There are no hard and fast rules about when a woman can have sex again after a vaginal birth or a caesarean section. When it comes to this, and if you are unsure, discuss it with your doctor.
After a vaginal birth, tears or an episiotomy may have been sustained, which can prolong the healing process. It is recommended that a woman who has just given birth not be sexually active until this area has healed and been cleared by your doctor or midwife.
Sexually activity before this can result in disruption of any stitches and open the wound. If there were tears or injuries, the recommended waiting time is four to six weeks. If a tear or episiotomy was present, then a minimum of six weeks should be allowed.
After a caesarean section, there is often no vaginal tear or sutures, unless the labour was very advanced. Sex may not cause vaginal discomfort but may apply pressure on the abdominal wound. The general guideline will depend on the woman’s progress and their health practitioner but is usually around four to six weeks post birth.
During the postpartum period, there is a shift in hormonal levels, which may cause vaginal dryness. This is completely normal and may make sex painful. In this case an oestrogen cream may be prescribed, which will make the perineum and vaginal area to be less sensitive.
If you don’t want to have sex, then waiting until you feel ready is completely understandable and acceptable. Lubrication can also assist in reducing any discomfort. The bottom line is to listen to your body and do what feels right.
Tears after vaginal delivery
Vaginal delivery may result in a vaginal tear, which can be due to a lack of stretching of the perineum, a larger than expected baby’s head or an uncontrolled birth. There are varying degrees of vaginal tears, ranging from a small skin opening, to first through fourth degree tears, which involve differing depths of the tear.
Most tears will need to be sutured and this can be done straight after delivery or may require theatre if the tear is complicated. Ideally a tear should be sutured as soon as possible, to prevent any unnecessary blood loss.
Tears can take as little as 7-10 days to heal but may be painful for longer. Deeper tears will take longer to heal. Initial treatment with an ice pack, will reduce pain and swelling. These can be placed inside your underwear and kept in place for 10-20 minutes at a time.
How to care for vaginal tears
Sitting in a shallow bath or tub of water with added coarse salt (a sitz bath) a few times a day, will keep the area clean and the salt will act as an anti-bacterial and dry out the area. You can also fill a squeeze bottle with salt water or plain water and apply each time after using the toilet.
Stool softeners are a must! These will ensure that you are not constipated or straining, and that passing a stool is not painful. It is essential to stay hydrated during this time to avoid constipation. Pain medication such as anti-inflammatories can be taken on a regular basis in the first few days to ease discomfort.
After a vaginal birth, there will be bleeding for a few weeks, this is known as lochia. It is pertinent to change sanitary pads regularly to keep the area clean and dry. It is not recommended to use a tampon after sustaining a tear, but rather to use sanitary pads for the first few weeks. Refrain from strenuous activity as this may cause damage to the area or disrupt the stitches.
A consultation with your healthcare provider one to two weeks after delivery will ensure that the wound is healing well and is healthy. Things to look out for include increased swelling and pain, redness or a foul-discharge. These can be signs of infection and require urgent attention.
Once the wound has healed and the skin is closed, massaging the area with an oil can reduce any scarring or hardness.
Long-term complications can include scarring, pain, loss of sensation and pain with intercourse. Severe but rare complications (usually with a fourth-degree tear) can include faecal incontinence. If an episiotomy is cut, the same care is advised.
Dr Kim Sonntag MBChB (UCT), FCOG (SA), MMed (UCT), is a specialist obstetrician and gynaecologist working at Life Kingsbury Hospital. She has a specialised interest in high-risk obstetrics and foetal medicine. She is an advocate for normal vaginal delivery where possible and willing to do vaginal births after caesarean section, given the right circumstances.
T +27 (0)21 6852375