The pregnancy and postpartum period have a profound impact on the body and can even impact sexual health in many ways. These changes are not just physical but can also be tied to emotional and psychological wellness. Maintaining a healthy sexual life during this time may be the last thing on your mind but understanding these changes is crucial in normalizing these experiences and feeling empowered to change our relationship with sexual health when we are ready.
In pregnancy, the physical changes are often at the forefront of conversations: expanding uterus, enlarged breasts, and weight changes but these changes also impact sexual health. During pregnancy we also see an increased blood flow to the genitals which can be a physical response to desire or sexual stimuli. This increased blood flow can have an impact on genital sensitivity; although studies show blood flow changes throughout pregnancy and postpartum the direction of these changes is not well researched. In general, women report a slight decrease in arousal in the first trimester, a slight increase in desire in the second trimester and a significant decrease in the third. Libido and desire are not only impacted by these physical body changes but also the changing environmental stressors. Increased stress, nausea, smell sensitivity, and fatigue also impact desire. Creating a space where desire and arousal can be supported takes time and energy. Many women report sustaining arousal can become more challenging and may take a sustained mental and physical effort.
Physical changes like enlarged breasts during pregnancy can also lead to increased sensitivity and tenderness which can impact our sexual lives. Exploring alternative ways to engage in sexual play that feel more comfortable during this time can help nurture our sexual expression. Postpartum physical changes are also of note, a difficult delivery may lead to increased sensitivity, discomfort or even pain. This may also be related to changes in natural lubrication which many vulva owners experience; using lubrication, and a lot of it, is critical at this time. Setting your own timeline for reintegrating penetrative sex and listening to your body are a top priority at this time. Couples report that sexual positions that allow the postpartum person to be in control of speed, pressure, and penetration support more positive sexual experiences.
The physical and emotional changes are also impacted by our changing hormones. Hormones have a huge effect on our emotional states; pregnant people may have more emotional needs and may ask for an increased level of affection and support. The emotional toll may also be related to a person's relationship with their body as it grows and changes. Many women report changes in self esteem and body image concerns both during and significantly after pregnancy; body image plays an important role in having a fulfilling sexual life so talking to your providers about these concerns can support long term mental health.
The pregnant/postpartum person is not the only person experiencing huge changes at this time in their life but their partners are too. Many couples struggle with their emotional and physical intimacy as well as communication and time constraints during this period. These factors play an important role in cultivating desire and can impact our sexual lives in a huge way. Having open communication between partners is vital in navigating the changes in sexual health both during pregnancy and postpartum. Partners may need additional patience and understanding as they navigate and reintegrate their sexuality into their lives. This means supporting comfortable positions, offering a space to name discomfort or pain, using appropriate lubrication and discussing feelings as well as realistic expectations. While this time is often challenging for partners it can create a unique opportunity for increased communication and conversations about intimacy that may have never been addressed previously.
Unfortunately, the impacts of pregnancy and postpartum on our sexual health is not always top of mind for patients as well as healthcare workers. Providers often fall short in addressing sexual health with pregnant people. Finding a doctor and other professionals who are comfortable talking about all things sex can be a protective factor and decrease stigma around the topic. Increasing your comfort in talking about sex and sexual health can also reduce the taboo nature and support you in advocating for your wants and needs. We can additionally push for more research regarding women’s sexual health at all life stages as the gaps in knowledge are still a barrier to comprehensive education for providers and patients.
References
Orsquo;Malley, D., Higgins, A., & Smith, V. (2022, August 17). Exploring the complexities of postpartum sexual health - current sexual
health reports. SpringerLink. https://link.springer.com/article/10.1007/s11930-021-00315-6
Sexual Health and Function in Pregnancy. Contemporary OB/GYN. (n.d.). https://www.contemporaryobgyn.net/view/sexual-health-and
Wood, S. N., Pigott, A., Thomas, H. L., Wood, C., & Zimmerman, L. A. (2022, May 8). A scoping review on women’s sexual health in the
postpartum period: Opportunities for research and practice within low-and middle-income countries. Reproductive health.
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