Last update: May 11, 2019

Sexual relations

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

After childbirth, coital sex during the first 4 to 6 weeks (the so-called quarantine) is not recommended, in order to allow healing or recovery of possible wounds or vaginal traumas and to avoid infection. If there was no tear or episiotomy and there is no vaginal bleeding, the period of coital abstinence can be reduced.
After that time, at first it is appropriate to adopt positions in which the woman controls the degree of penetration and the breasts are not compressed by the couple.
Sex without penetration can be practiced as long as the woman feels like it.

Maternal sexual desire may be diminished during the first 3 to 12 months after childbirth (O'Malley 2018) in most women. Breastfeeding increases prolactin levels and decreases estrogen levels, leading to decreased libido, decreased satisfaction and dyspareunia (pain) in sexual relations (Triviño 2018, O'Malley 2018, Wallwiener 2017, Yee 2013, Leeman 2012, Serati 2010, Brtnicka 2009, Rowland 2005, Signorello 2001, Avery 2000, Byrrd 1998, Glazener 1997).
The type of delivery, instruments used during delivery, episiotomy (Wallwiener 2017, Barbara 2016, Serati 2010, Brtnicka 2009, Signorello 2001, Barrett 2000), depression (Yee 2013, Leeman 2012), fatigue, a greater appreciation for breastfeeding (Ahn 2010) and physical changes can also influence decrease in libido and dyspareunia.

On the other hand, the levels of testosterone (and therefore of libido) decrease in men when they are parents (Grebe 2019, Gettler 2011) and it seems that there is more decrease if they do co-sleeping with the baby (Gettler 2012).

The hormones involved in sexual intercourse are many the same as those involved in breastfeeding, so it is normal for a majority of women (Pepe 1991) to experience sensual pleasurable sensations when breastfeeding (Robinson 2015, Magon 2011, Schmied 1999, Dignam 1995).

Possible dryness and vaginal pain due to hypoestrogenism can be solved with lubricating creams. If the couple uses a condom, the lubricant must be compatible with it.

If milk ejection due to the release of oxytocin bothers the couple, breastfeeding or expression can be carried out before.
The breast can be more sensitive due to breastfeeding and react with pain to the caresses of the sexual partner.
Sexual relations are perfectly compatible with breastfeeding.
Semen does not alter the composition of milk by any route.

Given the increase in prolactin achieved from sexual stimulation (Brody 2006, Krüger 2002, Exton 2001 and 1999), having sex has been proposed as a way to treat situations of hypogalactia (Menezes 2008).

The perception of the breast as an erogenous organ and one of sexual attraction in several societies can interfere with breastfeeding in general and particularly in public (Henderson 2011, Avery 2011, Dettwyler 1995, Rodriguez 1995).

Exclusive breastfeeding with feeds spread out less than 4 to 6 hours even during the night and as long as menstruation does not appear (LAM method) has a 98% efficacy as a contraceptive in the first 6 months (Sridhar 2017).

If intercourse with penetration occurs in the first month, male condoms and copper intrauterine devices are compatible from the first postpartum day.
Although it is better to avoid hormonal contraceptives during the first month postpartum, in case of risk of pregnancy, the benefits outweigh the risks when using intrauterine devices with levonorgestrel or etonorgestrel implants, depot medroxyprogesterone acetate injections and progesterone-only oral contraceptives.
From the first month all contraceptive methods are compatible with breastfeeding, including the diaphragm and spermicides and, with some precaution about milk production, the combination of estrogen and progesterone whether in the form of oral administration, vaginal ring or in implants (Sridhar 2017, Curtis 2016, Altshuler 2015, OMS 2015, Berens 2014).

Information in Spanish can be consulted (El parto es nuestro 2018, El País 2016)


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Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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References

  1. Grebe NM, Sarafin RE, Strenth CR, Zilioli S. Pair-bonding, fatherhood, and the role of testosterone: A meta-analytic review. Neurosci Biobehav Rev. 2019 Jan 9;98:221-233. Abstract
  2. Triviño-Juárez JM, Romero-Ayuso D, Nieto-Pereda B, Forjaz MJ, Oliver-Barrecheguren C, Mellizo-Díaz S, Avilés-Gámez B, Arruti-Sevilla B, Criado-Álvarez JJ, Soto-Lucía C, Plá-Mestre R. Resumption of intercourse, self-reported decline in sexual intercourse and dyspareunia in women by mode of birth: A prospective follow-up study. J Adv Nurs. 2018 Abstract
  3. El Parto es Nuestro. La vida sexual tras el parto acceso en 2018 Full text (link to original source) Full text (in our servers)
  4. O'Malley D, Higgins A, Begley C, Daly D, Smith V. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth. 2018 Abstract
  5. Sridhar A, Salcedo J. Optimizing maternal and neonatal outcomes with postpartum contraception: impact on breastfeeding and birth spacing. Matern Health Neonatol Perinatol. 2017 Abstract Full text (link to original source) Full text (in our servers)
  6. Wallwiener S, Müller M, Doster A, Kuon RJ, Plewniok K, Feller S, Wallwiener M, Reck C, Matthies LM, Wallwiener C. Sexual activity and sexual dysfunction of women in the perinatal period: a longitudinal study. Arch Gynecol Obstet. 2017 Abstract
  7. CDC - Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, Simmons KB, Pagano HP, Jamieson DJ, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. CDC - MMWR Recommendations & Reports. 2016 Abstract Full text (link to original source) Full text (in our servers)
  8. El Pais - Olga Fernández Castro La cruda realidad del sexo después del parto El Pais-Buenavida. 2016 Full text (link to original source) Full text (in our servers)
  9. Barbara G, Pifarotti P, Facchin F, Cortinovis I, Dridi D, Ronchetti C, Calzolari L, Vercellini P. Impact of Mode of Delivery on Female Postpartum Sexual Functioning: Spontaneous Vaginal Delivery and Operative Vaginal Delivery vs. Cesarean Section. J Sex Med. 2016 Abstract
  10. Berens P, Labbok M; Academy of Breastfeeding Medicine. Protocolo clínico de la ABM n.º 13: Anticoncepción durante la lactancia, revisado en 2015. Breastfeed Med. 2015 Full text (link to original source) Full text (in our servers)
  11. Robinson VC. Support for the hypothesis that sexual breast stimulation is an ancestral practice and a key to understanding women's health. Med Hypotheses. 2015 Dec;85(6):976-85. Abstract
  12. Berens P, Labbok M; Academy of Breastfeeding Medicine. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  13. OMS. Criterios médicos de elegibilidad para el uso de anticonceptivos Quinta edición. Who Library. 2015 Full text (link to original source) Full text (in our servers)
  14. Yee LM, Kaimal AJ, Nakagawa S, Houston K, Kuppermann M. Predictors of postpartum sexual activity and function in a diverse population of women. J Midwifery Womens Health. 2013 Abstract
  15. Leeman LM, Rogers RG. Sex after childbirth: postpartum sexual function. Obstet Gynecol. 2012 Abstract
  16. Gettler LT, McKenna JJ, McDade TW, Agustin SS, Kuzawa CW. Does cosleeping contribute to lower testosterone levels in fathers? Evidence from the Philippines. PLoS One. 2012;7(9):e41559. Abstract
  17. Obladen M. Bad milk, part 1: antique doctrines that impeded breastfeeding. Acta Paediatr. 2012 Abstract
  18. Obladen M. Bad milk, part 2: new-age doctrines that impeded breastfeeding. Acta Paediatr. 2012 Abstract
  19. Gettler LT, McDade TW, Feranil AB, Kuzawa CW. Longitudinal evidence that fatherhood decreases testosterone in human males. Proc Natl Acad Sci U S A. 2011 Sep 27;108(39):16194-9. Abstract
  20. Henderson L, McMillan B, Green JM, Renfrew MJ. Men and infant feeding: perceptions of embarrassment, sexuality, and social conduct in white low-income British men. Birth. 2011 Abstract
  21. Avery AB, Magnus JH. Expectant fathers' and mothers' perceptions of breastfeeding and formula feeding: a focus group study in three US cities. J Hum Lact. 2011 Abstract
  22. Magon N, Kalra S. The orgasmic history of oxytocin: Love, lust, and labor. Indian J Endocrinol Metab. 2011 Sep;15 Suppl 3:S156-61. Abstract
  23. Ahn Y, Sohn M, Yoo E. Breast functions perceived by Korean mothers: infant nutrition and female sexuality. West J Nurs Res. 2010 Abstract
  24. Serati M, Salvatore S, Siesto G, Cattoni E, Zanirato M, Khullar V, Cromi A, Ghezzi F, Bolis P. Female sexual function during pregnancy and after childbirth. J Sex Med. 2010 Abstract
  25. Brtnicka H, Weiss P, Zverina J. Human sexuality during pregnancy and the postpartum period. Bratisl Lek Listy. 2009 Abstract
  26. Menezes RG, Shetty AJ, Kanchan T, Lobo SW, Chauhan A, Manjunath S, Nayak VC. Is indulging in sexual activity a potential mode of treatment for hypogalactia? Med Hypotheses. 2008 Abstract
  27. Brody S, Krüger TH. The post-orgasmic prolactin increase following intercourse is greater than following masturbation and suggests greater satiety. Biol Psychol. 2006 Abstract
  28. Rowland M, Foxcroft L, Hopman WM, Patel R. Breastfeeding and sexuality immediately post partum. Can Fam Physician. 2005 Abstract
  29. Krüger TH, Haake P, Hartmann U, Schedlowski M, Exton MS. Orgasm-induced prolactin secretion: feedback control of sexual drive? Neurosci Biobehav Rev. 2002 Abstract
  30. Signorello LB, Harlow BL, Chekos AK, Repke JT. Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women. Am J Obstet Gynecol. 2001 Abstract
  31. Exton MS, Krüger TH, Koch M, Paulson E, Knapp W, Hartmann U, Schedlowski M. Coitus-induced orgasm stimulates prolactin secretion in healthy subjects. Psychoneuroendocrinology. 2001 Abstract
  32. Avery MD, Duckett L, Frantzich CR. The experience of sexuality during breastfeeding among primiparous women. J Midwifery Womens Health. 2000 Abstract
  33. Barrett G, Pendry E, Peacock J, Victor C, Thakar R, Manyonda I. Women's sexual health after childbirth. BJOG. 2000 Feb;107(2):186-95. Abstract
  34. Exton MS, Bindert A, Krüger T, Scheller F, Hartmann U, Schedlowski M. Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosom Med. 1999 Abstract
  35. Schmied V, Barclay L. Connection and pleasure, disruption and distress: women's experience of breastfeeding. J Hum Lact. 1999 Dec;15(4):325-34. Abstract
  36. Byrd JE, Hyde JS, DeLamater JD, Plant EA. Sexuality during pregnancy and the year postpartum. J Fam Pract. 1998 Abstract
  37. Glazener CM. Sexual function after childbirth: women's experiences, persistent morbidity and lack of professional recognition. Br J Obstet Gynaecol. 1997 Abstract
  38. Rodriguez-Garcia R, Frazier L. Cultural paradoxes relating to sexuality and breastfeeding. J Hum Lact. 1995 Abstract
  39. Dettwyler KA. Sexuality and breastfeeding. J Hum Lact. 1995 Abstract
  40. Dignam DM. Understanding intimacy as experienced by breastfeeding women. Health Care Women Int. 1995 Sep-Oct;16(5):477-85. Review. Abstract
  41. Pepe F, Garozzo G, Rotolo N, Calì V, Chirico E, Leanza V, Di Mauro S, Pepe P. [Breast feeding and pleasure]. Minerva Ginecol. 1991 Mar;43(3):115-8. Italian. Abstract

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