Pregnancy and delivery is a difficult time for intimacy in relationships. I was therefore not surprised when Rebecca walked into the Sexology Clinic with her husband, Gerald, and made one request: that I tell the man to keep off!
“Keep off from what?” I asked, trying to understand their situation given that I was meeting them for the first time.
“I refuse this blackmail,” Gerald shouted back. “You cannot keep punishing me for mistakes not of my own making.”
I requested them to calm down and explain what the issue was. In my many years in Sexology Clinic, I have learnt that sex issues can be emotive and calls for a lot of tolerance and patience to seek them.
The issue was that Rebecca was three months post-delivery. She had delivered a bouncing baby boy through vaginal means. It was her first delivery. Incidentally the pregnancy came too soon, conception happened during honeymoon. The couple was only one year in marriage.
“I already forgave him, in fact I told him that we were both responsible for the mistake,” Rebecca explained, her eyes welling up with tears. “His mind is however stuck there and he does not listen to me when I explain what I am going through.”
The problem was that in those three months after delivery, the couple was yet to resume sex. Gerald was getting weary of this. Every attempt he made at having sex was rejected. According to him, Rebecca always had excuses for refusing sex. He concluded that she was out to punish him for the mistimed pregnancy.
“Were we not advised to resume sex after six weeks?” Gerald interjected. “Is it something I am making up? Was it not medical advice?”
I intervened to explain the complexities around resuming sex after delivery. For one, women breastfeed exclusively during this time. The hormone that makes milk flow, known as prolactin, is high at this time and is known to numb the body against sex. It diminishes your desire for sex. So, all the fantasies, thoughts and urges diminish. In fact your body responds poorly to sexual stimulation and foreplay may not yield the desired effect.
Coupled with this is the exhaustion of looking after the baby. Babies have this habit of keeping you awake at night so that by morning, you are totally worn out. Unfortunately, you may not find time to compensate for the lack of sleep during the day, making you permanently fatigued, sex being the last thing in mind.
A number of women are also in some form of depressed mood in the months that follow delivery. Call it postnatal blues, psychological stress, anxiety or irritable mood. They may also hate the shape of their bodies, may lose self-confidence and they may feel hopeless and worthless. Their state of mind is just not right for intimacy.
Also read: Let's talk about sex after childbirth
The fact that you may have had some injuries in the vagina during delivery only serves to make things worse. It is common practice to be cut or to tear down there as you push the baby out. The damage is stitched back and healing is expected to happen in six weeks. What happens however is that pain, especially on intercourse, may persist for many months thereafter. Many women dread the pain and evade sex. Lack of lubrication due to difficulty in getting stimulation does not make things any better. In fact, pain is the commonest sexual dysfunction following delivery and requires time for complete resolution to happen.
“Please tell Gerald, I shudder to imagine that penetration is going to happen and I must confess I push him away hard and fast,” Rebecca exclaimed.
But even if penetration was to happen, the hormonal changes in the body makes it difficult for the woman to get orgasm. It may, therefore, take months before a woman feels satisfied with sex post-delivery.
“So, now that you have sided with her and dismissed the six week advice, can you give a way forward?” Gerald asked, throwing his hands in the air in frustration.
Well, couples have to learn to care for each other during these difficult times. The man is within his rights to demand for sex and yet still the woman must not be exposed to unnecessary pain and suffering if she is not ready psychologically and physically. The stress and burden of caring for the baby must be shared so as not to exhaust one party. The couple has to learn and do sensual exercises or what is known in common language as romancing to be able to re-energise and bring back the mood for sex. This may take months.
I supported Rebecca and Gerald through psychotherapy, use of lubricants and advice on parenting. It was not until six months that they were back to having satisfactory sex.
The lesson is that the six weeks advice on resuming sex after delivery is a guide. Every person faces pregnancy and delivery differently. Contexts are different. Following up with your doctor when you face difficulties is important to restart sex after delivery.