Sex and intimacy in pregnancy and after birth

During pregnancy: the essentials

If your pregnancy is going well, sex does not harm the baby: it is protected by the amniotic fluid, the womb and the mucus plug in the cervix. What does change, trimester by trimester, is desire and comfort:

• First trimester: nausea, tiredness and tender breasts lower desire for many people.
• Second trimester: often the most comfortable stage; sickness eases and the extra blood flow to the pelvis can heighten sensitivity.
• Third trimester: the bump, weight and fatigue limit positions; side-lying, seated and pregnant-partner-on-top positions work best.

From the second trimester it is better not to lie flat on your back for long, as the weight of the womb can press on major blood vessels and make you feel dizzy.

When to avoid sex or check first: if you have vaginal bleeding, leaking fluid, placenta praevia, a risk of premature labour, pain or contractions that don't settle, or if your care team has advised against it. We cover this in our article on sex during pregnancy.

After birth: when to have sex again

There is no fixed date. The NHS puts it simply: there are no rules about when to start having sex again after giving birth. Mayo Clinic generally advises waiting until your postnatal check, after both vaginal and caesarean births, because the risk of complications is highest in the first two weeks.

Two practical signs can help you decide:

• The lochia has stopped. According to the NHS, postnatal bleeding usually stops after 6 to 8 weeks, although it can last longer.
• You feel ready, physically and emotionally. You have nothing to prove, and penetration is not the only way to be intimate.

Everyone's pace is different. In an Australian study of 1,244 first-time mothers published in BJOG, 78% had resumed penetrative sex by 3 months and 94% by 6 months. If it takes you longer, that is normal too.

Contraception after birth

Ovulation can return before your first period, so you can get pregnant without having had one. The NHS says this can happen from 21 days after the birth, even if you are breastfeeding, and recommends waiting at least 12 months before your next pregnancy. It is worth choosing a method before you have sex again.

The lactational amenorrhoea method (LAM) only protects you if all three conditions are met at once: you are breastfeeding exclusively (your baby has nothing but breast milk), your baby is under 6 months and your periods have not returned. The American College of Obstetricians and Gynecologists (ACOG) adds that feeds should be no more than 4 hours apart during the day and 6 hours at night. As soon as one condition no longer applies, you need another method. All the options are in main contraceptive methods.

Dryness, pain and the pelvic floor

Dryness. Oestrogen drops after birth and stays low while you breastfeed. Your vagina may feel drier and more sensitive, even if you have never needed lubricant before. A water- or silicone-based lubricant usually helps; here is how to choose a lubricant.

Pain after a tear or episiotomy. Some discomfort the first few times is common. In the Australian study above, 44.7% of mothers had pain during sex 3 months after birth and 23.4% still did at 18 months. It helps to start slowly, with plenty of arousal first, lubricant and positions in which the person who gave birth controls depth. Mayo Clinic also suggests emptying your bladder beforehand and taking a warm bath. If the pain is still there at your postnatal check, see your GP: there may be scar tissue that needs treatment.

Pelvic floor. Pregnancy and birth stretch these muscles, which can show up as bladder leaks or a change in how sex feels. Mayo Clinic suggests Kegel exercises: tighten these muscles as if lifting a marble, hold for 3 seconds, relax for 3 and gradually build up to 10 to 15 repetitions, at least 3 times a day. If you have leaks, heaviness or pain, pelvic health physiotherapy is the next step. We explain it in our pelvic health and pain guide.

Tiredness, your relationship and your mood

Little sleep, caring for a baby and a body that is still recovering all lower desire. That is to be expected, not a failure of the relationship. It often helps to:

• Talk about what you feel like and what you don't, without assuming you have to go back to your old routine.
• Find short moments alone, even 15 minutes, and accept that desire often turns up once touch has begun.
• Value touch without penetration: caresses, massage or falling asleep cuddled up all count.

If a mismatch in desire drags on and causes tension, our article on desire discrepancy in couples may help.

Postnatal depression. In the first few days it is normal to feel tearful or emotional (the "baby blues"); the NHS says this usually passes within 2 weeks. If low mood, anxiety or loss of interest last longer, it may be postnatal depression. According to the World Health Organization, around 13% of women worldwide who have just given birth have a mental health condition, mainly depression. It can start up to a year after the birth, and partners can be affected too. It can be treated, and asking for help early makes recovery easier.

When to get help

• Urgent: sudden, very heavy bleeding, feeling faint or dizzy, or a pounding heartbeat after the birth.
• A temperature above 38°C, an unusual smell, clots, bleeding that gets heavier, or tummy or perineal pain that gets worse: these can be signs of infection.
• Pain during sex that is still there at your postnatal check or isn't improving.
• Leaking urine or faeces, or a feeling of a bulge or heaviness in the vagina.
• Low mood, anxiety or loss of interest lasting more than two weeks, or thoughts of harming yourself or your baby: seek help the same day.
• During pregnancy: bleeding, leaking fluid or contractions after sex.

Comfortable positions in pregnancy and after birth

A selection by stage. In pregnancy, support matters most, along with not lying on your back for long; after birth, the person who gave birth should control depth, with no pressure on the perineum.

Pregnancy: side-lying, on top or seated

The SpoonBajo

Side-lying with the bump free and no weight on the abdomen. A pillow between the knees or under the bump adds support in the third trimester.

The CowgirlMedio

The pregnant partner is on top and sets the pace and depth. Leaning back leaves room for the bump.

On a Chair (Straddling)Bajo

Straddling a sturdy chair with feet on the floor: the bump stays free and there is no need to lie on your back.

Tantric Sex (Slow Sex)Bajo

A seated face-to-face embrace with slow movement: little effort, lots of contact and no pressure on the bump.

The Half Moon EncounterBajo

Side-lying, face to face and cuddled up: comfortable while the bump still lets you get close from the front.

After birth: control of depth and no pressure on the perineum

Deep LongingBajo

Side-lying, face to face with shallow penetration: movements are short and the person who gave birth can stop at any moment.

The Venus MirrorMedio

Shallow side-lying penetration; pressing the thighs together limits depth and protects a recent scar.

The SpiralBajo

The receiving partner lies on their side at the edge of the bed with no weight on top; the standing partner can easily adjust the angle.

Side-by-Side Face to FaceBajo

Lying on your sides facing each other, with no weight on the pelvis: a good choice for the first times after birth.

Without penetration

Mutual Manual StimulationBajo

Shared pleasure while the perineum heals, during the lochia or when penetration doesn't appeal yet.

Erotic MassageBajo

Relaxes you and reconnects you with your body on tired days; works in pregnancy and after birth.

Keep reading