Sex after Natural Childbirth: Can it be better than before childbirth?

By Anchen Verster – Registered nurse, midwife, SA Certified Perinatal Educator – SACPE, wife, mother to 4 children including a set of twins

Sex sells movies, music, magazines, clothes, perfume, diets and cars! The link is sometimes very vague (perhaps even non-existent) but it emphasizes what a big role sex plays in society. Magazines are filled with tips for better sex and those articles are always featured on the cover for the very reason that it sells. It does make me suspect that we’re looking for a secret remedy to what might be quite a complex facet of life. As a childbirth educator I have become increasingly aware that women are concerned about how pregnancy and childbirth might permanently scar or damage their bodies. They are concerned that this might have a temporary or permanent affect on their sex lives. Years ago this would have been a silent fear, but with the obvious exposure and interest in society, more women are eager to discuss this fear. This article is thus by no means intended to be explicit or feed into the sex-crazy sales. Rather it addresses a very real fear with some evidence-based information and as well as women’s experiences in order to help you in your decision making about birth.

Caesarean Section has become the ‘birth of choice’ in many private hospitals across South Africa. Women and their caregivers choose this mode of delivery for a variety of reasons often in the absence of a legitimate medical indication. Although this has become a common mode of delivery it does expose the mother and baby to a set of risks (both from the surgery and the anaesthetic) – we often don’t like to admit this. These risks could be reduced or limited if the mother were allowed to give birth normally with the help of professionals within a safe birthing environment. However, it’s become much easier for us to choose a caesarean birth because it’s so common. Many women and their partners who have experienced vaginal birth believe there are more advantages to this mode than is often communicated medically.

Myth: It’s easy to assume that the “stretching” of childbirth irreparably damages your vaginal wall or perineum (area of tissue between your vagina and anus). I heard one woman ask another after natural childbirth; “So what’s it like down there? Is it all loose and hanging?” I was rather astounded by the question but I wonder if many of us don’t have similar thoughts in mind? It’s obvious then to think that a caesarean would “spare” us from such a stretch.

Truth: The vagina is designed like a concertina- draped in folds (rugae). This means that the potential for stretching is significant and it is designed to fold back again after the birth. The perineum does sometimes tear but this tear heals more easily and effectively than when the area is cut (episiotomy). The area may be protected from tearing if the mother gives birth in a more upright position instead of lying down or ‘semi-lying’. Some mothers have found it helped to care for and prepare the perineum by massaging it daily with an oil (e.g. almond or grape seed oil) during the last few weeks of pregnancy. A large Australian study published in a medical journal of Obstetrics and Gynaecology found that mothers who had an elective or emergency caesarean or a vaginal birth with vacuum extraction were more likely to suffer from painful intercourse 18 months after the birth by comparison to mothers who gave birth normally without intervention or a sutured tear. It is not uncommon for women to experience pain with sexual intercourse for months after a caesarean birth.

Myth: The damage to vagina or pelvic floor is done only by the birth and not the pregnancy.

Truth: Given the weight of 9 months (well at least the last 6 months) of pregnancy and the circulating hormones that cause a little more ‘relaxation’ in tissues and joints, it stands to reason that the pregnancy may have an effect on the changes as well as the recovery of the pelvic floor and the vaginal tone. This effect might manifest itself in urinary incontinence (passing urine when you don’t plan to), faecal incontinence (passing stool when you don’t plan to) or sexual difficulty. The difficulty in these areas during the first few months after birth (vaginal or caesarean) might be slightly higher in women who’ve had vaginal deliveries (particularly when they have had a vacuum, forceps or episiotomy), but after 6 months the statistics are similar for both groups. Strengthening your Pelvic floor with pelvic floor strengthening exercises has been shown to have a positive effect and be protective against long-term damage. This means it’s important to strengthen your pelvic floor during pregnancy and after the birth (ideally also prior to pregnancy).

Myth: Vaginal tone or lack of injury is the greatest role-player in sexual pleasure.

Truth: There are numerous aspects of sexual intercourse that may hinder or promote a satisfying experience. These are often not related to how the baby was born but may well be related to the presence of a baby in the house. There is a phase of normal adjustment that needs to take place in order to reach ‘new normal’ functioning. A few aspects that may affect intimacy after the birth of a baby: Lack of lubrication (may be related to breastfeeding); loss of libido (possibly due to change in body shape/image, sleep deprivation, fatigue, candida (thrush), emotional factors (postpartum depression, anxiety), medication or fear of pregnancy.

Myth: Partners find the change in body and tone after normal childbirth to be displeasing.

Truth: One mother told me her husband said “My inside was tighter before childbirth- but it’s not better or worse for him, just different. My sexual drive was less while breastfeeding. Orgasm comes easier after childbirth.” Other mothers (as cited by Kelly Winder on her blog) refer to their partners finding no difference after natural childbirth or some difference after the first baby but then much “tighter” after the second baby. One father of six reported that it was “as good as ever!” Many reported their intimacy being much better which their husbands loved. Some thought this was because they were so much more confident in the ability of their body.

By virtue of the nature of pregnancy and childbirth and the intensity of the initial postnatal phase; you and your partner are likely to be affected by some form of sexual difficulty or dyspareunia (pain during sexual intercourse) during the first few weeks. Whether the cause is fatigue, stress or physical in nature it is most likely a normal part of the adjustment. However, it would seem that beyond six months there is a potential for sexual intercourse to be better than prior to pregnancy particularly following vaginal childbirth by comparison to six months following a caesarean section. Another study conducted recently showed no connection between the type of delivery a women had, how many children she had and her long-term ‘sexual desire, activity and satisfaction’.

Pregnancy and childbirth is the entry into a new era that may usher in a new security in your femininity and ability as a woman. Despite some ‘flab and sag’, having a baby may well make you feel more confident which will have a positive effect on intimacy. An Australian women’s health specialist physiotherapist Allison Hilbig says the following “The result of vaginal birth is an increase in blood supply to the area. This can result in women becoming more orgasmic after vaginal birth. The effect may be reduced if the pelvic floor is weak but a women’s health physiotherapist can teach women how to correctly exercise these muscles to improve strength”.

During a study conducted last year in South Africa, women reported positive changes in their intimacy after having natural childbirth. These changes were noted 6 months or more after the birth. There is a natural adjustment phase, which can take from a few weeks to a few months after the birth. This adjustment phase may include pain during intercourse, dryness or loss of interest. It’s thus normal to expect a few hiccups in the beginning following a normal or caesarean birth, however this should improve a few months later.

Some women had the following to say when questioned about their intimacy with their partners after natural childbirth:

“I had a second-degree tear after my son was born which healed well. No issues six months or more after birth” [1 natural birth]

“Sex is a much more enjoyable experience. Penetration seems to be deeper. Stimulation seems more effective. More orgasms almost every occasion as before [childbirth] probably one in four. More relaxed time.”

“It’s less painful [than before childbirth].”

“More easily aroused and reach climax faster”

These women gave a ‘thumbs up’ for how natural childbirth has affected their sex life

Resuming sexual intercourse after a vaginal or caesarean birth may be scary for you and your partner. Some caregivers recommend waiting for 6 weeks and again others recommend waiting until you feel ready (which might be before 6 weeks). The International Childbirth Educators Association recommends first allowing the perineum to heal and waiting until the lochia (the vaginal discharge that lasts 4-6 weeks after the birth) decreases. The same organization recommends delaying sexual intercourse for 2-4 weeks after a caesarean delivery. Corresponding principles apply, waiting until the wound has mostly healed and until there is less lochia. Keep in mind that it is possible to fall pregnant during this period even if your normal cycle hasn’t restarted yet. The secret is good communication and consideration for each other. It is not uncommon to leak breastmilk during intimacy but try and be lighthearted about it.

Ultimately, choosing a caesarean on the grounds of how it may affect intimacy is not a legitimate reason. Although there are some mothers who struggle after birth, the reasons for this are diverse and might not be related to the type of birth. Knowing that some women find intimacy more pleasurable and they feel more confident with their body’s ability can be a helpful motivation to get you through the push of childbirth!

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