregnancy size, similar to the uterus.

How do I know if my pelvic floor is weak and what can I do about it?

Not being able to hold in urine, poop or gas when you want to and/or having trouble peeing, pooping or passing gas when you want to can all be signs of pelvic floor weakness and dysfunction, as can feeling a vaginal bulge or pressure when you are standing for long periods of time or with lifting something heavy.

The solution is usually a combination of pelvic floor muscle exercises to strengthen periurethral and perivaginal muscles, along with bladder training, biofeedback, or electrical stimulation.

Talk to your doctor if you have any bothersome symptoms and they will help guide you to next possible steps…and whatever you do, do not stick a jade egg into your vagina.

What are my birth control options + which is the most preferred by women?

So this is a critical question when talking about postpartum sex. Now regardless of whether your periods have started again or not and whether or not you are exclusively breastfeeding, you need an effective birth control plan.

For breastfeeding mamas, progestin only methods which come in a pill, IUD, shot and arm implant are all options postpartum.

Combined hormonal contraceptive which have both estrogen and progestin and come in a pill, patch or vaginal ring are safe to use 42 days+ postpartum from a blood clotting risk perspective. If your goals are to breastfeed, please know that all forms of hormonal birth control may decrease your milk supply and have been associated with early cessation of breastfeeding.

Barrier methods like condoms, natural family planning and lactational amenorrhea with exclusive breastfeeding all have higher failure rates and though favored by some women postpartum do increase your risk of unplanned pregnancies. Short pregnancy intervals, less than 6 months, may increase risks of growth restriction and preterm labor. 

Exclusive breastfeeding is not a fail proof form of birth control! Many breastfeeding parents can get their cycle back and ovulate while exclusively breastfeeding, especially if baby is sleeping through the night. It’s important to know your body and your cycle patterns – click here for our sex ed post and for our period after baby post.

Why do you have to wait to have sex until your provider clears you?

The majority of tissue healing through inflammation, wound closure and contraction takes about 4-6 weeks. So whether you had a vaginal delivery or a cesarean section, your doctor assesses how the tissue is healing and can help reassure you that your wound is closed well and that there is no exposed inflammatory tissue around your sutures.

Is it ok to wait to have sexual intercourse even after my provider has cleared me?

Oh my goodness, yes. We are only assessing physical healing and giving you medical reassurance that if you want to have sexual intercourse, you can. WANT being the operative word. Hormones, mental health and partner dynamics are all huge parts of the equation as well.

There is an old saying in sex therapy that you can’t make love until you make peace. Making peace with each other and yourself is critical.

A new baby can open the door for new relationship dynamics some of which are beautiful like seeing your partner as a loving and nurturing parent, some of which are challenging like the resentment of feeling like your workloads are uneven and your burdens are not equally being shouldered.

Making peace with your new body is also critical. I can’t tell you how many women use such negative language about their new bodies postpartum, describing themselves as matronly and magnify their least favorite traits in their reflection of self: stretch marks, saddle bags, cellulite, you name it. When you are overly focused on your appearance, your body will not be able to relax and respond sexually.

Because of this and/or ongoing pain/discomfort, MANY delivering partners are not having sex after 6 weeks. Some do quite a bit of physical therapy, couples counseling or personal therapy in the postpartum period before they are ready to have sex again and that is all okay.

Though most healing has occurred by 4-6 weeks, it can take up to 2 years for your scar tissue to achieve maximal strength and flexibility, so be patient with your body and give yourself grace through your healing process. Listen to your body and communicate how things feel to your partner so they can be present in this process with you. Introduce sex back into your life/relationship when you are ready.

Have more questions? Schedule a text or video chat consult with Kate, Lauren or Natalie (NICU RNs) and they can help answer any questions that you have!

Other helpful blog posts:

• 4 reasons why you should see a women’s health physical therapist
• Your period after baby
• Battling postpartum hair loss

**This post is educational and not meant to take the place of your provider. Bumblebaby makes a small commission on some of the items listed above