Sexual Health & Contraception
Now that you have given birth; it could be that sex is the very last thing on your mind. At this time, a lot of couples will find other ways of expressing their feelings for each other through kissing, cuddling and caressing. Many couples resume sexual intercourse around seven or eight weeks following their baby’s birth. However, the demands of a newborn baby and sleepless nights, can delay intercourse for several months. This is quite normal and it is important that you and your partner are able to share your feelings and be sensitive towards each others’ needs.
If you have had a lot of bruising, vaginal tears or stitches, this might cause some discomfort or pain. In these circumstances, it may take longer for the bruising to disappear and healing to take place, and this may also delay sexual intercourse. Keeping the area clean and dry and eating a healthy balanced diet will aid healing.
If you are breastfeeding, the influence of the hormones that support your body’s production of breast milk, can also affect how you feel about sex. You may feel less interested in, and get less satisfaction from, sexual intercourse. Sexual activity can also be affected by specific problems with mood swings after you have given birth; this may take the form of the third day ‘baby blues’ and/or postnatal depression. For further information see our article on ‘Mood changes after childbirth’.
Difficulties with sex are not uncommon. You might feel too awkward or embarrassed to talk to your midwife, health visitor or GP about your concerns; however, they will have offered help and advice to other couples in your situation and will be sensitive, discreet and very understanding of your feelings
Contraception after your baby is born.
You may already know quite a lot about the various methods of contraception available, but bodily changes related to recovering from pregnancy and the birth, as well as breastfeeding your baby, may mean that you need to consider different methods. The contraceptive choices available will depend on your personal preferences, whether or not you are breastfeeding, any previous or existing medical problems, regular prescribed medication, and whether or not you are very overweight or smoke.
How soon after having a baby will I need to use contraception?
If you are not breastfeeding, you will need to start using some form of contraception before, or by, 21 days following the birth of your baby; this is the timescale for when ovulation (the monthly release of an egg from the woman’s ovary) can resume. If you still have a slight vaginal blood loss from having your baby; you might not be able to tell whether or not you have re-started your periods and are capable of becoming pregnant again.
Exclusive breastfeeding, where the baby receives only its mother’s breast milk, delays the return of ovulation. However, where the pattern of breastfeeds is irregular or is supplemented by infant formula milks; this will affect your body’s hormonal balance and your menstrual cycle. As the frequency and duration of breastfeeding falls, so the ovaries begin to become active again. This means that the contraceptive effects of breastfeeding start to be lost, and a reliable method of contraception is essential.
Condoms may be used without restriction any time after you have given birth, although it is advisable to use lubricated condoms without spermicidal.
Diaphragms and cervical caps
If you have previously used a diaphragm/cap, you will need to be reassessed following childbirth to make sure you are fitted with one that correctly fits your cervix. This can be done around six weeks postnatal; usually at your six-week check. They should always be used with a spermicidal.
It is important to remember that only barrier methods of contraception (condoms, and to a lesser extent, diaphragms/caps) offer protection from acquiring sexually transmitted infections. [Tint box]
The Combined oral contraceptive pill (COCP)
This contains both oestrogen and progestogen and is considered; 99% effective, when taken as prescribed. It acts by thickening the cervical mucus, which prevents sperm reaching the egg and fertilising it. It also ‘thins’ the lining of the uterus, which prevents implantation taking place; even where fertilisation has occurred. If you have vomiting and/or diarrhoea, or if you are prescribed certain types of antibiotic, the absorption of the pill can be affected and will impair your contraceptive protection. The COCP is not a suitable choice if you are breastfeeding.
You can also receive these combined hormones as a contraceptive patch, which is equally effective and stuck onto your skin. It has the advantage that should you suffer diarrhoea or vomiting; your contraceptive protection is not affected.
The progesterone only pill (POP)
This can be taken if you are breastfeeding, because it won’t impair your milk production. Irregular bleeding, mood swings and weight gain can be experienced with its use.
It is also available as an implant (under your skin), which lasts for three years, but can be removed at any time. A key advantage is that you do not need to remember to take a pill each day; however, the disadvantages are; irregular bleeding and, for around 1 in 5 women, periods can stop altogether.
Depo Provera is the injection mainly used. This is injected every 12 weeks, which might cause a delay in the return of your fertility once stopped. Periods can be affected by either becoming irregular or stopping entirely. Some women also gain weight.
Intrauterine system (IUS) – Mirena
This is very similar to a contraceptive coil (also called an ‘Intrauterine device’- IUD), but contains progesterone. It releases the hormone directly into the uterus; this means much lower levels of the hormone in your blood. It can provide contraceptive protection for five years, but can be removed at any time. Irregular light bleeding is common up to the first six months of use, but it often helps to make periods lighter or they may stop completely. Normal fertility returns following the removal of the system.
Natural family planning
This method requires special instruction before it is used as the main form of contraception. Women need a good awareness of their own body and menstrual cycle, and there are times when you will have to avoid sexual intercourse or use protection.
This is a small handheld computer with urine testing sticks which measure hormone changes in a woman’s urine to predict fertile and non-fertile times of her menstrual cycle.
Intrauterine device (IUD)
This is a small plastic device containing copper which is around 99% effective. It stops sperm reaching the ovum (egg) and also prevents implantation. IUDs can remain in for between five and 10 years. They can be removed at any time, which is followed by a return to normal fertility and do not affect breast milk production.
Male and female sterilisation
Sterilisation is a permanent decision, made when you are certain that you do not wish to have more children. Ideally, it should not be undertaken immediately after delivery, as you may be more likely to regret your decision; there is also a higher failure rate. Male sterilisation (Vasectomy) carries less surgical risk, has lower failure rates and should be considered as an alternative when female sterilisation is being considered.
You do not need to use emergency contraception if you have unprotected sex or contraceptive failure in the first 21 days after you have given birth (regardless of how you are feeding your baby). After this time, emergency contraception is necessary; in tablet form (taken within 72 hours of unprotected sex), or by having an IUD fitted. This can be fitted from four weeks postnatal and is over 99% effective.
Whichever method of contraception you and your partner choose; if you have any problems or concerns, experience side-effects, or wish to consider using a different method; seek advice from your doctor or family planning clinic.