GETTING BACK TO SEX AFTER PREGNANCY LOSS
Though your body might be ready to return to sex after a miscarriage, are you?
How soon can you have sex after experiencing a pregnancy loss? It’s a common question among women of childbearing age, considering that up to 20 percent of pregnancies result in miscarriage and approximately 1 in 100 in stillbirth. There’s not a standard — or straightforward — answer. Generally, physicians counsel patients to wait until they feel ready. But readiness for a woman and her partner can depend on a number of physical, and emotional, factors.
“From a medical and practical perspective, the primary thing is to ensure that the pregnancy has passed completely, the cervix has closed, and that there isn’t an increased risk of causing infection in the uterus,” explained Zev Williams, M.D., Ph.D., chief of the division of reproductive endocrinology and infertility and an associate professor of obstetrics and gynecology at Columbia University Irving Medical Center. “The timing for this depends on how far along the pregnancy was at the time of the loss and how quickly the woman’s body recovers.”
A couple’s romantic readiness is another question altogether.
Emotional roadblocks are a big factor: Women may feel reluctant to engage in sexual intimacy while still grieving their loss. Miscarriage can also change a woman’s relationship with her body, and what sex represents to a couple might shift. If this seems hard to understand, it is: I am a psychologist specializing in women’s reproductive and maternal mental health, and I didn’t fully comprehend how complex returning to sex could be until I experienced a second trimester miscarriage firsthand. Then I understood all too well: There’s no one-size-fits-all answer.
“There are no guidelines with regard to telling patients what to expect about returning to sex after miscarriage. Routinely, we don’t discuss sex after loss unless patients bring it up,” said Jessica Schneider, M.D., an ob-gyn at Cedars Sinai Medical Center in Los Angeles. “There’s research about how safe it is to get pregnant again after a loss, but not about sexual function or satisfaction.” And the fact is, sexual function and satisfaction can, and do, change.
I talked to several women about their experiences around sex after pregnancy loss to find out how they approached returning to intimacy. (The women preferred their last names not be used due to privacy concerns.)
Some women, like Ash, 36, felt ready to have sex right away. After experiencing a stillbirth, she turned to sex for healing. “It was a way to feel powerful in my body,” she said. “I felt like my body had failed me, and sex was a way to get that back.” There was one caveat though: She didn’t want to risk another pregnancy. “It felt better to engage in sexual acts that couldn’t result in one.”
Trying to get pregnant again is a sensitive topic medically and emotionally. The World Health Organization’s official stance is to wait six months before attempting another pregnancy. Recent research, however, suggests that having sex sooner doesn’t have a negative effect on future pregnancies and could actually help success rates.
“The doctor told us to wait until we were comfortable,” said Maria, 26, who has had four miscarriages. “It was nerve-wracking to return to sex. I think because I was terrified of getting pregnant again and losing it or not getting pregnant again. It was challenging mentally.”
It’s understandable to feel conflicted, but the odds of future success are good: Up to 85 percent of women who experience a pregnancy loss, and 75 percent of women who have had multiple losses, go on to have a healthy pregnancy.
Shame and self-blame can enter the bedroom after pregnancy loss and create trouble where there previously was none. Hanan, 27, thought she was ready to have sex again immediately after a stillbirth, though her doctor told her to wait six weeks. She said she felt arousal and the desire to have sex, and engaged with her husband in everything other than penetrative sex, while waiting for medical clearance. But the first time they had intercourse, she wasn’t prepared for her emotional reaction. “I cried so much after the first time. I felt very guilty,” she said. “My body wanted to, but my brain didn’t. It felt selfish and immoral — like I should have been celibate while grieving.”
These thoughts are especially challenging for women who are actively trying to conceive again. “I did not want to initiate sex after my loss, but at the same time, I did want to get pregnant again,” said Maggie, 32. “My vagina became a constant reminder of the loss.”
Some women said they resented their bodies for a perceived failure. “After my miscarriage, I couldn’t be with anyone for over a year,” Zachi, 27, told me. “The fact that my body failed impacted the way I felt sexually afterward. I carried the baby emotionally, long after physically.”
While a 2015 survey found that 47 percent of respondents who had experienced a miscarriage reported feeling guilty about it — and nearly three-quarters thought their actions may have caused it — the reality is that chromosomal abnormalities are the explanation in about 60 percent of miscarriages. Pregnancy loss cannot be prevented.
If you’ve been trying to conceive for a long time, sex following a pregnancy loss can become especially fraught — even unappealing.
“After my first miscarriage, we only had sex to conceive. It started to feel like a task,” said Gina, 30, who has experienced infant loss and two miscarriages. “That mentality compounded after my second miscarriage and killed all sexual desire for me.”
Sonali, 33, who has lost four pregnancies, had difficulty returning to the very place she got pregnant. “Sex with your other half in the bed where you conceived the babies you lost is so triggering,” she said.
“Sometimes, I’m thinking about where I’d be in my pregnancy now; how I wouldn’t be able to have sex in this position,” Maria said. “It makes me feel guilty to feel great, when I should be seven months pregnant and uncomfortable.”
Pregnancy loss can have unintended positive impacts on a woman’s sexuality, too. Zachi said that she is more assertive in her sex life because of her miscarriage. “I have to listen to my body now,” she said. “It becomes painful not to. I am a lot more sure in what I want.” A miscarriage ultimately brought Maggie and her husband closer together, she said. “During the loss, I felt like I was on an island,” she remembered. “The first time my husband and I had penetrative sex, I cried from relief, because I felt so re-connected to him.”
Having and enjoying sex again is really about one thing — personal readiness — which is what I tell my patients. It’s O.K. to feel grief and sexual desire simultaneously. “Moving on” is not a prerequisite for pleasure.