Sex may be the last thing on your mind when you have just had a baby. Your perineum will probably be bruised and you may have had stitches for an episiotomy or tear. Apart from anything else, the flow of lochia may make intercourse impractical – at least for a while. Many women also find that breastfeeding reduces their sexual appetite, although others find it enhances it.
There are no general rules about. Each couple should resume intercourse when they feel ready. This may not be for several weeks, or it may be much sooner, it does not matter which. However, even if full intercourse is not desired, or possible, at the beginning, gentle lovemaking that stops short of penetration can give both the new mother and father much pleasure.
First attempts at intercourse after the baby has been born should be slow and gentle. Even if the perineum no longer feels sore under normal circumstances, insufficient vaginal lubrication during intercourse may cause discomfort. Often, longer foreplay will encourage the secretion of more lubricating fluid, but if this is still insufficient, the answer may be to use some lubricating jelly – available over the counter in most chemists.
With the resumption of sexual relations comes the need for. This in itself can initially make sex more problematical because the couple have not had to bother about this aspect of their lives for at least nine months.
If the woman is breastfeeding she is protected to some extent against; and if the baby is fully breastfed on demand (which includes feeding during the night) she is very unlikely to conceive. However, if the baby sleeps through the night and settles down to four-hourly feeds during the day, then the couple certainly need to use some form of , even though the woman’s fertility is lower than usual during the first months after delivery.
The advantages and disadvantages of most methods ofdo not change just because the couple have had a baby. It is still a matter of individual preference. There are two exceptions, however. First, breastfeeding women should not take the combined contraceptive pill (containing both oestrogen and progesterone) because it will affect their milk supply. The progesterone-only pill (mini-pill) does not seem to make much difference to the volume of milk produced. Second, some women may choose not to take the mini-pill because they are concerned that the hormone in it, which gets into the milk in small amounts, may not be good for their baby. Although there is no evidence that such tiny quantities of progesterone are harmful, the mini-pill has not been with us for long enough to be certain.
An intrauterine device (IUD) may be the ideal contraceptive after childbirth, even for women who have found this method troublesome before. This applies particularly to first-time mothers. After a woman has had her first baby her uterus is slightly larger than previously, and the cervix is less sensitive owing to the stretching it has undergone during labour. An IUD may therefore be inserted more easily, with less discomfort, and once in place is less likely to cause cramping pains. A disadvantage, however, is that the IUD may also be expelled more easily.
A barrier method – using a condom (sheath) or diaphragm – may suit some couples. If they have used barrier methods before, so much the better, but if not they may find that these types of contraceptive seem less unattractive than they did. This may be because, having shared the birth of their child, the couple are more relaxed together, or, perhaps as a result of giving birth, the woman is more familiar with her body and therefore willing to try a diaphragm for the first time. If so, she will need to visit her doctor or family planning clinic to be properly fitted for one. Diaphragms are made in different sizes and one that does not fit will not do its job.
If the woman was using a diaphragm before she became pregnant she will probably need a new, larger one. Accurate fitting of a diaphragm is not possible until at least six weeks after birth, when the uterus and cervix have returned to their pre-pregnant state, so this could be done at the first postnatal check-up. The condom, used with a spermicidal pessary or cream (or one of the newer types of condom that have a spermicide incorporated) has much to be said for it. However, if lack of vaginal lubrication and a sore perineum are making sex uncomfortable, a sheath is unlikely to improve matters. Lubricating jelly may help in these circumstances.