Now that you have given birth, sex may be 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 and cuddling. 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 may mean you don’t get around to making love for several months. This is quite normal and it is important that you and your partner are able to share your feelings and can 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. It could take a while for the area to heal completely, and may delay you getting back your normal sex life. Keeping the area clean and dry and eating a healthy balanced diet will aid healing.

If you are breastfeeding your baby, the influence of the hormones that support your body’s production of breastmilk can also affect how you feel about sex. You may well feel less interested in having sex and also get less satisfaction from it.

Your sex life 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 more on this subject, visit www.choicesforbirth.org.)

Difficulties with sex are not uncommon. You might feel too awkward or embarrassed to talk to your midwife, health visitor or GP about it but they will have offered advice to other couples in your situation and will be sensitive, discreet and understanding of your feelings.

Contraception choices
You may already know quite a lot about the methods of contraception available, but bodily changes related to recovering from pregnancy and 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 you are breastfeeding, any previous or existing medical problems, regular prescribed medication, and whether or not you are very overweight or smoke.

If you are not breastfeeding, you need to start using some form of contraception before, or by, 21 days after the birth of your baby; this is the timescale for when ovulation (the release of an egg from your ovary) can resume. If you still have a slight vaginal blood loss from having your baby; you might not be able to tell whether you have re-started your periods and are capable of becoming pregnant again.

Exclusive breastfeeding, where the baby receives only its mother’s breastmilk, delays the return of ovulation. But if the pattern of breastfeeds is irregular or you supplement with infant formula milk, your body’s hormonal balance and menstrual cycle will be affected. As the frequency and duration of breastfeeding falls, the ovaries become active again and a reliable method of contraception is essential.

Whichever method of contraception you and your partner choose, if you have any problems, experience side-effects, or want to think about using a different method, seek advice from your doctor or family planning clinic.

Using condoms?
If condoms are your preferred method of contraceptive, it is advisable to use lubricated varieties without spermicidal

Condoms
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 or 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.

The combined oral contraceptive pill (COCP)
This contains both oestrogen and progestogen and is considered 99 per cent 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. If you have vomiting and/or diarrhoea, or if you are prescribed certain antibiotics, it can impair your contraceptive protection. The COCP is not suitable if you are breastfeeding.

You can also receive these combined hormones in the form of a contraceptive patch, which is stuck onto your skin and is equally effective. It has the added advantage that should you suffer diarrhoea or vomiting, your contraceptive protection is not affected.

The progesterone only pill (POP)
You can take this if you are breastfeeding, because it won’t affect your milk production. It can sometimes cause irregular bleeding, mood swings and weight gain.

It’s also available as an implant (under your skin), which lasts for three years, but can be removed at any time. One advantage is that you don’t have to remember to take a pill. Disadvantages are irregular bleeding and, for around one in five, periods can stop altogether.

Contraceptive injection
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 become irregular or stop entirely. Some women also gain weight.

Intrauterine system (IUS) – Mirena
This is very similar to a contraceptive coil (also called an intrauterine device or 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. Normal fertility returns following the removal of the system.

Natural family planning
This 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.

Persona
A small handheld computer with urine-testing sticks measures hormone changes in a woman’s urine to predict fertile and non-fertile times of her menstrual cycle.

Intrauterine device (IUD)
A small plastic device containing copper which is around 99 per cent effective. It stops sperm reaching the ovum and also prevents implantation. IUDs can remain in for between five and 10 years. They can be removed at any time, after which normal fertility returns and they do not affect breastmilk 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.

Emergency contraception
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, however, emergency contraception is necessary – in tablet form (taken within 72 hours of unprotected sex), or an IUD. This can be fitted from four weeks postnatal and is over 99 per cent effective. 

For more information on postnatal sexual health, visit www.choicesforbirth.org