Last updated on Feb 22nd, 2021 at 09:56 am

There’s no doubt that your body changes after you’ve had a child, and with this comes a host of anxieties and questions – especially when it comes to being intimate with your partner again. Our experts answer the top five post-birth intimacy concerns all women have.

ALSO SEE: 6 things you need to know about having sex after birth

Do I need to hold my perineum when I go to the toilet after having a baby?

As a general rule, no, says sexual health physician Dr Jireh Serfontein, but this may help to ease any anxiety or pain. “After you give birth, your perineum (the area between your vaginal opening and your anus) can feel sore and tender for a couple of weeks and this is especially true if you’ve had stitches. Even without stitches, your perineum may be swollen and sore and many women fear the pain of a bowel movement after delivery. If this is the case, you can try to push up against your perineum in front of your anus with a piece of toilet paper while you bear down to have a bowel movement. This will support the area that hurts and prevent any stitches from pulling.”

ALSO SEE: 5 things you should know about your first postpartum poop

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How soon after birth can we have sex?

Wait for at least six weeks before you attempt to have penetrative sex and take it slow, advises psychologist and sexologist Dr Marelize Swart. “This may involve much planning and organisation with a newborn baby around as you’ll need adequate foreplay to help ease any anxiety about penetration and possible vaginal pain. The good news is, research shows childbirth does not appear to affect a woman’s long-term sexual functioning and having frequent intercourse will help your vagina to bounce back into shape. Always speak to your healthcare provider or a sex therapist if any pain or discomfort you may experience doesn’t improve over time.”

How do I get my sex game back on?

With a great deal of patience − from both of you, says Dr Serfontein. “Remember, what you’re going through is not unique and most new moms experience the same difficulties. Not only do you have physical changes, but the emotional changes of having a new baby at home can be overwhelming. Talk to your partner. Many men feel isolated during the postpartum period as their partner is busy with the baby 24/7. Make time for each other − even if it’s just taking a bath together. Stock up on a good water-based lubricant since hormonal changes can cause vaginal dryness resulting in pain during sex. If you do find sex painful, chat to your doctor or a sex therapist. Vaginismus (a condition involving a spasm in the pelvic floor muscles) is common during the postpartum period, so always seek professional help.”

ALSO SEE: Why does sex hurt after birth?

Is breastfeeding a good form of birth control?

“Yes”, says Dr Serfontein, “but only under certain conditions.” Breastfeeding can be used as a form of contraception if:

  • Your baby is younger than six months
  • Your menstrual periods have not yet returned
  • Your baby is exclusively breastfed on demand (both day and night), and gets nothing but breast milk, or only token amounts of other foods.

“The most important factor is whether or not your menstrual period has returned,” she adds. “Only 7% of women who breastfeed and are not menstruating will fall pregnant within the first year after delivery compared to 50% of breastfeeding women who are menstruating. So, it’s always safer to use reliable contraception. Combined hormonal contraceptives (the pill, patch or vaginal ring) aren’t advisable during the first few months as they can affect milk production. Some doctors suggest using the progesterone-only pill (the mini pill) but intra-uterine devices (Mirena, Kyleen, copper IUD) are more effective in preventing pregnancy and won’t have any effect on milk production.”

ALSO SEE: Your guide to birth control while breastfeeding

I’m having violent thoughts

Having a baby is wonderful, but sometimes intrusive thoughts of a violent nature can leave you feeling scared and alone, says Marelize. “‘I think I’m going crazy. I have thoughts about harming my baby. How can I ever tell anyone that this is the way I feel?” Most of us associate motherhood with overwhelming feelings of love and contentment, but for some women many conflicting feelings, thoughts and fears may surface. While anger and feeling depressed may not fit in with your fantasies about motherhood, they do happen. Postpartum depression occurs in approximately 15% of women and symptoms can include lack of energy, fatigue, difficulty sleeping, loss of appetite, thoughts of suicide, or thoughts of harming your child. Depression on any level decreases feelings of desire and interest in being sexual with your partner and will affect your relationship with your baby. If you’re struggling with any of these feelings, contact your doctor immediately. There’s no shame in feeling depressed, so always speak out and seek help. Medication and therapy can work wonders.”

ALSO SEE: Postnatal depression – know the signs