Practicalities of Postpartum Sex
Women during this time are very concerned about their internal healing. Their vulnerability and susceptibility comes to the fore during this time. If the woman has had complications or undergone stitches she has a fear set in her mind. This might make it difficult for her to perform, and thus sensitivity and patience are the key words to be kept in mind not only for her partner but the entire family. Most doctors have women return for a checkup around six weeks postpartum to determine degree of recovery, readiness for intercourse, and appropriate contraception. But many women are told little or nothing of how to care for the perineum in the interim.
Why is there a time limit on sex? There is a six week ban on sex which most practitioners advice but a woman can have sex if she chooses to. Then again, the experience may be so fraught with anxiety and not a little pain that it is both worrisome and disappointing. Ordinarily, it takes about ten days for the uterus to return to normal size and the cervix to close securely. Sex during this time is correlated to bleeding beyond the normal postpartum flow. There may also be some risk of uterine infection. Stitches are a major contraindication, they take a week or so to dissolve and at least two more to heal. A woman who has had a repair should really have herself checked before intercourse, even if it means scheduling an appointment earlier than her practitioner expects or recommends.
Some women are so anxious about “The first time” that even the official all–clear is not enough. In this case, self–massage can help, particularly in areas with scar tissue. When scarring is particularly extensive, evening primrose oil (found in health–food stores) can make a noticeable difference. Due to a decrease in estrogen postpartum, lack of vaginal lubrication poses a definite problem during sex. Water–based lubricating jelly is best for intercourse, as excess oil can clog delicate vaginal tissues and glands.
Estrogen production will increase spontaneously if a mother stops nursing, or may resume gradually as she introduces solid foods and the baby nurses less often. There are exceptions, though. Some women nurse their babies (or even toddlers) just once or twice a day and still do not resume their normal cycles. Others may nurse exclusively and have milk in abundance, yet start menstruating as early as six weeks postpartum. The reasons for this discrepancy are uncertain.
In India, however, women are a lot more conscious and inhibited to seek approval of even talk about sex and the problems they face during intercourse. A woman had been suffering for seven months with pain and bleeding during intercourse. She had been back to see her doctor, who offered little advice or assistance. Unfortunately, he was also a relative, so she hesitated to seek a second opinion lest word get back to him. As suspected, she had been sewn up too tightly (the so–called “Husband’s stitch”). Even with gentle pressure to the area, drops of blood appeared as the skin tore ever so slightly apart. She and her partner were quite frustrated and miserable. Ultimately, she had to have reconstructive surgery.
Bleeding without pain is normal for up to six weeks but should be fairly light from about the third week on. It may increase temporarily with intense physical activity, indicating the need for more rest. The first intercourse may also cause a bit more bleeding, this is perfectly normal. But if bleeding persists past six weeks, placental fragments may be retained or the endometrium may be over–proliferating. If there is any doubt, it’s best to see a doctor.