Once their child is born and the difficult challenges of pregnancy are behind them, many couples look forward to having a normal sex life again. Unfortunately those expectations may not be realistic -- at least not immediately. Following childbirth, one partner may just not want to have sex. The possible reasons -- some physical, some psychological -- are many.
Fatigue is one. The period of caring for a newborn -- especially if it's the first child -- can be the most tiring and difficult phase in a couple's life. For many a new parent, fantasies about sex are supplanted by fantasies about sleep.
A woman might be self-conscious about her shape, and if she had a cesarean delivery, she may be experiencing extra discomfort or feel unattractive.
Both partners may be having trouble adjusting to their new roles as parents. A new mother could have postpartum depression (in which case she should consult her doctor).
A woman who is breast-feeding may feel that her body "belongs to the baby." The father in turn may become jealous of the time and attention that his wife devotes to the new baby.
There may be concern, too, that sex won't be the same as before delivery. Childbirth can leave soreness or bruising, and the couple may fear that sex will hurt, or cause harm.
In addition, one or both partners may be wary of starting a new pregnancy, especially if the delivery of the baby was traumatic.
On the other hand, some women find they have unusually strong sexual desires during this time.
There's a broad definition of what constitutes a normal length of time before resuming sex. In a recent study published in the Journal of Family Practice, fewer than 20% of participating couples returned to sexual activity in the first month after childbirth. More than 90% had resumed relations by four months after birth. The average time before resuming intercourse was seven weeks.
Most health care providers suggest waiting about four to six weeks before resuming intercourse, to allow the woman's body to heal. The uterus and vagina must return to their prepregnancy size, a process that usually occurs more quickly in breast-feeding women.
There are health reasons for not engaging in sex too soon. "The biggest risk of postpartum sex, particularly too soon, is infection," according to Robin Weiss, the pregnancy guide at About.com. Bleeding is normal for up to six weeks. First-time intercourse can increase bleeding, and it's not a reason for alarm. If bleeding persists beyond six weeks, though, it would be best to consult a health care professional.
Intercourse after childbirth can be quite painful. If the woman has had an episiotomy or laceration, there may be discomfort for weeks or even months after the stitches have healed.
Resume your sex life slowly, possibly with cuddling and petting, oral sex, or mutual masturbation, but not with penetration. Many couples wait until well after the recommended time to resume sex.
Keep a lubricant handy, since the decrease in estrogen after childbirth can reduce vaginal lubrication.
Experiment. Side-to-side or woman-on-top positions allow more control of penetration and put less pressure on parts of the body that may be healing. If soreness persists, you might ask your practitioner to prescribe an estrogen cream to lessen pain and tenderness.
Do not expect orgasms the first time you have sex after delivery. Some women don't have orgasms for weeks after childbirth, even if they were highly orgasmic before.
Try to spend some quality time alone with your partner regularly, even if for only 15 minutes at a time.
Communicate. If either of you feels strange, scared, or sore, tell your partner. Keep a sense of humor and don't expect too much -- there is always another time.
Although most couples find this a demanding time, they also ultimately find it very rewarding. Keep your expectations realistic, and it can be a time of renewed intimacy and pleasure.