Understanding Postpartum Sexuality

The Myth of the 6-Week Clearance

One of the biggest myths about sex postpartum is that once an ObGyn gives the green light, a woman is READY for intercourse. However, clearance usually means tissues are healed enough to not be dangerous, not that the body, nervous system, hormones, or desire systems are ready for pain-free sex.

Painful or uncomfortable sex postpartum is very common and mostly due to a lack of education about postpartum bodies. So let's get educated!

Hormonal Changes

After childbirth, estrogen levels drop sharply. Estrogen plays a crucial role in maintaining vaginal health by keeping tissues thick, lubricated, and elastic. Low estrogen can mean:

• Vaginal dryness

• Burning or tearing sensations

• Pain with friction

These changes often make penetration uncomfortable or painful. Low estrogen can persist for months or even longer if breastfeeding continues, meaning vaginal discomfort may not resolve quickly without the use of lube. So please please please USE LUBE!

Other research suggests that lower testosterone and androstenedione post-birth (especially if breastfeeding) is associated with reduced sexual interest.

Oxytocin (sometimes called the “bonding hormone”) is elevated with breastfeeding and caregiving. It plays roles in maternal bonding, stress regulation, and sexual arousal physiology, but research indicates it may shift focus toward infant cues and away from sexual desire in some postpartum women. To be clear, there is no evidence that oxytocin directly inhibits sexual desire per se — its role is more nuanced and context-dependent, and it can facilitate aspects of arousal even as it supports parental behaviors.

Pelvic Floor Changes

The pelvic floor is a group of muscles that sit like a hammock at the base of the pelvis. These muscles must be able to both contract and relax.

Pregnancy places prolonged stress on the pelvic floor as it supports the growing weight of the baby, uterus, and placenta for many months, while hormones like relaxin soften muscles and connective tissue, reducing their ability to recoil and provide support. During birth, the pelvic floor must lengthen significantly to allow the baby to pass through—sometimes leading to stretching, tearing, or changes in coordination.

After pregnancy and birth, many people assume the pelvic floor is “weak.” But just as often, the issue is the opposite: the muscles are too tight, overactive, or unable to fully relax.

Pregnancy, vaginal birth, tearing, episiotomy, or even prolonged pushing can signal danger to the nervous system. Muscles may tighten to protect vulnerable tissue—much like clenching your jaw after dental pain.

Over-tight pelvic floor muscles can lead to:

• Pain during penetration

• A feeling of tightness or burning

• Difficulty relaxing muscles during intimacy

  
  

Pelvic floor physical therapy can be a key support for postpartum pain. A trained pelvic floor physical therapist assesses how the pelvic floor muscles are functioning—not just their strength, but their ability to relax, coordinate, and respond to touch without pain. Therapy may include gentle manual work, breathing and relaxation techniques, scar tissue care, and education to help the nervous system feel safe again. For many postpartum people, this approach significantly reduces pain and restores comfort, confidence, and trust in their body.

Emotional and Nervous System Responses

For some people, birth can trigger trauma responses or even past sexual trauma. Experiences such as loss of control, pain, exposure, invasive procedures, or having one’s body touched without choice or pacing can be traumatic and/or can mirror past sexual trauma. The nervous system may respond by reactivating survival responses—such as freezing, dissociation, or muscle guarding—which can later show up as pain, avoidance, or distress around intimacy.

Then there's the fatigue, stress, and mental load that comes with new motherhood. These factors affect arousal and natural lubrication. Even if the body is physically healed, emotional exhaustion can reduce sexual desire and responsiveness.

And of course, body image. Many people grieve or feel disconnected from a body that no longer feels familiar or fully their own. Body image distress, self-consciousness, and pressure to “bounce back” can pull attention away from sensation and pleasure, making arousal, desire, and comfort during sex more difficult.

What Can Help Improve Postpartum Sexuality

• Pelvic floor physical therapy!!

I truly cannot recommend pelvic floor physical therapy enough! I think it should be a given for all postpartum women. If you are experiencing ANY pain with penetration RUN don't walk to a pelvic floor physical therapist. I highly recommend Origin, which accepts insurance.

• LUBE!!! Please please please use lube!

• Gradual, non-penetrative intimacy

Focusing on touch, massage, and closeness without penetration allows the body to feel safe and aroused.

• Trauma-informed sex therapy

Therapy can address emotional and nervous system responses related to birth trauma, sexual trauma, and painful sex.

• Open, pressure-free communication

Honest conversations with partners about needs, fears, and boundaries create a supportive environment for intimacy.

• Topical estrogen (when recommended by a provider)

The Myth That Motherhood Ends Sexuality

On the other end of the spectrum we have the myth that becoming a mother diminishes or replaces a woman’s sexual identity. Many new mothers internalize the patriarchal idea that their bodies are now only functional, nurturing, or “for the baby.”

Almost all of the studies I found while researching postpartum sexuality were about how motherhood negatively impacts sexuality, which I find VERY DISSAPOINTING and a REFLECTION OF SOCIETAL IDEALS as opposed to of the truth. Here's the truth: yes, of course motherhood IMPACTS sexuality, but this impact DOES NOT have to be negative.

Motherhood does not erase sexuality, it reshapes it—and only you get to decide how that reshaping looks. Managing expectations with compassion and patience is essential, but what if this transition weren’t framed as a loss at all—what if it were an OPPORTUNITY to broaden and redefine sex and intimacy, to explore new ways of connecting, experiencing pleasure, and discovering what feels good and accessible in this new context?

You don't have to choose between the Madonna and the Whore. You can be both. Or neither. Or some entirely new archetype of your own creation.

REFERENCES

Abbasi, et al. (2013). Sexual behaviour in pregnancy, after childbirth, and during breast-feeding. Journal of Sex & Marital Therapy.

Bo, K., Hilde, G., Stær-Jensen, J., & Siafarikas, F. (2015).Postpartum pelvic floor muscle training and pelvic floor dysfunction.Current Opinion in Obstetrics and Gynecology, 27(6), 500–505.

Clephane, K. & Lorenz, T. K. (2021). Putative mental, physical, and social mechanisms of hormonal influences on postpartum sexuality. Current Sexual Health Reports, 13(4), 136–148.

Rupp, H. A., James, T. W., Ketterson, E. D., Sengelaub, D. R., Ditzen, B., & Heiman, J. R. (2013). Lower sexual interest in postpartum women: Relationship to amygdala activation and intranasal oxytocin. Hormones and Behavior, 63(1), 114–121.

Gutzeit, O., Levy, G., & Lowenstein, L. (2020). Postpartum female sexual function: Risk factors for postpartum sexual dysfunction. Sexual Medicine, 8(1), 8–13.

Leeman, L. M., & Rogers, R. G. (2012).Sex after childbirth: Postpartum sexual function.Obstetrics and Gynecology, 119(3), 647–655.

McBride, H. L., Kwee, J. L. (2017). Sex after baby: Women’s sexual function in the postpartum period. Current Sexual Health Reports, 9(3), 142–149.