Women tend to assume that after their bodies have bounced back from childbirth, their sex lives should do the same.
But Pamela Levin, MD, Assistant Professor of Clinical Obstetrics and Gynecology at Penn Medicine, knows this is not the case for many women.
A lot of women soon come to realize that sex after birth simply doesn't feel the same. You may not have the desire, you have trouble getting or you even feel pain during sex.
"If you're still having persistent discomfort, maybe your body just needs more time," Dr. Levin says. "But I think once you get past six to eight weeks, we would expect you to start getting back to your usual sexual activity."
Knowing what causes issues with sex after birth is a good first step in coming up with solutions.
Common Causes of Issues with Sex After Childbirth
The birth itself
After birth, "your vagina is different. You had a baby. You may have had a repair. You may have a scar there," Dr. Levin explains.
Women who had an episiotomy — a cut below their vagina to enlarge the opening for delivery — or who experienced a tear during delivery may find sex painful for the first few months after childbirth, says the American Congress of Obstetricians and Gynecologists (AGOG).
"Depending upon the type of delivery and repair, the sensation may be different," Dr. Levin says.
Stress about sex after childbirth
For many women, stress and anxiety can make sexual challenges worse.
If you get anxious about sex, the anxiety heightens your awareness of every twinge of discomfort. And like a destructive cycle, worrying brings about the very issue you're concerned about.
Changes in hormones
After giving birth, your body's hormone levels need to readjust to their pre-pregnancy state. This readjustment can reduce your sex drive and sexual response.
For instance, women who breastfeed have lower estrogen levels, which can lead to vaginal dryness.
New relationship dynamics
Your relationship with your partner might change after childbirth, too. It will take time for a new sense of balance to emerge in your family. After all, you've added a whole new person — and a pretty demanding one, at that.
During this transition period, your interest in sex may not match up with your partner's. And that's fine. Talk openly about expectations and what you're experiencing to make things less confusing.
Pelvic organ prolapse
Vaginal childbirth can injure your pelvic floor muscles, potentially leading to a condition called pelvic organ prolapse.
Symptoms range from a sense of dropping or gaping of the vagina to the appearance of a bothersome bulge near the vaginal opening.
Many women simply don't find sex enjoyable when they're dealing with pelvic organ prolapse.
When should you see a doctor for issues with sex after childbirth?
Sometimes, all you need to get your sex life back on track is time, but most women don't know they can talk to their doctor about challenges with their sex lives.
Dr. Levin says that because sex may feel different, "getting used to that idea and easing back into intercourse are also factors that come into play."
There's no standard timeline for when things should start getting back to normal; however, Dr. Levin says that "Anything that extends beyond that standard six to eight weeks of healing should prompt you to talk to your doctor."
The good news: Sexual issues after childbirth are usually not long-term. Whether you've had one child or several, or delivered via c-section or vaginally, none of this should have a long-term impact on your sexual desire, activity or satisfaction in later life.
That means there's hope. Talk to your doctor if your sex life hasn't returned to normal after six to eight weeks.