Sex after pregnancy: Set your own timeline

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.

After the baby is born, how soon can I have sex?

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, postpartum blues and changes in body image all can take a toll on your sex drive.

Will it hurt?

Due to hormonal changes your vagina may be 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. For most women, sexual response requires the entire brain. 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. A low dose estrogen cream applied to the vagina may help, but can also interfere with your milk production if you're breast-feeding. Ask your health care provider to help you weigh the pros and cons.

Will it feel different?

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

To tone your pelvic floor muscles, do 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.

What about birth control?

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. Initially, barrier methods such as condoms and spermicides can be useful. If you're breast-feeding and prefer hormonal birth control, it's important to select a method that won't decrease your milk supply, such as the minipill. Ask your health care provider about birth control options before having sex or during your postpartum checkup.

What if I'm too tired to have sex?

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 or while your baby naps.

What if I'm not interested in sex?

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. Also share your feelings about your new roles as parents.

Until you're ready to have sex, you can 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 throughout the day or occasional soaks in the tub. 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. If your mood is consistently low, you find little joy in life or you have trouble summoning the energy to start a new day, contact your health care provider.

What can I do to boost my sex drive?

Most sexual problems that women experience after pregnancy 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 healthy foods, and drink plenty of fluids.
• Include physical activity in your daily routine.
• Rest as much as you can.
• Ask your partner, family 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.

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• Kegel exercises: A how-to guide for women
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• Postpartum depression
• Weight loss after pregnancy: Reclaiming your body
• Postpartum care: What to expect after a vaginal birth
• Maternity leave: Tips for returning to work
• Exercise after pregnancy: How to get started