For many couples, the months following a new baby’s arrival are a sexual desert—as they battle with sleepless nights and as new moms recover and regroup from the myriad changes their body has gone through during pregnancy and labor.

After delivery, obstetricians see patients at the six-week mark, which is usually their final post-partum checkup. So long as the new mother has healed properly, women are usually told that they can resume sexual activity at this point. For many, however, sex could not be further from their minds. Vaginal dryness, incontinence, pain during intercourse and a general lack of libido can impact a new mom’s interest in slipping between the sheets, not to mention the fatigue, stress and the emotional rollercoaster ride that many experience adjusting to life with baby. For better or worse, these symptoms are all normal during the first six months following delivery. In a survey of nearly 500 women published in the journal BJOG, 83 percent of women reported sexual problems in the three months following their child’s birth. At six months, that number had dropped to a still-high 64 percent, compared to pre-pregnancy levels of 38 percent.

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Despite all this, few doctors broach the subject of postpartum intimacy issues with their patients—and few women ask. In the BJOG study, only 15 percent said they sought medical help or input about their sexual problems following delivery. “Everyone focuses on birth plans, but labor is only 12 hours of your life,” says Lauren Streicher, M.D., an associate professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and author of “Love Sex Again.” “But no one is talking about postpartum, which goes on for months and is incredibly difficult for women.”

Physical Changes Behind the Loss of Libido
The issues that cause a new mom’s libido to take a nosedive are numerous and can take her and her partner by surprise. For starters, after delivery, women experience a drastic drop in estrogen, to the point that their vaginas function as if they were post-menopausal. The tissue becomes very thin, taut and dry, which can make sex painful even when lubrication is used. This issue often persists until breast-feeding stops. “The vaginal dryness problem is huge,” Dr. Streicher says. “Lots of doctors don’t mention this to women, and they wind up being blindsided by that.”Caro Reyes, 28, can relate: “The first time I had sex after my daughter was born, it felt like I was a virgin again—it was so tight,” says the mother of two from San Diego, who waited about three months to have sex again after her first delivery. “The only position I felt comfortable in was him on top in missionary. I couldn’t be on top of him because penetration would be painful. Any other position was too tender.”

During vaginal delivery, the vagina experiences trauma as its delicate tissues are stretched, bruised or torn. Depending on the severity, this trauma plays a major role in when a woman is physically ready to have sex again. Although the BJOG study found that dyspareunia—pain during sex—was significantly correlated with vaginal deliveries, having a C-section does not necessarily preclude a woman from experiencing dyspareunia. The estrogen drop is still very much at play, in addition to the residual pain at the incision site.

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Michelle Langford, 29, a mother of two from Atlanta, delivered both of her children via C-section, but still found sex afterwards to be painful. Rebecca Green*, 41, had a similar experience: “I assumed that since I had a C-section, our sex life would pick up right where we’d left off. I was mistaken. Penetration was surprisingly painful at first, even with lubrication, and no one had warned me about that. It took a couple of weeks of trying before sex became more comfortable and then things got better and better.” Other physical changes can impact dynamics in the bedroom. As a woman’s uterus shrinks back down to its normal size, bleeding often occurs for four to six weeks, according to Streicher. After Reyes delivered her second baby, she was surprised to find that she bled on and off for six months. She and her husband decided to hold off on sex for the first two months.

Other surprising changes: Breasts can squirt milk at the most inopportune times. “Leaking milk can also be something people don’t talk about and could be something that happens in the bedroom,” points out Rose Hartzell, Ph.D., a sex, marriage and family therapist at San Diego Sexual Medicine. The breasts’ new role as milk supplier can also impact bedroom dynamics and how a partner feels about the wife’s breasts, notes Streicher. For some partners, “it’s hard to see your child put his mouth on the wife’s nipple all day—it can be hard to get sexually excited about [the breasts], and then touch it and milk spurts out,” she says.

Incontinence is also a common but little-talked-about problem. During delivery, the baby’s head can push against its mother’s pelvic floor, weakening her pelvic tissues. This can cause urine and sometimes stool incontinence that persists for weeks, months or even life. “You can’t imagine how horrifying it is for a young woman in her 20s or 30s who finds she is able to have sex again, but then discovers that she’s actually peeing on her partner when she orgasms,” Streicher says.Luckily, there are things new moms can do to deal with incontinence. “The first thing I tell patients is don’t panic—oftentimes tissues can heal,” Streicher says. A pelvic floor physical therapist can help women regain control of their bladders and recommend exercises to strengthen the pelvic floor. There are also vaginal-strengthening devices, such as InTone and Apex, that use electrical stimulation and biofeedback to build up pelvic floor muscles.

Emotional Changes That Dampen Sex Drive

Along with physical changes, there are also psychological ones. Some women find that their new role as a mom dampens their view of themselves as a sexual person. “That was definitely a change,” says Langford, “just that mentality of what my body is really for. It’s more or less going from viewing yourself as a sexual being to a mother. I didn’t see my body as something to be used for sexual purposes anymore. I guess it’s just [a matter of] getting back into that feeling of being more than just the carrier of a child. I still haven’t gotten all the way back to that feeling of ‘sexy.’ ”Women who loved having their breasts touched during foreplay and sex prior to delivery, for example, might now relate to them solely as a source of food for the baby. “I’m no longer a fan of people touching my boobs,” Langford admits. “It doesn’t arouse me anymore, and it even kind of annoys me.”

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What’s more, postpartum depression hits about 14 percent of women, while the baby blues affects up to 80 percent of women. Some feel very alone and assume that there must be something wrong with them because they are not experiencing the happiness that everyone presumes will come with having a baby. Others grapple with anxiety over whether or not they are meeting all of their baby’s needs. Women might suffer from identity issues as a new mother, and also find themselves dealing with relationship problems they never encountered before. If a woman spends all night and day feeding, diapering and tending to the baby, and then her partner comes home from work and wonders why there’s no dinner on the table or is ready for a romp in the bedroom that night, this does not always go over well, Streicher says. “The woman is like ‘Are you kidding? I’m depressed, exhausted, anemic, fat and my vagina hurts.’ ”

Langford, who delivered her second baby about five months ago, is currently living a version of this scenario. Aside from having sex once on her husband’s birthday about two-and-a-half months after the baby’s birth, they have not been intimate. When she gets back from long hours at the office, she finds that the rest of her evening is consumed by taking care of the baby and tending to her first daughter, who is in elementary school. “So much of myself is going to other people who need and depend on me, so it’s hard for me to give any more,” she says. “I come home and he wants a kiss and a hug, but I don’t have that second for him right now.”

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“Sometimes, dads get put on the second list of priorities,” confirms Hartzell. But it’s important to find time whenever you can to nurture your bond with your partner and prioritize your marriage. “Remember that 18 years from now, you’re going to be the ones left with each other, so don’t forget to foster your relationship as well,” Hartzell points out. To that end, Langford and her husband began counseling earlier this month. “I hope we can build back that bit of romance that has been lost,” Langford says.

Light at the End of the Tunnel

Things do get easier, though. It helps to talk openly with your partner and set realistic expectations about intimacy to avoid frustration and disappointment. And keep in mind that it’s OK if you don’t jump right back into intercourse, but instead ease back into a sexual routine by beginning with kisses, massages and touching. Oral sex and vibrators are other ways to stay intimate if you’re not yet ready for sex. Reyes and her husband used this strategy while she was healing. “I’m a very, very sexual person and not being able to be intimate at all was not working for me, so we had to find other ways, like oral sex,” she says.

If you’re still having trouble getting back into the swing of things by the six-month mark, Hartzell recommends thinking about consulting a sex therapist, who can help encourage baby-steps in the bedroom and work out any underlying issues getting in the way of intimacy.

The good news is, by six months, many couples have become intimate again. In the BJOG study, 89 percent said they had undertaken some sort of sexual activity with their partner at this point. “It’s a process, it’s a journey,” says Streicher. “but it does get better.”

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*Name has been changed