Do you really have to wait six weeks after delivery to resume sex? Can you do it earlier? After delivery, many doctors tell their patients "no sex until the 6-week postpartum visit." However, couples often get little or no explanation of what they can or cannot do, and are left to their own imagination as to what's allowed and what isn't.

What doctors usually mean by "no sex" is that it's recommended to avoid penetration into the vagina (and also rectum), which means not inserting a penis, fingers, dildo, vibrator, or other things. Other doctors may specify only four or even two weeks or when the lochia (postpartum discharge from the vagina) stops, whichever is later. 

Why should you wait to have sex?

There are several reasons for delaying postpartum intercourse:

• Allowing genital tissues to heal, especially if there was an episiotomy or tearing
• Allowing a cesarean skin or uterine scar to heal
• Avoiding infection to the genitals and the uterus

However, in most cases, these risks don't necessarily require weeks of abstinence from intercourse, and there is little scientific proof to require abstinence for exactly 6 weeks after delivery.

The postpartum visit has been traditionally at six weeks, though there are really no firm rules if 4 weeks, or 8, or even 10 weeks are better. The reason for the "six week no sex rule" is more for the doctor's convenience than the new mom's medical needs. 

Between recovering from childbirth, barely sleeping, and the demands of breastfeeding, sex often falls by the wayside.

However, six weeks is usually when the uterus should have returned to its pre-pregnancy size. This is the last of the major physical postpartum changes (again, from the doctor's perspective). But a woman doesn't really need her uterus return to its pre-pregnancy size to have sex.

Do women want to have sex at 6 weeks postpartum?

Though many women's desire for sex is lower after delivery, there are many others who want to resume sex right away. Some women feel that perineal and abdominal healing has not progressed enough to make intercourse pleasurable. Other just don't feel "up to it" postpartum for many reasons including hormonal and other body changes.

Studies have shown that the average woman resumes sex after 6 weeks, with a median time of 3 months, while other studies found that 1 in 5 first-time mothers took 6 months to feel physically comfortable during sex, and still another study found that over 50% of women were still having less frequent sex at 12 months after childbirth.

Women who breastfeed sometimes also say that by the end of the day, they are pretty done with being touched.

Fear of pain

Many women do not desire sex after childbirth because of pain, or fear of pain, during intercourse. The time it takes for a woman's desire to return to previous levels depends largely on her birthing experience.

Women who deliver with the assistance of forceps tend to take longer to feel comfortable during sex. The same goes for women who experience internal vaginal tears. Likewise, women with swelling after childbirth and/or any breakdown of the perineum (the external region between the vulva and the anus that is made up of skin and muscle) also tend to take longer to feel comfortable during sex.

Surprisingly, whether a woman has an episiotomy doesn't seem to make a difference. If a woman experiences pain or fears pain she might try oral sex, manual sex, or being on top during sex, which can help her steer her partner away from sore spots and guide the penis into her vagina gently. Using a lubricant will also combat pain due to vaginal dryness. 

Fatigue

As any new mother knows, the first weeks and months after childbirth are exhausting. Fatigue is one of the most common reasons for low sexual desire. Childbirth requires huge adjustments on the part of both parents and sex can be difficult to fit into an already packed schedule, besides the changing roles of the individual parents and the partnership itself. For most women, decreased libido is only a temporary change that requires time to return to normal.

The bottom line

New mothers may find that it takes them a while to get back into the groove when it comes to sex. Many, if not all, of these postpartum issues, will improve with time, and as these problems disappear, your sex life will likely improve.