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Intimacy After Childbirth: Scared, Touched Out or Not Ready at 6 Weeks? · Life After Birth by Her Health Room

• 0:00
  Are you six weeks postpartum and now scared to have sex?
• 0:03
  Asking yourself,"Will it hurt?
• 0:06
  Will it feel different?
• 0:07
  And what if I'm not ready but my partner is?" Let's be clear, six weeks is not a deadline.
• 0:12
  You do not owe anybody sex just because six weeks has passed.
• 0:16
  By the end of the episode, I want you to understand what's actually happening for you physically and emotionally so whenever you decide to have sex, it's actually your decision I'm Remi, I'm an obstetrics and gynecology doctor.
• 0:27
  I'm also a mother, and this is a Making Room podcast where we make space for honest conversation around pregnancy, postpartum, and early motherhood.
• 0:35
  Today specifically, we're gonna talk about sex after childbirth, and not simply when can I have sex,'cause if you type that into Google, it will most undoubtedly tell you six weeks.
• 0:44
  But that can't be the blanket statement for everybody But I'm gonna answer the real questions that women actually have, is it going to hurt?
• 0:51
  Will it feel different?
• 0:52
  What if I'm all touched out?
• 0:54
  What if I don't want to do it, don't even feel like it?
• 0:57
  This specific conversation came up after a podcast couple were discussing sex after she had a baby.
• 1:05
  She mentioned that she was two weeks after having a baby.
• 1:08
  He was quite keen on having sex, got really frustrated, to the point that she had to take him with her to the six-week check just so he could understand that she wasn't physically ready to have sex until six weeks had passed.
• 1:21
  And this went viral, as you can imagine.
• 1:24
  People were saying that his behavior was a bit coercive.
• 1:27
  Some people were like,"You can't judge their relationship off of a one-minute clip," but there is always this pressure that some women will feel to have sex after a baby's born just because their partner's ready, but they're not ready, And they don't deal with the underlying niggling thought or doubt as to why they might not yet be up for having sex And what I do feel is that conversation revealed what happens a lot to women who've just had babies.
• 1:52
  People would've been triggered by it because they'll remember their own recovery period, and how relationships are not quite set up because we've got this six-week myth that floats around.
• 2:03
  Six-week check with the doctor, six weeks to be A-okay.
• 2:07
  Some people only get six weeks maternity leave in other countries around the world.
• 2:12
  But this six-week number is ridiculous because it's taken you 40 weeks to grow a baby, for your body to change, to deliver that baby.
• 2:22
  Maybe you have tears down below or across the stomach, and now you're expected to bounce back six weeks later?
• 2:30
  It's unreasonable.
• 2:32
  Almost as long as it's taken you to be pregnant, carry a baby, is how much time we need to recover.
• 2:39
  Having said that, whether or not you have sex is your choice.
• 2:43
  The six-week myth around sex is also not necessarily medically indicated.
• 2:48
  So the NHS website would say,"Have sex when you're ready," and you cannot put a blanket number of weeks or months, or days even, on when another person is gonna feel ready to have sex but first things first, because I'm a doctor, let's think about the physical things that might mean that sex may be painful or unpleasant for you after having a baby In the first six weeks after recovery, when you go to your postnatal check, the things that they should be checking for is the bleeding.
• 3:15
  Has the bleeding gotten lighter over the time?
• 3:17
  Are your wounds healed?
• 3:19
  So either a wound across the tummy or in the perineum, any wound in that area, how have they healed?
• 3:24
  Are they back to normal?
• 3:25
  Do they need more treatment?
• 3:27
  Are you having any leaking from either the bladder or the bowel, which I cover off in my last podcast episode of how common that is after having a baby.
• 3:36
  And then also just pain.
• 3:37
  Are you breastfeeding okay?
• 3:39
  'Cause we know with breastfeeding people can get vaginal dryness and discomfort with sex as well.
• 3:44
  Contraception as well.
• 3:45
  So I've got a video on this channel about how quickly you can conceive after having a baby.
• 3:51
  So even from 21 days after having a baby, you're able to get pregnant again.
• 3:56
  So if you are going to resume sex, like how are you gonna plan your family, so to speak, if you're not wanting to get pregnant straight away?
• 4:04
  And even if your doctor gives you the sign-off, that doesn't necessarily mean that sex is a must or sex is something that you have to do because there might not be any physical issues wrong with you.
• 4:14
  You're still allowed to be in pain, you're still allowed to be recovering slowly, and all of those will impact when it is that you choose to have sex And just to caveat that, just because the wounds look healed doesn't mean what's underneath the wounds are healed.
• 4:29
  I speak about this a lot in the cesarean section recovery video.
• 4:32
  you've gone through layers of tissue, and even though the skin might have healed within the first six weeks, the other layers underneath will take time to heal.
• 4:42
  The pelvic floor will take time to heal.
• 4:45
  And it may well need longer than the six weeks for it to go back to normal and for you to be able to enjoy sex, and not find sex to be uncomfortable or painful And also, I'm not here to say that women should just wait for months and months on end.
• 5:00
  It actually has to be a personalized decision.
• 5:03
  I remember having a patient who was post cesarean section who had come in with some abdominal pain, and off the cuff, I just asked her,"Look, have you been sexually active?"'Cause I couldn't really figure out what had triggered her new pain.
• 5:15
  And she said she had been.
• 5:16
  And I was a bit like,"Oh, okay, any reason why?" And she was like,"Yeah,'cause I wanted to." And that's a really valid response.
• 5:22
  If you feel that you want to have sex before the six weeks are up, provided that you're not unwell, provided that you don't have gaping open wounds in the perineal area or even in the tummy so there shouldn't either be shame for women who are having sex before the six-week mark or shame for women who are choosing to wait six months if that's what makes them feel comfortable And what we don't need to do is have a rigid rule in place that we apply to all women.
• 5:50
  We should respect that women have choice and they have desires, and they can do whatever is best for them in their situation.
• 5:58
  The same way every pregnancy is different, every birth is different, every postpartum experience is also different, and therefore, the desires to having a sexual relationship is there.
• 6:09
  And also, I think it's really unfair to label men as the only people that miss the intimacy and miss sex and have desire.
• 6:15
  There are definitely women who fall into that camp.
• 6:18
  Granted, not many when I speak to people in, my social circle, and definitely not many when I see them in hospital.
• 6:24
  But I have come across patients who will have resumed having sex sometimes in the first week, sometimes in the second week, like, whenever they choose to.
• 6:33
  There is space for both If you've enjoyed this video so far, subscribe to this channel.
• 6:38
  The point of this channel is to help you navigate pregnancy and the postpartum period with safety, clarity, and support.
• 6:44
  Link down below and sign up to my wait list where you'll be the first to hear about resources that I have for you, events either online or in person to help you thrive in this season of life And so what if it hurts when you are having sex?
• 6:57
  One might think that if you've had a reasonably low injury vaginal delivery, that when you come to have sex that you're going to be fine.
• 7:07
  So I was reading on Reddit in preparation for this video, where all the honest voices are, and it was a woman who'd had a small first-degree tear, but actually when she went to have sex, felt that the sensation had changed And her partner had been gentle, but she herself felt nothing, felt numb.
• 7:24
  it just wasn't what she had expected from when she was having sex before having a baby.
• 7:31
  And I've also heard this socially as well.
• 7:32
  Like, when you've had a baby, the sensation of sex might change.
• 7:37
  You might find that what you used to enjoy you don't enjoy at all now, and that's where we have to leave space for honest conversation with your partners because they are also participating in it.
• 7:49
  and it has to be something that you're both enjoying.
• 7:52
  And also, with the question of will it hurt, that's a really valid question to have with your partner as well and thinking about ways in which you can reduce, pain or discomfort that's associated with it.
• 8:02
  So again, thinking about if you've had a tear in the vagina or in the perineum and it has healed, like completely healed, considering the use of things like a water-based lubricant that's gentle on the vaginal wall, gentle on the vaginal tissue, and using that to help you have sex may well improve your experience of it And it's not completely unusual for women to develop vaginismus after having a delivery.
• 8:30
  So sometimes trauma of having a vaginal birth, maybe having an assisted vaginal birth with an instrument might have caused pain.
• 8:38
  And so what happens is when you then go to have sex, that your body is a bit like,"Oh, let's protect ourselves from pain," because we've had this experience of birth, either with or without an instrument, either with or without a tear.
• 8:51
  And so then what happens is if you then have painful sex, what might then happen is that reinforces this idea of tensing of the pelvic floor muscles, guarding of the pelvic floor muscles, and may well be the starting point of associating sex with pain, which might start a vicious cycle.
• 9:12
  So being relaxed, using lots of lubrication, doing it when you're ready, when you feel healed, is way more beneficial in the long run than rushing into it and potentially propagating mental cycles that cause you to hold on or guard your pelvic floor against trauma and pain, if that makes sense at all.
• 9:32
  And these things are really important'cause physically you might look fine.
• 9:37
  Your pelvic floor might be assessed.
• 9:39
  You might be examined by a physiotherapist if you go down that route, and everything looks fine.
• 9:44
  But if it doesn't feel fine, that's the thing that I think that you need to go off on more And I'm not here saying that,"Oh, just relax.
• 9:52
  Just relax." No, that's not realistic.
• 9:55
  if anyone tells you to relax, if anything, you tense up more in anticipation of what might be coming.
• 10:00
  But you can engage the services of a physiotherapist who are really good with dealing with painful sex, especially after birth, where they can give you tools around how to relax the pelvic floor in preparation for sexual intercourse to make sure that sex is way more beneficial.
• 10:17
  But also actually just working with your partner, right?
• 10:18
  sex doesn't just have to be about penetration.
• 10:21
  It could be about touch.
• 10:23
  It could be about cuddles and intimacy.
• 10:25
  Caveat, I'm not a psychosexual therapist, it doesn't have to just be penetration.
• 10:29
  are there other ways that you and your partner can achieve intimacy without re-injuring yourself?
• 10:35
  And also what might happen is you have sex to please your partner, say it hurts, or say it's not satisfying, or say it feels different.
• 10:43
  You then hold all of that in mentally, and not only does it start a vicious cycle, it's probably not great for your recovery postpartum either And you might be thinking,"Okay, that's all well and good," because I've spoken a lot about vaginal birth, vaginal delivery and but what if someone has a cesarean section?
• 10:58
  The strain on the pelvic floor throughout pregnancy for the 40 weeks that you're carrying that baby, the stress and the strain on the pelvic floor is intense, So just because you have a cesarean section doesn't mean you evade or avoid pelvic floor dysfunction.
• 11:16
  You are still at risk of things like having a leaky bladder, leaky bowel, diastasis recti, so where the muscles along the midline of the abdomen are split, which means that your core isn't functioning as well as it should be.
• 11:30
  Also at risk of having painful sex.
• 11:33
  Like, all of these things can still happen.
• 11:35
  And prolapse, let me not forget.
• 11:37
  All of these things can still happen even if what you've had is a cesarean section And also, when you're healing from a cesarean section, you've got layers and layers of tissue that need healing from the inside out, and sex isn't just a thing that happens in the bottom part of the body.
• 11:53
  It's all connected, and there are women who will get abdominal pain, back pain, and things like that whilst having intercourse.
• 12:00
  So that doesn't mean that because you've had that Ugh, can't even imagine thinking about someone who's fresh off a section, who is still recovering.
• 12:10
  It doesn't mean that you're going to find sex necessarily smooth sailing.
• 12:14
  So you should still take it easy on yourself.
• 12:16
  You should still have that conversation with your partner because pain can still be a real issue for you, even if you have had a cesarean section at the top of the video, I alluded to breastfeeding, and how that can cause vaginal dryness.
• 12:30
  So what that does is it means that your estrogen levels are low, and so when it's lower, you get vaginal dryness, as you might expect in women who have menopause, probably not to the same degree, but that's the same mechanism of with which it works.
• 12:44
  And when you're breastfeeding and you get the vaginal dryness, sex might be way more uncomfortable.
• 12:49
  Your libido, like your desire to have sex as well, might be lower.
• 12:52
  That's worth discussing with your doctor and your clinician.
• 12:56
  Like it's not absolutely unheard of for you to have vaginal estrogen, to make it a bit more tolerable.
• 13:01
  So even if you decide that you wanna breastfeed for a year, that's still a long time to have, significant vaginal dryness that affects your sexual health.
• 13:10
  So if it is something that you wanted to do, you could speak to a doctor who was comfortable or familiar with that, Way before that just consider a water-based lubricant like I discussed early on to see if that helps with your symptoms We've spoken about pain, we've spoken about discomfort, dryness, the physical things, and, moving on to, more of the emotional and mental things, what if you just don't wanna have sex?
• 13:32
  That's also valid.
• 13:33
  You are well within your rights to say no.
• 13:36
  it's your body.
• 13:37
  And obviously depending on your relationship, the sensible thing is to have a honest and open conversation with hopefully a mature partner who can understand why it is you are where you are, and working through it together.
• 13:52
  Yeah, not wanting to have sex when you've just had a baby is also valid because, you might be breastfeeding, or even if you're not, you're waking up to feed, so you're tired.
• 14:02
  Your partner's likely at work.
• 14:03
  There's a whole load of sort of postnatal fatigue, insomnia, loneliness as well.
• 14:10
  So say they go back to work after two or three weeks, whatever their paternity leave is, and then you're on your own, and you're wading through this, fog of recovery, and it might just be the last thing on your mind.
• 14:23
  it might just be the last thing you wanna do.
• 14:26
  So can you do for that?
• 14:27
  And I think with conversation with your partner, again, speaking from experience more so than my clinical knowledge at this point, is being honest, right?
• 14:36
  I was quite surprised by how much my drive or libido would be lower after having my first baby.
• 14:44
  So when it came to our second, I was like,"Okay, this is potentially gonna take as long for me to feel like I want to do this.
• 14:52
  Maybe we can have conversations.
• 14:54
  Maybe we can figure out intimacy in other ways, like cuddling and things like that." And I think that it's things like that are more likely to bring you closer to wanting to have sex.
• 15:05
  the idea of sex being the biggest thing around your relationship is probably gonna make you wanna do it less because you are just tired and in need.
• 15:14
  It's a conversation I have often with friends.
• 15:17
  "How long did it take you?" Which is ridiculous.
• 15:20
  But it is more just to figure out if it's just you.
• 15:23
  you're not on your own.
• 15:25
  And there again, there's no shame if it was two weeks, and there's no shame if it was seven weeks or eight weeks or seven months.
• 15:32
  there's no shame in that.
• 15:33
  But it's figuring out that you're actually not alone, and sometimes reading through comments and threads, even if you never comment yourself, validates you and will give you tools that some people have found useful.
• 15:47
  So as anything, if it's becoming problematic, like it's affecting your mental health, it's providing a real strain on the relationship, then at that point you probably would benefit from some support, either like a psychosexual therapist or counseling, or even just going to your GP to see if there's an underlying condition for you.
• 16:07
  There are so many things that influence our desire for sex.
• 16:09
  So physical, yes, like about pain and things like that, but also physical in the sense that are you physically well?
• 16:14
  Are you healthy?
• 16:16
  Are you deficient in anything?
• 16:17
  Iron, thyroid problems, vitamin D.
• 16:20
  I don't know.
• 16:21
  is it winter?
• 16:23
  Are you having low mood?
• 16:24
  Are you anxious?
• 16:25
  Are you not sleeping because you're worried about the baby, or are you struggling to sleep because you've got postnatal insomnia?
• 16:31
  So there are so many other things that could be happening in you that have affected your desire to want to.
• 16:38
  So if it is becoming problematic, it is worth going to see your GP and talking through it.
• 16:45
  If you have a good GP or even, seeking support with psychosexual therapy to try and get to the bottom of why it is you feel the way you are.
• 16:53
  And I'm not saying you need to do this if you're six weeks and one day after, having a baby and not having sex, but more so if it's, a few months and it's something that bothers you, then you might as well go and seek help, get advice about it, see if you can put yourself in places where there's peer-to-peer support, and speak to other people who may well have gone through it as well And so just going back to the TikTok clip we saw, when does your partner wanting sex turn into coercion?
• 17:18
  And I think that's a really interesting thing because again, it's something that probably most people in their own relationships might not recognize.
• 17:26
  But when pressure starts to feel like coercion, like when you start to feel like you have to do it because they're in such dire need of it, and that's an unhealthy space to be in.
• 17:37
  And I would love to think that most people are in healthy relationships, that you could have a conversation with your partner and they would back off.
• 17:43
  but that doesn't do much.
• 17:45
  So I guess the minute that you know that someone wants it, even if it's three months, four months down the line, it might then feel like whenever you're doing it, you're doing it for them.
• 17:53
  So when does it become coercion?
• 17:54
  That's really tricky to answer because I'm not an expert in this field.
• 17:58
  But I would say that if you are feeling pressure and you're feeling like the relationship is not healthy, you seek support.
• 18:06
  So a few questions I'm gonna end this on, how do you know if you're ready to have sex?
• 18:09
  If you just take stock and ask yourself a few questions, then you'll be able to realize if you are ready or not.
• 18:16
  So the first question is, do I want this?
• 18:18
  do I actually want to have sex?
• 18:20
  And if that answer is no, it's like, why not?
• 18:23
  Is it because I'm worried about pain, or is it'cause I'm actually not interested?
• 18:27
  Is it because I'm feeding all day?
• 18:29
  Is it because I'm not getting any help around the house?
• 18:31
  If the answer is no, do a little bit more digging.
• 18:34
  If the answer is yes, however, then you might then wanna ask yourself this next question Do I feel safe saying stop?
• 18:41
  So if we have sex and it's really painful, or it's really uncomfortable, can I tell my partner to stop?
• 18:45
  and maybe having that conversation way before you get into that situation and then seeing the response to that.
• 18:51
  Are they willing to be gentle with you?
• 18:53
  Are they willing to support you?
• 18:55
  Are they willing to stop if it becomes too uncomfortable?
• 18:58
  And if the answer to that is yes, then you're good to go.
• 19:01
  If the answer to that is no, then maybe you need to be asking more serious questions.
• 19:05
  And lastly as well is if you do want it, you do feel like your partner would stop if it's too uncomfortable, the third question is, does it really have to include penetration?
• 19:16
  Can it be something else that demonstrates intimacy, that serves both of your needs and slightly warms you up to go on to have a a healthier sexual relationship later on?
• 19:28
  And I think if those three answers you feel comfortable, then yeah, go ahead, enjoy it.
• 19:33
  So if you are six weeks after having a baby and you are asking yourself,"Should I be ready to have sex now, and what if I'm not?" I really hope in this video that you've understood that, it's, one, your choice, but there'll be a number of things that might be going on for you that actually explain why you don't feel ready, why you might feel scared, that might explain why it might feel different after that you've had sex.
• 19:56
  And sometimes there is support for that, and sometimes it is just time, but even then, time shouldn't be infinite.
• 20:04
  It should be limited for if there is a time in which you feel it's becoming detrimental, that you then do seek help The whole point of this podcast is to have honest conversations around pregnancy and postpartum, difficult conversations as well.
• 20:18
  and I hope that you have gained something from this.
• 20:20
  I hope this has given you some ideas, and drop some comments down below because you actually don't know who else is gonna read it and how it might support them.
• 20:26
  I'm Remy.
• 20:27
  I'm an ob and gyn doctor.
• 20:28
  I'm a mother of two, and I'm building this space, for you to navigate pregnancy and postpartum with safety, with clarity, and support.
• 20:35
  If you found value in this video, subscribe to my YouTube channel, subscribe to the podcast wherever you're listening.
• 20:41
  And join my wait list where I'll be releasing resources around postpartum health and even some events online and in person to help you navigate this season of life?