Having sex again

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• Trust your own judgement on when to start having sex. There is no need to rush things.
• If sex causes discomfort or is less satisfying, it may be a physical problem you can treat.
• Try to decide about contraception as early as possible after having a baby. Your body might be ready to conceive again before you have your first period.

When you have a new baby, having sex may seem impossible, especially for women who have had stitches. However, you will heal, and normal feelings will return. This may happen quickly or may take some time, especially if you had a difficult birth, or you are feeling exhausted or down.

You don't need to wait until the postnatal check if you and your partner feel you are ready for sex. If you feel comfortable, and bleeding has just about stopped, it is OK (unless your doctor has advised otherwise).

However, the first try may be a little difficult, especially if you feel anxious, which is likely. Take it slowly and use some lubrication if you need to. If it is too painful, try again in a week or so, when healing is more complete.

Sometimes, even when an episiotomy has fully healed, a tender spot remains, making intercourse painful. You will need to speak to your doctor if this is an ongoing problem. Pain may also be due to muscle spasm caused by tension and anxiety.

Some women find their muscles are too loose rather than too tight after being stretched during birth, so they (and their partner) find sex less satisfying. Pelvic floor exercises will help this.

While you are breastfeeding, your vagina may feel more dry than usual because of the change in hormones.

Plenty of preparation can help, and many women use a lubricant to help things go smoothly. You can buy lubricating gel at the chemist.

Breastfeeding mothers may also notice milk leaking or even spurting during sex. This is because the hormone oxytocin which causes milk to let down is involved in sexual arousal as well. Many people find this part of the fun, but if it is a problem try feeding the baby or expressing first.

Because of the oxytocin hormone, some mothers feel not only sensual but also sexual while feeding the baby. This is normal, so there's no need to feel guilty about it.

While some new mums feel more sexual than usual in the first few months after the baby is born, many do not. The main reason for this is not usually pain, dryness or milk but sheer tiredness. Feeling that you are giving all you have to your baby day and night can leave you drained, with nothing left for your partner.

It is good if your partner can be understanding and loving in other ways and share more of the baby care, but if you are feeling really flat much of the time, it is important to work on regaining some energy. Taking care of yourself is not being selfish; the whole family will benefit.

Contraception

If you've just had a baby, having another is probably the last thing on your mind. To make sure this doesn't happen until you are ready, you do need to give contraception some thought, and talk about it with your doctor.

Breastfeeding itself can be a good contraceptive when several conditions are met.

• The hormones involved in lactation (making milk) tend to stop you ovulating for the first few months.
• As long as you are fully breastfeeding day and night (not giving any other foods or fluids to your baby), have not had a period, and your baby is less than six months old, you have very little chance of falling pregnant (although it's not a guarantee).

This is called the Lactational Amenorrhoea Method, and works as well as the mini-pill or condoms but it can 'fail'.  You can use the minipill or condoms while you are still fully breastfeeding.

You need to use another method of contraception once:

• you have a period
• your baby reaches six months
• you start giving baby other foods (for example a bottle of milk, or solids).

The combined oral contraceptive pill is not good to use when breastfeeding as it can decrease your milk supply. However, progesterone-only pills (or minipills) are usually safe to use.

Condoms and diaphragms are safe, whether or not you are breastfeeding. If you used a diaphragm before having a baby, this may need to be refitted. An IUD (intra-uterine device) is another possibility. See your doctor if you are interested in this.

If you are not breastfeeding, or as soon as you stop, your body gets ready to make another baby. You will probably get a period within a couple of months of giving birth (if not breastfeeding), or within a few weeks of weaning.

It can be different when you are fully breastfeeding. You may ovulate, and therefore possibly get pregnant, before your first period.

Choose a contraceptive method as soon as you decide not to breastfeed. In this case you have a lot of choice, including the combined pill or an implant such as implanon.

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