I’ve had two cesarean births and the recovery for both was, well, it was really rough. Even a solid 7 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.
When Can You Have Sex After A C-Section?
“Usually your physician will clear you for penetrative intercourse at your 6-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 4 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 6 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 6 to 8 weeks,” obstetrician Dr. Mary Jane Minkin, tells Romper, comparing postpartum sex clearance after a c-section versus a vaginal birth.
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 completed absorbed, so you could cause injury to the tissues on the inside and reopen the wounds that are not healed.”
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 Lyons tells Romper. “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. Intercourse poses a threat to this healing in both c-section and vaginal births. Additionally, a cesarean incision interrupts multiple layers of tissue including abdominal and uterine muscles. The incision needs time to heal before those structures are used or you are putting yourself at significant risk.”
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 9 months — including surgery for c-section moms — so some discomfort can occur.
“Your pelvic floor still adapted to the weight of the baby over 9 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,” she tells Romper.
As c-sections can often be done in an emergency situation, 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 6-week postpartum check-up, or possibly sooner. Minkin tells Romper the most important thing she wants c-section moms to know is that “babies can be born 9 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 4 weeks after delivery, but you can always use condoms.”
Are Sex Toys Safe To Use After A C-Section?
For some moms, 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 moms once cleared for intercourse.
“Toys are just as safe as intercourse, depending on the toy,” Lyons 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 1 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,” Lyons 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 okay 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.”
Mary Jane Minkin, MD, OBGYN, Clinical Professor of Obstetrics & Gynecology at Yale University
Sara Lyon, birthing expert, doula, author of The Birth Deck and You’ve Got This: Your Guide to Getting Comfortable with Labor