Caring for a baby while recovering from a C-section is no easy feat. You’re likely feeling a cocktail of emotions ranging from happy to exhausted, and if you’ve had a cesarean birth (or C-section), your recovery time will be longer than that of a vaginal birth. Soon after giving birth, you probably won’t be ready to leave the hospital and jump straight in the sack, but, as your body heals, you might wonder when (and if) you'll be able to resume a normal sex life.
Here are all the details about sex post-cesarean, including how long you might have to wait, and what new sensations you might experience.
What to expect after a C-section birth
Dr. Anna Reinert, a fellow in minimally-invasive gynecological surgery and chronic pain at Dignity Health in Phoenix, helps us understand what happens during the C-section process and what to expect on your road to recovery.
During a C-section, the abdominal wall is cut open, and the muscles are pulled apart to get to the uterus and the baby. Patients experience pain during recovery because the skin and muscles that were cut need to repair themselves, not because the uterus was lacerated.
"For both the vaginal delivery and the C-section, your uterus is emptied of the pregnancy, so the placenta, amniotic fluid, and the baby come out," says Dr. Reinert.
The typical patient will experience vaginal bleeding that is heavier than a period, regardless of the delivery method. The blood starts out bright red with a few blood clots and will gradually lighten over the course of two to six weeks.This vaginal discharge, called lochia, includes amniotic fluid, blood, bacteria, and immune cells. During the healing process, patients will shed small amounts of fluid daily, losing up to half a liter total.
Dr. Reinert explains that the cervix tends to be dilated a few centimeters for a few days after a cesarean delivery. It will contract down to about one centimeter after about a week, for both vaginal deliveries and C-sections and remains dilated to allow blood and fluid to pass. The uterus also gets much smaller post-baby. It contracts to detach the placenta, close off blood vessels, and shrink back to its normal size. This process, which reduces the uterus by about a fifth, can also lead to cramping.
C-section recovery
Most physiological changes of pregnancy reverse in about six weeks, but if you have a major abdominal surgery like a C-section, it might take more like eight weeks to heal. Patients may still have pain and decreased muscle strength even three months after the delivery.
"Your body is still going to be healing the abdominal wall for a longer period of time," says Dr. Reinert. "You want the uterus to heal well before getting pregnant again."
The incision site will also feel sore and painful for at least a couple of weeks, and you may have trouble getting in and out of bed. You may also struggle with urinary incontinence issues brought on by your pelvic floor muscles weakening and sore breasts as your breast milk starts coming in.
When can you have sex after a C-section?
It’s recommended that you wait at least six weeks after giving birth before having vaginal intercourse–after your vaginal bleeding has stopped, your incision site has healed, your uterus has returned to its pre-pregnancy size, and your cervix has closed. You’ll also have your six-week postpartum check-up around this time, so it’s best to let your body heal and get the green light from your doctor before getting it on.
A lot of the precautions that doctors give about avoiding sex, not swimming, or taking a tub bath is because they’re worried about the risk of infection.
"It's easier for bacteria to climb up into the uterus if the cervix is dilated," says Dr. Reinert. "Normally, when people are not pregnant, not postpartum, not having their menses, the cervix is very tightly contracted and so it would be hard to pass even a thin straw up through it."
This means having penetrative sex within six weeks of your C-section increases your chances of getting bacterial infections or a UTI. You’ll also still be bleeding, which puts you at risk for a hemorrhage. The other main reason that doctors recommend waiting is because you also run the risk of re-opening your surgery wounds that haven’t had the chance to heal.
Anal sex also follows the same rules as vaginal sex: wait a minimum of six weeks post-birth. Because hemorrhoids are a common after-effect of giving birth, having anal sex before six weeks can be painful and even lead to heavy bleeding.
It’s also important to note that there’s no rush to get frisky even after six weeks of waiting. Sex is more than just a physical act. You need to feel emotionally ready, and it’s okay to wait if you’re exhausted, suffering from postpartum depression or anxiety, or just aren’t feeling it.
If you do crave intimacy with your partner, you can engage in oral sex or mutual masturbation as soon as two weeks after arriving from the hospital until you reach the six-week mark. However, be sure to be gentle and avoid contact with any areas that have stitches.
Tips for having sex after a C-section
When you’re finally ready for sexy times again, here are some tips to make sure that your sex isn’t painful.
Use lots of lube
After giving birth, your estrogen, which is responsible for vaginal lubrication, drops dramatically and stays down for at least a few weeks (even longer if you’re breastfeeding). This makes the walls of your vagina thin, leading to vaginal dryness. Use a generous amount of lube to counteract this and make things go as smoothly as possible.
Go slow
Take your time and explore what feels good and what doesn’t because your body has undergone a massive change. Experiment a little to rediscover the type of stimulation that works for you. Make foreplay your friend and make sure that you’re aroused–mind and body–before trying penetrative sex.
Avoid certain sex positions
While no sex position is technically off-limits, some positions, such as missionary or doggy style, can put pressure on your surgery wound or pelvic area. Positions where you’re on top, like the reverse cowgirl, or lying on your side and “spooning” are ideal for maximizing comfort and minimizing pain.
Don’t forget birth control
Your first period after giving birth might not come for a few months, but that doesn’t mean you can't get pregnant. Your body starts ovulating as soon as three weeks postpartum, which means pregnancy can happen if you don’t use contraceptives.
Does sex feel different after a C-section?
Yes, sex can feel a bit different after a C-section, especially the first time. You might feel a bit uncomfortable at the wound site and during penetration, have very little vaginal lubrication, have a low sexual drive, or just feel…off. Due to a drop in estrogen, you may not experience an orgasm the first time you have postpartum sex, which may last for a few weeks.
All of this is entirely okay and normal. Listen to your body, take things slow, and explore different ways to be intimate to see what feels most pleasurable. There are no rules!
When to call a doctor
While everyone heals on their own timetable, your flow should lessen and the blood should become lighter over time. Around one to five percent of women experience a postpartum hemorrhage, so if you experience major bleeding like having to change your sanitary pad every hour or your discharge gets heavier after a period of getting lighter, call your doctor.
"There still could be an infection risk without there being pain," says Dr. Reinert. "The greatest risk from sex comes from having sex. The tissues aren't quite as resilient to pathogens when they're still healing."
Even if you aren't experiencing pain and feel like your body is healed, make sure your provider gives you the green light before engaging in sex.
Check out our unique lines of vaginal care products and postpartum care, including our condom subscription and our natural cleansing wipes.
FAQs
What happens if you have sex before 6 weeks postpartum?
Within six weeks postpartum, your vagina is still bleeding, your cesarean scars haven’t healed, your cervix hasn’t closed up completely, and you’re likely feeling sore. If you have penetrative sex during this time, it increases your chances of contracting bacterial infections, reopening your unhealed surgery scars, or having a hemorrhage.
Is sex painful after a C-section?
Yes, sex after a C-section can be painful due to vaginal dryness, soreness, irritation of your surgery scar tissue, or general postpartum fatigue. If you feel a lot of pain, stop immediately. If the problem persists past six weeks, contact your doctor.