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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 is 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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