Shortly after giving birth you may feel like you’ll never want to have sex again. But at some point, you probably will, so it’s good to be prepared for how you might be feeling physically and emotionally – and to consider what form of contraception you may want to use.
It’s OK to wait
Physically, there’s no real reason why you shouldn’t have sex as soon as your vaginal discharge (lochia) has cleared up (usually after about 4 weeks), and any cut or tear in your perineum has healed. Before that, sex maybe uncomfortable and there’s a risk of infection if you haven't healed up properly.
In practice, many couples wait longer than that. Either of you may feel too tired for sex. The new mum may feel a bit bruised from the birth (physically and emotionally) and may want to wait a while. There’s no right or wrong – it’s up to you when you feel ready – different people want to resume their sex life at different points.
This can be a tough time for relationships. Try to spend some time together (to remind yourselves why you like each other) and, most importantly, keep talking to each other about how you feel. Couples should make it clear that they’re not rejecting each other.
Taking your time
Remember there are other ways of being close that don’t involve penetrative sex. And cuddling is almost always welcome. When you do feel the time is right, don’t be surprised if it feels a bit strange and different. Your muscles can take several months to get back to normal. Doing pelvic floor exercises can help your body to recover. Remember too that you’ll both probably be a bit nervous, so use some lubrication and don’t rush it.
Sometimes you can feel too ‘dry’ for sex after childbirth and vaginal dryness caused by low oestrogen levels during breastfeeding can make sexual intercourse uncomfortable. Lubricant can make vaginal sex more comfortable and a water-based lubricant (such as KY Jelly) can help. However, if you are using condoms or a diaphragm as contraception, avoid using extra lubricant unless you really need to - using it when you don't need to can increase the chance that the condom might slip off. Don’t use oil-based lubricants such as Vaseline or massage oil as they can damage latex condoms or diaphragms. If you're finding that sex actually hurts, talk to your GP.
You should start using your chosen method of contraception within four weeks of the birth if you don’t want to become pregnant again. Health professionals bring up the issue now so that you can think about it before it becomes more pressing. It may be that the method of contraception you used before you became pregnant may not be the most suitable one now.
The pill (combined and progestogen only)
If you’re breastfeeding, it’s recommended that you avoid the combined pill (types with both oestrogen and progesterone) as the oestrogen will reduce the amount of milk you produce. The mini-pill (progesterone only) is thought to be more suitable, but can have side-effects. You also need to be a lot stricter about making sure you take it at the same time every day. However, there is a new type of progesterone only pill which has a 12-hour missed pill window.
Family planning experts may be able to suggest other methods, such as progesterone implants or an injection, which mean you don’t have to remember to take the pill every day.
If you use a diaphram or cap, you need to get it checked to make sure it still fits as the size and shape of the cervix which can change during birth.
The condom is the simplest choice of contraception for many women and can be used with other forms of birth control. Condoms also offer protection against some sexually transmitted infections. They don't contain any hormones so there are very few side effects and are safe to use during breast feeding. Condoms are available free from sexual health clinics and many GP surgeries.
Natural family planning
Natural family planning methods are used by couples to achieve or avoid pregnancy based on evidence based and scientifically accurate information about fertility. The Billings Ovulation MethodTM teaches you to recognise the natural signs and symptoms of fertility and infertility in each menstrual cycle at any stage of
your reproductive life, including during breastfeeding. Couples choosing this method should be taught by an accredited BillingsTM teacher. Information, teaching centres and statistics available at Fertility Care Scotland or call 0141 352 7930.
Longer acting, reversible contraception (LARC)
LARC (also known as Longer Acting Reversible Contraception) are more reliable methods of contraceptive than the pill and could suit some people better. They are also reversible, that means once you stop using that method your fertility returns.
LARC methods are a great way of protecting yourself from unplanned pregnancy because, unlike the pill, you don't have to remember to take your contraception everyday.
There are four main types of LARC methods:
- the Implant
- the Injection
- Intrauterine device (IUD – also known as the coil)
- Intrauterine system (IUS – similar to a coil)
Lots of women use a LARC method because:
- it is safe to breastfeed with any LARC method
- it can be fitted and forgotten
- it lasts for a long time (different options last from 12 weeks up to five years)
- it is the most reliable way a woman can protect herself from unplanned pregnancy
- the failure rate is less than 1%, making it the most effective contraception available
- it can be stopped without affecting long-term fertility
- they do not interrupt sex
- they are not affected by other medicines e.g. antibiotics.
The implant is a small (4cm), thin flexible tube that is placed under the skin of your inner, upper arm. It steadily releases progestogen hormone into your bloodstream to prevent an egg being released (ovulation) to prevent pregnancy. Periods may become irregular, lighter or stop altogether.
A specially trained nurse or doctor fits the implant using a local anaesthetic to numb the area. Most women can feel the implant, but it can't be seen. Once the implant is in place, you don't have to think about contraception for three years. It is OK to breastfeed with an implant. Fertility returns quickly following removal.
The contraceptive injection or jag is given every 12 weeks and releases the hormone progestogen into the body, which stops an egg being released from the ovaries (ovulation) to prevent pregnancy. Periods may become irregular or stop. Regular periods and fertility may take up to a year to return after stopping the injections. It is safe to breastfeed while on the injection.
The Intrauterine device (IUD – also known as the coil)
An Intra-Uterine Device (IUD) is a small, T-shaped plastic and copper device that is inserted into your uterus (womb) by a specially trained doctor or nurse. The fitting takes about 15-20 minutes after an initial brief examination. The IUD releases copper into the body which prevents sperm from surviving in the cervix, uterus or fallopian tubes. It may also prevent a fertilised egg from implanting in the uterus. This method can last for between 5 and ten years, depending on the type fitted and is safe to use during breastfeeding. Fertility returns quickly following removal.
Intrauterine system (IUS – similar to a coil)
An Intra-Uterine System (IUS) is small, T-shaped plastic device that is inserted into the uterus (womb). It slowly releases the hormone progestogen. This prevents pregnancy by thickening the cervical mucosa to prevent sperm from reaching the egg, prevents implantation on a fertilised egg into womb. It also thins the lining if the womb so making periods lighter or stop altogether. You can safely breast feed while using this method of contraception. Once fitted it can last 5 years. Fertility returns quickly following removal.
Assess your options
So you can see there are a range of contraception choices available to women so its important to discuss all your options with a sexual health nurse at the sexual health clinic (formally the family planning clinic) or with your health visitor, midwife or GP. For further information contact www.fpa.org.uk or visit the Sexual Health Scotland website.