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When the pregnancy is first confirmed it can be an emotionally charged time ranging from jubilant excitement, joy and hopeful anticipation, or to abject misery, especially if the pregnancy was not planned.
During pregnancv: women can retain their full range of sexual responsiveness throughout pregnancy, although there is usually a decline in libido in the first and third trimesters [2]. At these times you may prefer close physical contact and caressing to intercourse, and it is important to communicate this to your partner, and carry on your lovemaking as you both feel inclined even during the last month of pregnancy. There is a difference between 'making love' and 'having sex'. The former does not have to include penetrative sex, and does not have to include orgasm. Couples can greatly enjoy giving and receiving pleasure and share intimacy and sensuality once performance pressures are removed.
Problems may arise if intercourse has to be avoided because of: spotting, bleeding or pain, or the woman has high blood pressure, diabetes or is carrying twins, or has a history of repeated miscarriages, then her doctor should advise about the safety of having intercourse and/or orgasms. But there is never any reason why you should not express your love through "outercourse" which means mutual caressing and pleasuring and this can extend to stimulating your partner to climax if you are advised not to have intercourse or orgasms.
Positions: you may need to experiment with different positions that are comfortable as your tummy increases in size, and place pillows in strategic positions to support your tummy and back. The lateral [side by side] position would be more comfortable than the 'man or woman on top' positions.
Birth: ideally both partners should share the intense feelings of the powerfully emotional experience of labour as a culmination of your shared intimacy. This is only advisable if your partner has been adequately prepared during the pregnancy.
After the deliverv: about 50% of women have low levels of interest in sex, and this can continue for 3 months and even extend to up to a year [3]. Following delivery the frequency of intercourse decreases by half [4].
Women are affected in many ways by: lack of sleep, anxiety about the baby, difficulties with coping and adjusting to the role of motherhood, resentment at being tied down, away from work and her usual social stimuli, post natal depression, altered hormonal status and mood swings, anaemia, breast tenderness, and in some cases painful intercourse, and
fear of another pregnancy,
Men: may not approach their partner for sex because of resentment over being excluded from the intense bond between the mother and baby, fear of causing pain or another pregnancy, rejection of his advances because of her fatigue and diminished libido. Men need their partners’ response in order to enjoy sexual encounters, and do not enjoy using them as a receptacle. As a result he may develop sexual problems due to prolonged abstinence, which can result in premature or inhibited ejaculation, or erectile dysfunction and performance anxiety, any or all of which may require treatment. Some men find it difficult to change from making love to his lover to a 'mother', and you both need to discuss these feelings and conflicts.
Both partners need to make a special effort to be understanding in order to avoid problems. It is important to start kissing and cuddling and petting soon after delivery to reinforce emotional and physical bonding.
Medically speaking it is safe to start having intercourse after the lochia [blood stained discharge] has stopped [usually 3 weeks] - but some women have cultural and religious constraints that require that they wait about 6 weeks after the delivery.
Remember that ovulation can occur 28 days after delivery if you are not fully breast feeding, and it is important to ensure that you are protected by appropriate contraception before that time.
Pain may be caused by [temporary] dryness as estrogen levels are low after delivery, so ensure that you have a suitable lubricant and apply it as part of love- play before penetration.
If the episiotomy is painful have it checked by your doctor, as it may not be completely healed yet - this takes about 3 weeks, as there may be a granuloma - a tender red spot, -which can be treated. It may be a relief for you to take a mirror and look at the episiotomy to reassure yourself that it has healed - and that you will not come apart!
Remember that it is possible to achieve orgasm by mutual stimulation without penetration until the episiotomy has healed. It is helpful to massage the episiotomy for 3-5 minutes twice daily with your [clean] finger using KY jelly to ease the scar tissue. The episiotomy should be non-tender before you start having intercourse. Take time, be gentle and use lots of lubricant, communicate your feelings, and protect the sensitive area by using the 'women-above' position so that you are in control, and bear down [push] gently during entry to prevent any spasm of the vaginal muscles.
After stretching during the delivery the vaginal muscles don't 'grasp' as well as before and lubrication is less, and orgasm occurs with fewer contractions than before. But these changes return to normal after about 3 months. It helps to do the Kegel's exercises [see: Kegel’s exercises] to strengthen the muscles that contract reflexly during orgasm.
After Caesarean section: once the scar has healed outside, you are healed inside, and won't come apart with intercourse or weight bearing. It is safe to start having intercourse after 6 weeks, but you should check with your doctor if you have a discharge or any discomfort.
The baby: women usually bond easily and quickly with the baby because they are physically close, handling, caring for and feeding, but it is crucial to allow your partner into the circle so that he too can bond and not feel left out. Men may become jealous of women's preoccupation with the baby, and if in addition she is unable to respond sexually, the scene is set for disruption of the relationship.
Sleepless nights, exhaustion and limited time together can contribute to relationship and sexual difficulties as the new mother and father lose touch with each other. She feels burdened, he feels left out and these emotions can also affect the relationship. Father learns to sleep through the baby's crying more successfully than the mother. Hopefully you can laugh about this, and not be resentful - but arrange to get nights off. The need for 'survival sleep: fatigue is one of the commonest reasons given by new mums for sexual avoidance who say "I need sleep, help, affection- not sex". Make sure that you drop off to sleep whenever possible when the baby does. Express milk at least once a week so that you can sleep through the night, and father can feed and bond with baby - preferably on the weekend so that he doesn't fall asleep at work next morning. Show him that you trust him with the baby, and let him deal with changing and burping and cuddling as often as possible. Don't criticize what he does, but encourage him by tactfully showing him -he may do things slightly differently from the way you do, but he won't harm his baby. Granny is often very willing to help out for an afternoon or even overnight--- take advantage of this, she will love it and you and the baby will benefit, as will the man in your life.
Breastfeeding: 75% of breastfeeding women experience a reduction in sexual interest. This reduction can last for 6 months in at least half of the breast feeding women. In at least 25% of breast feeding women the reduction in sexual interest is severe [4]
Some women experience sexual arousal, and milk may be ejected during orgasm. Both are normal reflexes. The sexual arousal associated with suckling can even result in orgasm, and make some women feel confused and upset. As a result she may – subconsciously- "de-eroticizes " herself from the sensuous feelings connected to her breasts by suppressing all her breast responses both from the baby and her partner. In some cases this may then generalize to all the arousal responses causing anxiety, and can lead to inhibition of all sexual desire or arousal. This situation may require counselling. The hormone that promotes lactation- prolactin - causes loss of libido, and it is not that something has gone wrong, but it is a temporary hormonal change, and does not warrant discontinuing breast feeding. Breasts and nipples may be tender and too sensitive to give pleasure. Also they may leak during sexual arousal, so you may want to wear a pretty bra, and guide your partner to more receptive areas. Don't leave him guessing- it is even more important than before that you get in touch with your own feelings, and guide him by telling him what feels good or not. Tell him, or and show him with your hand on his how you wish to be touched, and where so that he can stimulate you effectively.
Depression: is common after the delivery and is often not recognized, and is a very real problem. Difficulty sleeping, loss of appetite, uncontrolled 'blues', difficulty making decisions, and loss of libido are important symptoms that require urgent help. See a post natal depression counsellor or your doctor, as anti depressants may be indicated, and can make all the difference.
