🎵Let's talk about sex, baby. Let's talk about you and me. Let's talk about all the good things and the bad things that may be. Let's talk aboooouuut sex.🎵 Salt-N-Pepa were right, it's definitely time we talk about the good and the bad when it comes to postpartum sex.
LOW LIBIDO POSTPARTUM
"I have no libido since having a baby."
"My husband thinks there's something wrong with me since I have zero interest in sex anymore."
"I want to have sex but I'm just too tired."
Years ago I read this blog by the amazing Jolene Brighten. If you have time to read it, I'd highly recommend it but here's the cliff notes- we have a hierarchy of hormones. On the bottom of that pyramid we have insulin and adrenal hormones, in the middle we have thyroid hormones and finally at the top of the pyramid we have sex hormones.
When we lack sleep, feel stressed, and constantly feel like we're in a state of fight-flight-or-freeze, our body focuses on making sure we are safe. Think of it this way, if you were being chased by a bear, your body doesn't care if you're able to enjoy sex or reproduce- your body's goal is first and foremost to get you to safety. This is the same thing postpartum but instead of a ferocious bear, you're constantly waking to and caring for an adorable newborn. You might be thinking, "but I love my baby" and you're 100% correct. You can be an amazing mom and love your baby AND be stressed by caring for a baby while recovering from birth. Even though it is a "good stress" it is still stress!
The key to helping libido is finding the root cause of your low libido. If you Google, you'll find a ton of ways to support your hormones but that's like fixing a roof that's leaking when the foundation is crumbling…it may help for a little bit but you'll find yourself with a leak somewhere else or never really getting anywhere. I unfortunately hear this all too often, "I took maca and it was amazing for awhile but I feel like I hit a brick wall." Oftentimes you get to the root by looking at your thyroid, glucose and insulin management, cholesterol and adrenals first. That way you can set a strong foundation to build upon and the brick walls and roof dont become an issue.
How to improve sex drive with low libido:
Functional medicine provider is key! It's easy to do a Google search and try ALL of the supplements but I prefer a more focused treatment. I frequently refer to Dr. Taryn Cass in Oak Park or Dr. Kalli Prater in St. Charles. They are both amazing masters of hormones who understand the hierarchy of needs and beyond. Instead of getting a bandaid to help your sex drive, they can help you get to the root cause so you start feeling better faster and ideally avoid those plateaus.
If your pregnancy, labor or delivery was traumatic, reach out to a mental health practitioner for 1:1 care. I can't emphasize this one enough. If birth was traumatic or you find yourself battling anxiety, depression or moments of rage, finding someone to help you work through those emotions (and out of fight-flight-or-freeze) is one of the best self care gifts you can give yourself. EMDR is also fabulous for helping process traumatic events.
Give yourself grace- this may sound odd but if you were used to sex 3-5 times a week and now only want sex once a week or maybe even once a month, it may be normal. Your body may just need more time to recover before it is ready! Let your body and soul heal so it can be ready.
PAINFUL SEX POSTPARTUM
"I feel bad for my husband because we tried to have sex but it hurt and we stopped."
"It hurts to even do foreplay"
"I have pain during sex so it isn't really enjoyable"
"I have pain after sex where I feel like someone punched me down there"
Sex should NEVER be painful.. yes, even if you are postpartum. Sometimes painful sex is caused by physical birth trauma like perineal tears, pelvic floor muscles tears, forceps or vacuum delivery or cesarean delivery. Tears and scars, even cesarean scars, can cause pain with sex. By releasing the tension underneath the scar, it can relieve pain.
If you experince pain during sex or after intercourse, often times this is a sign the pelvic floor is too tight and causes spasms. This is usually a "chicken or the egg" scenario because this can start in preconception, pregnancy or pospartum and can continue or become more prominent. Before starting kegels, it's important to find out if you have a tight or hypertonic pelvic floor and actually need relaxing/lengthening! One key take away is to find out why your pelvic floor is tight. Sometimes it's simple changes in how you move and breathe and other times you need more strengthening in other areas so the pelvic floor can relax.
Looking back at the hierarchy of hormones, painful sex can also be related to hormones in a few ways. First, if you have pain with penetration, this is often linked to inflammation or hormone in imbalances. If you're breastfeeding, it naturally decreases normal estrogen levels which can cause vaginal dryness and pain. There is a connection between pain with deep penetration and gluten intolerance so painful sex may simply be connected to what you are eating! There are even more ways that nutrition, the gut microbiome, hormones and inflammation play a role in painful sex so it's important to find out the why behind your pain.
How to improve painful sex after having a baby:
Work with pelvic floor PT, OT, DC who can help determine the cause of pain! If you're not sure if you have a tight pelvic floor or need strengthening and seeing a provider isn’t currently an option, the program "whats going on down there" can help you better understand what your next steps could be!
See a functional medicine provider If you believe your pain may be from inflammation or hormones
If you experince vaginal dryness, talk to provider about hyaluronic acid or topical estrogen and get a high quality lubricant!
FEAR OF POSTPARTUM SEX
"I have a prolapse and I'm terrified sex will make it worse."
"Honestly, if I wasn't afraid of getting pregnant, I'd have a lot more sex."
Fear can be the actual fear of sex or the fear of getting pregnant or fear around the changes your body has been through (or more).
Often times sex drive is related to our bodies being ready to carry another baby or not. Remember that stress component up at libido? If your body thinks it isn't ready for the physical or hormonal stress of carrying another baby, you might have low libido. It's the body's natural way of protecting itself.
If you have a prolapse or experience incontinence, you might be thinking, "is it even safe for me to have sex?" The good news is, there's no evidence that having sex while experiencing a prolapse or incontinence will make it worse. In fact, the increased blood flow that comes with an orgasm can actually help the nerves and muscles heal faster!
If you're afraid of getting pregnant again, it's time to have a candid conversation with your partner. Are they open to using condoms, helping with FAM (ahem, abstinence or condoms during ovulation)? Often times birth control falls on the woman but having an open conversation, tracking your cycle and using protection can help decrease those fears.
How to improve postpartum sex if related to fear:
Start counseling with someone trained in prenatal and postpartum can help you navigate the many fears that come along with postpartum sex.
Journal it. Share it with your partner if you feel comfortable. Often times when we hide or suppress our fears they can rear their ugly heads as anger, resentment or depression. Be open and honest with your partner about your fears so you can move forward together.
If you have fears about the safety of sex or the best position because of a prolapse, reach out to your pelvic floor rehab provider as they should be able to give you tips to ease the fear of sex.
BODY IMAGE AND POSTPARTUM INTERCOURSE
"I'm freaked out because I have a prolapse and something is falling out down there."
"I don't feel sexy after having a baby."
As someone who previously had a prolapse I wholeheartedly get this one. I felt gross and broken. With the help of counseling and focusing on how I talked about myself and to myself, I grew into loving my physical body again and I hope you can too.
The one thing I want you to know is that you are not broken and you are stronger than you know.
How to improve postpartum sex when body image plays a role:
Counseling. Talk to someone who is unbiased. Who can give you advice and help you reconnect with your new self.
Positive self talk. Let's be real, often times as moms we talk down about ourselves. You'd probably never let another person talk to you like that, so don't accept it from yourself! The next time you find you're beating yourself up, stop and acknowledge it. Instead of commenting on how gross or disgusting you feel, or how you didn't do enough, find one or two things that you truly like about yourself. It could be your nails or your hair or your teeth…anything. Highlight all of the parts of your body that you currently love.
Take 2 minutes to see if you're actually upset about your image or about the emotions and stories that come up with it. Maybe youre worried that your partner will love you less because of the prolapse. Or you feel like you're not worthy of love because you leak. Let the stories behind the feelings come out. Don't suppress. Don't try to reason with them. Just let them be. Let the ick stick and move forward.
DECREASED CONNECTION & POSTPARTUM SEX
"I feel like sex is more of a chore since having baby."
"I want to have sex but I feel so disconnected."
This one is so hard when you're in the midst of caring for a tiny human, healing, trying to nourish yourself and connecting with your partner. There are a ton of huge emotional shifts around childbirth and it's okay to feel uncertain. But it's important to not let that uncertainty trap you.
If you feel like you're lacking connection, it's first important to figure out who you are disconnected from. You may feel disconnected not only from your partner or friends and family but also the person you were prior to having a baby. Becoming a mother (again) can change who you are, what your goals are, what your dreams are and even who/what you value. This can be uncomfortable as you're trying to find yourself in this new role when you feel disconnected from who you were and who you are now.
How to improve sex when connection plays a role:
Do you know your love language? If not, it can be great start to better understanding how you would like to be shown love. For people that have acts of service as a love language, simply doing the dishes or laundry without being asked can help. For someone who loves quality time, scheduling a date night so you can bond 1:1 can help rekindle that spark. For someone who thrives with words of affirmation, reminding them how much you appreciate them and what they have done to help support the family can help them feel more connected.
Have I mentioned counseling yet? In all seriousness, working on yourself and your partnership in counseling is a great way to build a stronger relationship and connection. When your emotional safety needs are met, it can increase sex drive, desire, and satisfaction.
Schedule it. No, seriously. Put sexy time in your calendar. You can schedule a day date or morning coffee with sex afterwards (you know, after brushing your teeth). Time block it and stick to it. Remember, sex doesn't have to only be before bed when you're exhausted from the day…you can schedule it for 5AM if you're an early bird and stay your day off a little bit brighter.
THINGS ARE JUST "OFF" AFTER HAVING A BABY
Okay, this is me cheating. Sometimes we need to look at the bigger picture of postpartum sex and while I mentioned parts of these above I want to make sure they are not forgotten.
First, make sure your basic needs are met. Along with Jolene Brighten's hierarchy of hormones, we have Maslow's Hierarchy of Needs. Your basic needs such as food, water, warmth and rest need to be met before you can feel safe and secure. Only after you feel safe and secure can your body focus on intimate relationships and love needs.
Support your basic needs through:
Adequate hydration (use of electrolytes like LMNT or nuun can help)
Eat regular meals that include noth protein and fats. Reduce inflammation by reducing alcohol, sugar and large quantities of coffee
Sleep! I know this one is hard but when we don't sleep it can actually make depression and anxiety worse and also increases our sensitivity to pain. Ask for help so you can take a nap or see if your partner will take the baby in the early morning so you can sleep for 4 straight hours.
Next, how much do you really know about sex? If you're anything like me, the sex education I received was about as helpful as using a pinecone to wipe. Honestly, most sex education is one of two extremes – never have sex, sex is dirty, you will get pregnant and ruin your life or the opposite side where sex has to rough and erotic to be enoyable. The thing is, when you learn about sex and understand the why rather than being fearful, enjoyable sex is easier.
Support your understanding of sex through:
Omgyes.com is a website full of information on how to have an orgasm from an evidence based direction. It includes "insights about everything from specific ways of squeezing the clit in between surrounding skin to ways to stop overthinking in bed." This website can help you better connect with yourself sexually and help you give feedback to your partner for better foreplay and sexual satisfaction
Principles of pleasure on Netflix. This three-part series highlights the myths many of us grew up thinking was the truth, helps you understand how youe mind can empower you and how to navigate pleasure so you can truly enjoy sex.
Emily Nagoski is first a researcher of sexual health and well-being who turned to be an author for the book "Come As You Are". Her goal is to help people live with confidence and joy by better understanding how their body works. This may be through self pleasure or increased foreplay to help with orgasms.
Finally, stress. Oh how I wish this didn't play a role in postpartum sex but I would be lying if I said it didn't. Here's the catch- we all have stressors in our life. It is part of living. Oftentimes we can't truly reduce our stress but we can change how our body perceives it. This is called stress resilience…it's our ability to adapt and work through stress rather than letting stress take over. It takes time, it takes practice and it usually takes help to get there.
Support your sexual needs through stress resilience:
Stress resilience techniques- this can include going outside and connecting with nature, going for walks, taking time to rest (no multitasking!), exercise, contrast showers (hot-cold-hot-cold), active coping with emotions rather than hiding, mindfulness and meditation, and even creating a social support system
Find a counselor that specializes in perinatal mental health.
If you are open to supportive techniques online, some of my favorite therapists to follow are @somaticexperiencingint @iamhayleykaye @psychmonicavogt