How to Return to Sex Postpartum

Written by: Dr. Helene Darmanin, PT, DPT, CSCS, founder of Mama Bear PT
Posted: July 24, 2021
My OB cleared me for sex at my six-week checkup and I thought, “There is no way I am ever doing that again, I just started being able to sit without pain a couple of weeks ago!” And the advice often given to women about discomfort or pain with sex, “just drink a glass of wine,” doesn’t cut it.

Returning to sex postpartum is just like returning to any other activity postpartum: with a little information, support, and some patience, you can find a comfortable, enjoyable new normal. 

Here are some steps that you can take to make the transition more enjoyable. (“Sex” can mean different things, but for simplicity in this article, I will use it to refer to penetrative sexual activities.)

Ahead of time:

  • Deep breathing
    Why to do it: Deep, diaphragmatic breathing moves the pelvic floor through a full range of motion, helping it recover from birth (vaginal or cesarean) and regain the suppleness that is required for many of its functions, including sex. The pelvic floor mirrors the motion of the diaphragm, so the more we can use the diaphragm to breathe, the more the pelvic floor will benefit.
    How to do it: Sit comfortably with the feet planted and your arms relaxed and supported. As you inhale, focus on the breath expanding the bottom of the ribcage in 360 degrees. It may require extra concentration to expand the back of the ribs. Exhale and let all the air go before you repeat. Try 5–10 breaths at a time, once or twice a day.

  • Perineal massage
    Why to do it: The perineum is the space between your vagina and your anus, and the site of possible tearing or episiotomies during childbirth. Even if you had a cesarean birth, this area may still be tight because your pelvic floor had been working hard to hold up your growing uterus for almost 10 months. Giving the perineum a massage will increase blood flow, relax the muscles, and help the nervous system begin to tolerate pressure in that area again, and if you had tearing or an episiotomy it will also help improve the elasticity of the scar tissue that has formed.
    How to do it: While you are in the shower or laying on your bed, gently insert a finger or thumb into the vagina (use lubricant if you’re not in the shower) to the depth of your first or second knuckle. Add a little pressure straight back toward the anus, then sweep the finger toward one hip, maintaining the pressure. Sweep back toward the anus and around to the other hip. If you find that one spot feels tighter, you can pause on it and gently hold some pressure into the tissue, taking deep breaths. Continue this for 2–5 minutes. It is common to feel some discomfort, or potentially a gentle burning sensation, during and up to one day after the massage. 

  • Consider purchasing:

    • Lubricant: Especially if you’re nursing, hormones can cause vaginal dryness, and the last thing your vagina needs after pregnancy and birth is irritation. I recommend avoiding generic lubricants, as many of them contain ingredients that can also cause irritation. My favorite brand is Slippery Stuff.

    • Supportive nursing bra:  If you are nursing, your breasts are going to be larger, and you will probably want to wear a supportive bra during sex, especially if you’re going to take my advice on positions (see below). You can find a sexy one with some lace if that’s your jam.

    • Oh-Nut: A lovely, gentle way to reintroduce penetrative sex with a penis is to use these soft silicone rings that control the depth of penetration. They come as a stackable set that slide easily onto the penis, and you can take rings away as your vagina heals.

In the moment:

  • Choose positions where the birthing parent can control the depth of penetration: Generally any position with the vagina owner on top, but you can get really creative with that! A few to try are: cowgirl, reverse cowgirl, or seated. 

  • Setting the mood: Your body will be different postpartum, and generally you’ll be more tired and have less time. But this can be an opportunity to re-explore what feels good to you and your partner, and embrace your fabulous, magical new body. So make the time to set the mood, explore, play—whatever will make you feel good. Setting the mood will also help the pelvic floor relax and the vagina become lubricated.

  • Nursing breasts may have some surprises in store, according to lactation specialist Disa Farris, MSEd, CLC:

    • May leak/spray: Oxytocin, the “love hormone,” is released when you breastfeed, and also when you orgasm. Therefore, your body may let down milk when you orgasm, or with nipple stimulation. It may not happen, but be prepared to laugh it off or find a way to enjoy it if it does!

    • May have different sensation: Your nipples have changed in size, color, and function since giving birth, so it’s no surprise that they may also have different sensation. You may find different things pleasurable, or just not be interested in any nipple sensation during sex—this can all be part of your exploration!

    • May want some support: Your breasts will be larger and possibly full of milk, and especially if you are going to follow the position suggestions listed above, it will probably be more comfortable to have some support (see previous recommendation for nursing bra).

If you try these steps and sex continues to be painful, or even just uncomfortable, for more than a couple of times you do NOT just have to live with it. It is very common and nothing to feel ashamed of, and a pelvic floor physical therapist can help. Pleasurable sex is a right of every human being who desires it—it can improve anxiety and depression, boost pelvic health, enhance your relationship, and just be fun!


Dr. Helene is one of our providers listed on the Be Her Village Registry, you can find out more about her here!
And check out Dr. Helene's interview on the Be Her Village Podcast.
Category: Fourth Trimester
Tags: sexual wellness , sex positive , safe sex , postpartum body , postpartum , postpartum recovery , sex after baby