Body Image and Confidence After Childbirth, and a Changed Sex Life

Many new mothers look in the mirror after giving birth and feel they do not recognise themselves: a tummy that has not gone down, stretch marks, hair falling out, not enough sleep, and when their partner comes close, not knowing how to feel. I want to say that all of this is very common. Your body is not damaged; it has just been through one of the biggest jobs a human body can do.

How the body changes after childbirth

• Hormones: oestrogen drops immediately after birth, especially while breastfeeding, when prolactin is high. This can cause vaginal dryness and lower desire.
• Perineal tear or caesarean wound: these may hurt for longer than you expect.
• Pelvic floor muscles may be weak, causing urine leakage or a feeling of heaviness.
• Tummy: separation of the abdominal muscles (diastasis recti) is common and usually improves with recovery and the right exercises.
• Exhaustion: chronic lack of sleep is the most direct desire-killer of all.

Your mind changes too, and that is normal

A new role makes many women feel their old self has disappeared. The body belongs to the baby all day, so you may not want anyone else to touch you (feeling "touched out"). Some women feel guilty for not wanting sex; others worry that their partner sees them differently.

The baby blues are common in the first 2 weeks, with tearfulness and irritability that improve on their own. But if you feel low, joyless, worthless or so anxious that you cannot function for more than 2 weeks, it may be postpartum depression, which affects about 1 in 7 mothers and is treatable.

Baby blues

• Common in the first 2 weeks
• Tearful, irritable
• Can improve on its own

Postpartum depression

Postpartum depression

• Sad, no joy, feeling worthless
• So anxious you can't function
• Lasts more than 2 weeks
• About 1 in 7 women; treatable

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If you have thoughts of harming yourself or your baby, get help at once: 1323 (mental-health hotline) or 1669 (emergency).

When can I have sex again?

There is no fixed day. Many doctors advise waiting at least about 4–6 weeks, or until the postnatal bleeding has stopped, wounds have healed and you have had your postnatal check. But what matters more than any number is whether you feel ready in body and mind.

• Use contraception from the very first time, because you can get pregnant before your first period returns. Breastfeeding works as contraception only under strict conditions; talk to your doctor about a method suitable while breastfeeding.
• Use a lubricant, because the vagina is often dry while breastfeeding. Read vaginal dryness.
• Start slowly and stop whenever it hurts. Closeness without penetration is valuable sex too; try sensate focus exercises.
• If pain continues for several months, read painful sex.

Pelvic floor recovery with Kegel exercises

Find the muscles you use to hold in urine and wind. Squeeze and hold for 3–5 seconds, then relax for the same time. Do 8–10 squeezes, 3 times a day, Breathe normally, don't tense your tummy, and keep going for at least 3 months. A Cochrane review (2020) found that pelvic floor training reduces the chance of urine leakage, especially when started during pregnancy, while the evidence for treating leakage after birth is less clear. If you still leak after training, or have pain because the muscles are too tight, see a pelvic floor physiotherapist.

Breastfeeding and vaginal dryness

While you are breastfeeding, the hormone prolactin suppresses the ovaries, so oestrogen is low and the vaginal walls become thinner and drier. Research has found breastfeeding to be linked with pain during sex at 6 months after birth. Use a water-based or silicone lubricant, or a vaginal moisturiser. If it still hurts, your doctor may consider a low-dose vaginal oestrogen. Symptoms usually improve after weaning or when periods return.

Rebuilding confidence step by step

1. Accept your body's timeline. It took nine months to change, so give it at least as long to recover.
2. Look after the basics first: sleep in blocks when you can, eat enough, drink water, and ask people at home for help.
3. Move your body once your doctor says it is fine, starting with walking and pelvic floor exercises. There is no need to rush weight loss.
4. Wear clothes that are comfortable for the body you have now, not the body of a year ago.
5. Compare yourself less with images on social media. Most of them are selected and edited.
6. Have a little time that is your own, even just 15 minutes a day.

1. 1Accept the timeNine months of change; allow at least as long to recover
2. 2Cover the basicsSleep in blocks, eat enough, drink water, ask for help at home
3. 3Move your bodyWhen your doctor allows, start walking and pelvic floor work
4. 4Compare lessMost social media images are selected and edited
5. 5Time for yourselfEven 15 minutes a day

Your partner can help more than you think

• Share housework and childcare equally, not just "help out".
• Give sincere compliments and touch that is not always aimed at sex.
• Do not pressure or count the days; ask, "What would you like me to help with today?"
• Fathers can also become stressed or depressed after a birth. Read a man's perspective in being a father and being a husband.

If talking keeps turning into arguments, read common couple problems and how to talk them through.

How to talk with your partner when you're not ready

Talk about your own feelings rather than blaming, for example: "Right now I'm exhausted and still sore, but I still want to feel close to you." Say what you are ready for, such as cuddling or lying together, and agree when you will talk about it again. Speaking openly stops your partner from reading it as rejection.

When postpartum depression affects your sex life

Postpartum depression lowers desire and pleasure. Some antidepressants can lower desire further. Don't stop your medicine on your own; tell your doctor, because it can be adjusted. Read antidepressants and sex. If you have felt low for more than 2 weeks, or have thoughts of harming yourself, get help straight away: call 1323 (Thailand's mental-health hotline; Thai language, ask for English support) or 1669 in an emergency.

When to see a doctor

• Low mood, anxiety, or being unable to sleep even when you have the chance, for more than 2 weeks
• A wound that becomes more painful, fever, pus, or unusually heavy bleeding
• Leaking urine or stool, or a feeling of something bulging in the vagina
• Ongoing pain during sex, or no desire at all for several months that causes you distress

At Dr. Kris Clinic, we look after confidence, sexual desire and relationships after having a baby, privately, and refer you to an obstetrician-gynaecologist or physiotherapist when needed. You can come alone or with your partner, and English-speaking consultations are available in person or online.