Sex after pregnancy might be the last thing on your mind. Understand what to expect and how to renew intimacy with your partner. By Mayo Clinic Staff

Sex after pregnancy happens. Honestly. First, however, vaginal soreness and sheer exhaustion are likely to take a toll. Whether you're in the mood or sex is the last thing on your mind, here's what you need to know about sex after pregnancy.

Whether you give birth vaginally or by C-section, your body will need time to heal. Many health care providers recommend waiting four to six weeks before having sex. This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.

The other important timeline is your own. Some women feel ready to resume sex within a few weeks of giving birth, while others need a few months — or even longer. Factors such as fatigue, stress and fear of pain all can take a toll on your sex drive.

Hormonal changes might leave your vagina dry and tender, especially if you're breast-feeding.

To help ease any discomfort during sex, take it slow. Start with cuddling, kissing or massage. Gradually build the intensity of stimulation. If vaginal dryness is a problem, use a lubricating cream or gel. Try different positions to take pressure off any sore areas and control penetration. Tell your partner what feels good — and what doesn't.

It's also important to focus on the moment. Keep your mind on yourself and your partner — not the diapers, laundry and other household chores.

If sex continues to be painful, consult your health care provider about possible treatment options.

After a vaginal delivery, decreased muscle tone in the vagina might reduce pleasurable friction during sex — which can influence arousal. This is usually temporary.

To tone your pelvic floor muscles, try Kegel exercises. Simply tighten your pelvic muscles as if you're stopping your stream of urine. Try it for five seconds at a time, four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. Once you've got the hang of it, do at least three sets of 10 Kegel exercises a day.

Unless you're hoping to become pregnant right away, sex after pregnancy requires a reliable method of birth control — even if you're breast-feeding.

At first, your health care provider might recommend barrier methods such as condoms and spermicides. These are available over-the-counter and are safe to use at any time. You might also consider birth control methods that contain only the hormone progestin, such as the minipill or Mirena, a hormonal intrauterine device (IUD). You can begin using the minipill and other progestin-only contraceptives immediately after childbirth.

Birth control methods that contain both estrogen and progestin — such as combined birth control pills or NuvaRing (vaginal ring) — pose an increased risk of blood clots shortly after delivery. For otherwise healthy women, it's OK to begin using combined birth control pills and other types of combined hormonal birth control six weeks after childbirth.

Although birth control methods that contain both estrogen and progestin have long been thought to decrease milk supply for women who are breast-feeding, recent research suggests this might not be true. If you're breast-feeding and want to take birth control pills, ask your health care provider to help you choose between combined birth control pills, which contain both estrogen and progestin, and the minipill, which contains only progestin.

Caring for a newborn is exhausting. If you're too tired to have sex at bedtime, say so. This doesn't mean your sex life has to end, however. Consider making love early in the morning, while your baby naps, or while your baby spends a few hours with a trusted friend or loved one.

That's OK. There's more to an intimate relationship than sex, especially when you're adjusting to life with a new baby. If you're not feeling sexy or you're afraid sex will hurt, share your concerns with your partner.

Until you're ready to have sex, maintain intimacy in other ways. Spend time together without the baby, even if it's just a few minutes in the morning and after the baby goes to sleep at night. Share short phone calls or send text messages throughout the day. Look for other ways to express affection. Rekindle the spark that brought you together in the first place.

If communicating with your partner doesn't help, be alert for signs and symptoms of postpartum depression — such as intense irritability and anger, overwhelming fatigue, lack of joy in life, and difficulty bonding with the baby. If you think you might be experiencing postpartum depression, contact your health care provider. Prompt treatment can speed recovery.

Most sexual concerns associated with pregnancy or childbirth resolve within a year. In the meantime, concentrate on ways to promote your physical and mental health. For example:

  • Set reasonable expectations as you adjust to parenthood.
  • Appreciate the changes in your body.
  • Eat a healthy diet, including plenty of fluids.
  • Include physical activity in your daily routine.
  • Rest as much as you can.
  • Ask your partner, loved ones and friends for help.
  • Join a support group for new moms.

Remember, taking good care of yourself can go a long way toward keeping passion alive.

Jul. 10, 2012