Supporting Patients With Sexuality in the 4th Trimester

Often, health care professionals provide soon-to-be parents with a surfeit of information on what to expect during a pregnancy. However, once the baby is born, the flow of information pertaining to the parents’ health tends to fall off as the attention generally shifts to the well-being of the newborn.

Nevertheless, growing research consistently indicates the advisability of providing ongoing support and information to women and their partners about their own health after childbirth. This is particularly important in the 4^th trimester, or the first 12 weeks after giving birth.

Sexuality is just one component of a woman’s life that is impacted by childbirth. Mothers who may already be adjusting to the challenges of postpartum depression, physical recovery from childbirth, sleep deprivation, and caring for and feeding a new baby might also encounter emotional or physical obstacles when it comes to resuming sexual activities. Below are some talking points health care providers may choose to employ when supporting women and their partners with their postpartum sexuality.

It is important to allow yourself time to heal from childbirth. Most experts recommend waiting at least six weeks after childbirth before putting anything into the vagina to allow time for it to heal. According to a 2012 study on postpartum sexual function in women, more than half of women resume sexual intercourse by six weeks postpartum, and 90% resume intercourse by 12 weeks postpartum. That said, every situation is different. Couples will know what is best for them, and it is okay to wait a bit longer before resuming sexual activity. Encouragingly, data illustrates that although sexual function declines throughout pregnancy and the postpartum period, it gradually and steadily recovers 3-6 months after delivery.  

You may not feel like having sex right away, and that’s normal. Even in the best circumstances (e.g. spontaneous vaginal delivery or planned cesarean section), childbirth takes a toll on a woman’s body and mental health. This physical and emotional toll is further exacerbated by deliveries requiring a vacuum, forceps, or an unplanned cesarean section. A woman may experience new-onset health problems in the first few months after giving birth such as depression, urinary incontinence, infection, heavy bleeding, physical exhaustion, weight concerns, and hemorrhoids, among other issues. Furthermore, a woman’s estrogen and testosterone levels drop when she is breastfeeding, which may lead to reduced sexual drive. Naturally, caring for the baby and addressing these health concerns may take precedence over sexual activity in the beginning, and it is nothing for patients to feel ashamed of.

Body changes after childbirth are natural, but they may still affect your self-esteem. If you are struggling with body image concerns or your sexual expression after giving birth, you are not alone. Research shows that many women experience a lack of self-confidence after giving birth. In fact, one prospective study that assessed the sexual function and body image of 107 women throughout pregnancy and postpartum found that while body image did not change significantly during pregnancy, it worsened in the six months after childbirth. Women may feel self-conscious about their weight, their initially extended abdomens, and/or their genitals. Although these feelings are normal postpartum, women may benefit from seeking counseling and additional self-care opportunities during this time.

When you are ready to resume sexual activity, you may choose to start slow. Psychologist, certified sexuality educator, and doula Amy Gilliland, PhD, explains that couples may find it helpful to “try smaller things” after childbirth. “We’re very intercourse-focused rather than being pleasure-focused,” said Dr. Gilliland. “I would say focus on the things that give you both pleasure, whether that’s physical pleasure, or sexual pleasure, or emotional pleasure.” New parents might consider easing back into sexual activity with sensual pursuits that foster intimacy like kissing, hugging, cuddling, and/or trading massages.      

Resources:

Han, J.W., & Kim, D.J. (2020). Longitudinal Relationship Study of Depression and Self-Esteem in Postnatal Korean Women Using Autoregressive Cross-Lagged Modeling. International journal of environmental research and public health, 17(10), 3743. DOI: https://doi.org/10.3390/ijerph17103743.

Johnson, C.E. (2011). Sexual Health During Pregnancy and the Postpartum. The Journal of Sexual Medicine, 8(5), 1267-1284. DOI: https://doi.org/10.1111/j.1743-6109.2011.02223.x.

Leeman, L.M., & Rogers, R.G. (2012). Sex after childbirth: postpartum sexual function. Obstetrics & Gynecology, 119(3), 647–655. DOI: 10.1097/AOG.0b013e3182479611.

PSfromPenny. (2015, November 13). Sexuality After Childbirth – Conversation with Amy Gilliland, PhD [Video]. YouTube. https://www.youtube.com/watch?v=6bCX20ZhXwA.

Verbiest, S.B., Tully, K.P., Stuebe, A.M. (2017). Promoting Maternal and Infant Health in the 4^th Trimester. Zero to Three, 34-44. http://beforeandbeyond.org/wp-content/uploads/2017/01/Zero-to-Three-Article-for-Dr.-Verbiest.pdf.