'Let's Talk About Sex': Not a High Priority for All New Moms

Troy Brown, RN

February 13, 2019

Most new mothers are told by healthcare professionals that they can resume having sex 6 weeks after giving birth, but the reality is that some women are ready by then while many are not, a small study has found.

The researchers conducted in-depth 2-hour interviews with 70 women, 55 of whom had given birth, as part of a larger study of reproductive health throughout the lifespan. During the interviews, women recalled conversations between themselves and their physicians about postpartum sex.

"Among participants, the most frequent recommendation from health providers was to resume sex after the 6-week postpartum visit," lead author Andrea L. DeMaria, PhD, from the College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, said in a news release from her institution.

"But we found some women were ready before 6 weeks due to personal and partner desire, while other women expressed difficulties resuming sex, including pain and exhaustion from caring for a new baby."

DeMaria and colleagues published their findings online February 4 in Culture, Health & Sexuality.

"That providers recommend the same 6-week standard almost universally implies that it pertains to women regardless of age, parity, mode of delivery, or personal feelings about sex resumption," the authors explain.

Instead, advice should be personalized, they say.

"These findings provide practical recommendations for health professionals to further develop tailored, timely health messaging related to safe and healthy postpartum sexual behaviors."

Varying Levels of Readiness at 6 Weeks Postpartum

Most women surveyed (n = 40) delivered vaginally; 10 gave birth by Cesarean delivery; three had had both kinds of delivery in different pregnancies; and two did not specify the type of delivery. Overall, 73% of the women who had given birth had multiple children whereas 27% had one child.

Women identified clinicians as being the most influential concerning when they should and could resume sexual activity. Positive advice included: "You're healthy, you can go ahead and have sexual (relations)" or "You're healed, you can do it whenever you want to do it."

But others recalled having received terrible advice. One remembered her gynecologist stating, "Well, girl, you better, because if you don't, somebody else will," when discussing returning to sex with her partner.

Some were ready for sex by 6 weeks but others were reluctant for reasons that included physical discomfort and psychological barriers, among others.

One woman said, "I was scared. I was sore."

For others body image was an issue. "I was probably a little bit more self-conscious about my body than before [giving birth]," one woman observed.

Exhaustion was another barrier. "I hadn't slept in 6 weeks and I wouldn’t sleep for a long time, so I was like, 'If you get near me, I will murder you,'" said another.

Women also reported shifting priorities after having a baby. “I was a mother first. Even in terms of sexuality I was a mother first. My breasts were my kids," one recalled. "It was not on my radar. I didn't want any attention," another said.

Others, however, were ready to resume having sex by 6 weeks and found it pleasurable when they did. "It was probably more satisfying, I probably enjoyed sex more after I gave birth than before. In some ways I think it was more liberating," one woman remembered.

And women weren't the only ones who had second thoughts about resuming sex, with some stating their partners were scared and unsure.

The researchers also found that mode of delivery impacted sexual satisfaction and that if women are aware of these potential difficulties before engaging in intercourse they may have opportunities to find solutions to enjoy sex, rather than becoming discouraged.

6-Week Guideline Should Be Flexible and Fluid

The American College of Obstetricians and Gynecologists used to recommend a one-time visit at approximately 6 weeks after birth, although it updated its recommendations on postpartum care last year, from an initial visit within the first 3 weeks, followed by ongoing care as appropriate and a comprehensive visit by 12 weeks postpartum.  

The authors say clinicians should talk with patients regularly about sex after childbirth and that doing so will make it easier for women to express their concerns.

It is important to reassure women that sex is "familiar to them" and "it may take some practice to get back into their sexual routine or establish a new one" they explain.

The 6-week recommendation should therefore "be discussed as a flexible and fluid guideline, rather than a strict rule."

"If healthcare providers can bring this up and normalize these different experiences, then women and partners will be more aware of what they should be on the lookout for, that these feelings they're experiencing are normal," noted coauthor Stephanie Meier, a doctoral student at Purdue.

"Those conversations should continue throughout prenatal and postpartum visits," she concludes.

The authors have disclosed no relevant financial relationships.

Cult Health Sex. Published online February 4, 2019. Abstract

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