Postpartum Sex

a woman's c-section scar shows over her waistband. sex after a c-section can be a slow process
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Your Guide To Having Sex After A C-Section

Don’t be surprised if things are different at first.

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I’ve had two Cesarean births and the recovery for both was, well, it was really rough. Even a solid seven years later, I still get phantom pains and weird twinges where my incision scar is now and then. Especially after sex. There’s actually a lot to know about sex after a C-section, and if you’ve not experienced it before, some of the sensations can be surprising, especially right at first.

Just like with any major surgery, there are some pretty strict rules and guidance from your medical providers to follow in order to make sure your body heals properly. And because of that, you will likely have to hold off on some activities following a C-section. Even once you are officially healed and cleared from a medical standpoint, you may not even feel comfortable yet returning to everything you used to do before giving birth for a wide range of reasons.

For everything you need to know about returning to sex after having a C-section, as explained by experts — including when it’s safe to have sex, what happens if you do it too soon, why you might experience some pain, how to deal with changes in your sex drive, and more — read on.

When can you have sex after a C-section?

So, how long after a C-section can you have sex? “Usually your physician will clear you for penetrative intercourse at your six-week follow-up,” Liz Miracle, a physical therapist at Origin, a physical therapy practice focusing on female-specific health issues relating to the pelvic floor, tells Romper. “You might be a little sore at first; go slow and use lubricant. If you are having more than four out of 10 discomfort, we recommend you stop and reach back out to your doctor or seek the care of a physical therapist if your doctor cleared you and it still hurts.”

A cesarean birth requires major abdominal surgery, so some physicians request that you wait more than the requisite six weeks to have intercourse to help prevent pain or complications. “After a C-section, some health providers are a bit more cautious, and some will say to wait six to eight weeks,” obstetrician Dr. Mary Jane Minkin tells Romper, comparing postpartum sex clearance after a C-section versus a vaginal birth (after vaginal birth, doctors typically recommend waiting four to six weeks to have sex).

Even after your doctor clears you, you still may not even feel ready to have sex. “Honestly, after a X-section, it takes two weeks to even just barely feel OK, combined with a low estrogen that is in the post-birth state,” Dr. Cherbua Prabakar, a board-certified obstetrician, tells Romper. “Because a lot of that estrogen is going towards making milk and everything, a lot of women have a lack of estrogen vaginally. A lot of people are not even ready for three to six months after. As we know, sex is much more than just the actual act, so much [of it is] psychological and other things.”

Can postpartum sex impede your recovery after a C-section?

Waiting to have sex until your doctor has cleared you to do so is the best course of action after you’ve had a C-section to help prevent complications. Even if you think you’re totally healed, your body may still be working to get back to your baseline.

“Remember that a Cesarean section is major surgery. Both the incision on your belly as well as the stitches you have on the inside need to heal before you resume sexual activity,” board-certified obstetricians Dr. Neely Elisha and Dr. Michael Geria tell Romper in a joint interview. “It may look like the incision on the skin is healed, but the stitches on the inside may not be completely absorbed.”

Just like your body must recover after vaginal birth, the same is true for a C-section, and having sex too early can hinder this process. “It’s important to remember that birthing via C-section still requires pelvic floor and uterine healing in many of the same ways that vaginal birth does,” birth educator and doula Sara Lyon tells Romper.

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Risks if you have sex too early after a C-section

If you don’t give your body that proper time to heal, there are some potential complications. “While you may not be healing from vaginal sutures, you still have to pass the lochia — the residual birth matter in the uterus that appears as blood — and you need the uterine wall to heal completely to prevent hemorrhage where the placenta was attached,” Lyon says. “Intercourse poses a threat to this healing in both C-section and vaginal births.”

As with any surgery, the incision site, as well as all of the muscles surrounding it, needs time to heal without interruption. And impending that healing can cause major pain. “Additionally, a Cesarean incision interrupts multiple layers of tissue, including abdominal and uterine muscles,” says Lyon. “The incision needs time to heal before those structures are used, or you are putting yourself at significant risk.” According to Elisha and Geria, “You could cause injury to the tissues on the inside and reopen the wounds that are not healed.”

That being said, as Prabakar explains, because the surgery is an abdominal surgery, it’s pretty unlikely that you would disrupt a stitch through penetrative sex alone — though it is possible, as physical activity poses a threat to healing from essentially every surgery. “The biggest concern is really just discomfort,” Prabakar says. “And it also depends on some other things that were going on around the c-section, like did the patient have any infection or did the patient push for three hours before having to go to c-section. Then the vagina is simply going to be sore and not ready.”

Why postpartum sex after a C-section can be painful

While experts agree that you shouldn’t experience much pain once your body has healed, having sex for the first time postpartum can be a bit uncomfortable if you don't take it slow and prepare your body. As Miracle explains, your abdominal muscles and pelvic floor have experienced a lot over the last nine months — including surgery for C-section parents — so some discomfort can occur.

“Your pelvic floor still adapted to the weight of the baby over nine months and was working overtime to support the baby weight and stabilize the changing bony pelvis. These muscles can remain overactive and have increased tension in postpartum. They control the entrance of the vagina so that increased tension can make penetrative intercourse uncomfortable,” Miracle tells Romper.

As C-sections can often be done in an emergency situation, as opposed to a planned one, you may have also used your muscles to push or experienced contractions prior to your C-section. “This is still a strain on your pelvic floor, which can then be in a state of protective guarding during postpartum,” Miracle says. “If these muscles are on guard, it means they will also guard against anything trying to enter.”

Your positioning during sex after a C-section can also matter when it comes to comfort. “You want to be careful with what position you’re having sex in,” Miracle tells Romper. “If there is pressure from the person on top, the healing scar may be compromised. Checking in with each other to make sure the scar is not being pulled or pressured during is a great way to ensure it’s not being provoked.”

Additionally, you could experience dryness during postpartum sex, which can be uncomfortable or cause superficial tears that can lead to spotting after sex. “Pain from vaginal dryness, which can be due to the hormones associated with pregnancy and breastfeeding, can be handled using a water-based vaginal lubricant,” Elisha and Geria tell Romper.

When can you use birth control after a C-section?

Your doctor will typically discuss your hormonal birth control options at your six-week postpartum check-up, or possibly sooner. Minkin tells Romper the most important thing she wants C-section parents to know is that “babies can be born nine months apart — even with breastfeeding.” She explains that “most providers won't want you to start using combined hormonal (estrogen-containing) birth control until at least four weeks after delivery, but you can always use condoms.”

Are sex toys safe to use after a C-section?

For some, it could be tempting to try stimulation with a sex toy prior to exploring intercourse postpartum. Experts agree that this may actually be a good strategy for C-section parents once cleared for intercourse.

“Toys are just as safe as intercourse, depending on the toy,” Lyon tells Romper. “Use common sense and start slowly so you can learn what works for you. In fact, this is a great time to start using less invasive toys that might be more sensual before you introduce penetration of any kind.”

How to cope with postpartum sex changes

After a major abdominal surgery like a C-section, your body will feel different, so it’s important to ease your way into intimacy. This process can start during your recovery process over the initial few weeks after birth, even before sex is on the table again.

“I always recommend that clients start by resting their hands very lightly over their incision early on, around one week postpartum. Then ask your partner to rest their hands over the incision point very lightly. Use the warmth of your hands to stimulate circulation in the tissue and reintroduce touch to the area,” Lyon recommends. “The last thing you want is for the pelvic and genital region to be a no-go zone. The sooner you can create safety in contact, the better. Both the postpartum person and partner will build trust in themselves to be sensitive enough and in the body to heal enough for a reinvigorated sex life down the road.”

When you’ve just given birth — whether vaginally or via C-section — your whole world is different. Coping with changes to your body, as well as tending to your emotional state, is imperative. It is completely OK to take it easy when it comes to postpartum sex.

“Being ready for postpartum intercourse is more involved than just your body being ready or healed,” Elisha and Geria tell Romper. “There is an emotional component to sex after having a baby. Your breasts may be sore or tender, you may be exhausted from lack of sleep, your hormones may decrease your sexual drive, and you may not feel like it! Be good to yourself and give yourself time if you need it. Discuss with your partner and take your time.”

Sources interviewed:

Dr. Mary Jane Minkin, M.D., OB-GYN, clinical professor of obstetrics and gynecology at Yale University

Dr. Cherbua Prabakar, M.D., board-certified OB-GYN

Liz Miracle, PT, MSPT, WCS at Origin

Dr. Neely Elisha, D.O., and Dr. Michael Geria, D.O., board-certified obstetricians at Inspira Health

Sara Lyon, birthing expert, doula, author of The Birth Deck and You’ve Got This: Your Guide to Getting Comfortable with Labor

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