Sex after a C-section: Everything you need to know

Most women need to wait at least 6 weeks before having sex after a C-section, or until their doctor or midwife says it is safe.

They may also need to take a few precautions and make some adjustments to their sexual activities in the short term.

A C-section, also known as a cesarean delivery, involves a doctor delivering a baby through a long incision in the abdomen instead of through the vagina.

An estimated one in four pregnant women will undergo cesarean delivery, and questions about how it affects postpartum sexual activity are very common.

In this article, we address some common concerns, including how long to wait, what to expect, and if there will be an increased risk of bleeding.

How long to wait

Could holding hands and considering having sex after a c-section
A doctor will tell a woman when it is safe to have sex after cesarean delivery.

While there is no standard amount of time a woman should wait before returning to regular sexual activities following cesarean delivery, it is best to wait until a doctor says it is safe.

Most women get the OK from doctors at their 6-week postnatal checkup and may choose to start having sex after this point.

In a 2013 study that included more than 1,500 women, 53 percent had attempted sexual activity within 6 weeks of giving birth. Of these women, 41 percent had tried vaginal sex.

Everyone’s recovery is different, and the pace may depend on whether the cesarean delivery was extensive or unplanned.

Many women who have undergone cesarean delivery chose to wait at least 4–6 weeks before having sex because they experience soreness, vaginal bleeding, and fatigue following the birth.

Women should also avoid wearing tampons until postpartum bleeding, or lochia, is complete.


Precautions

After a doctor says that it is safe to try sexual activity, people may still need to take some precautions to reduce the risk of complications.

There may be some soreness and swelling around the incision site, and the surrounding skin may feel tight or stretched.

As the incision site heals, it will also be more prone to tearing, so it is essential to avoid strenuous activities, including some sexual activities. It is best to avoid lifting anything heavier than the baby.

There is also usually heavy bruising along and around the incision site, and this will slowly fade in the weeks following the surgery.

A doctor may remove the surgical staples before a woman leaves the hospital, but the abdomen will still be very sore and tender for a few weeks.

The vagina usually feels wider, swollen, or bruised after giving birth. The cervix also needs time to heal and return to its regular size before a person can start having sex or using tampons again.

Anyone who has recently undergone a cesarean delivery should watch out for signs of infection and other complications. These signs include:

  • a fever over 100.4° F
  • severe pain
  • leaking urine
  • heavy vaginal bleeding, such as bleeding that soaks a maxi pad in 1 hour
  • large clots
  • bad-smelling discharge oozing from the incision
  • severe or continual bleeding from the incision
  • swelling around the incision site
  • swelling or pain in the lower legs
  • pain when peeing
  • vomiting, diarrhea, or nausea
  • shortness of breath
  • hives or a rash
  • an intense headache that comes on suddenly and does not go away
  • unexplained anxiety, depression, or panic
  • flu-like symptoms

What to expect

Couple holding a baby
Sex may not be a high priority after a baby is born.

Many women do not feel like having sex for a few weeks or months after giving birth, either vaginally or by cesarean delivery.

There is no need to rush. Most women and their partners are exhausted from taking care of a newborn, so sex may not rank high on the list of priorities.

It is essential to keep in mind that sex should be pleasurable. If sexual activity causes any pain or discomfort, it is best to stop.

If the incision site is sore, try positions that do not put any pressure on the woman’s abdomen.

Hormonal changes after birth may lead to vaginal dryness, so it may be a good idea to use a lubricant.

If penetration is uncomfortable or painful, it can help to focus on nonpenetrative activities. Some types of foreplay, such as massage, can also help people to relax and enjoy their experience.

It is crucial to keep in mind that everyone heals differently. If sexual activity becomes more painful over time, talk to a doctor.

Authors of one study reported that the rate of sexual problems in first-time mothers rose from 38 percent before pregnancy to 83 percent in the first 3 months following delivery. This figure declined to 64 percent 6 months after birth.

In one cohort study, the researchers found no differences regarding sexual problems after delivery among women who gave birth vaginally and those who underwent cesarean delivery.

However, results of another cohort study suggested that women who had undergone cesarean delivery were more likely to delay having sex longer than those who had given birth vaginally.

Is there an increased risk of bleeding?

After giving birth, all women experience a period of vaginal bleeding called lochia. This bleeding continues until the uterus shrinks back to its regular size.

Lochia causes bright red blood to leak from the vagina. Most women wear extra-absorbent pads or padded underwear during this time.

Lochia bleeding eventually changes from bright red to dark red or pale pink. Over time, it fades to an orange or yellowish color.

Activity levels can also affect this period of bleeding. If the amount of blood suddenly increases, it may mean that a woman is doing too much too quickly after surgery.

For 1 or 2 weeks after cesarean delivery, a woman may also notice some periodic, minor bleeding from the incision site.

Strenuous activity, including sex, can increase the risk of opening the incision or experiencing a blood clot.


Birth control after giving birth

Technically, a woman can get pregnant as soon as 3 weeks after giving birth, regardless of whether they are breast-feeding.

Women can even get pregnant after giving birth if they have not yet had a period.

This means that women who may become pregnant through sexual intercourse usually wish to use birth control.

Many women return to their preferred method of birth control. It is best to speak to a doctor or nurse about the best methods before leaving the hospital or during the 6-week checkup.

Recovery

mother and newborn baby in hospital
After cesarean delivery, most women will spend 3–4 days in the hospital.

Most women need to spend 3–4 days recovering in the hospital after cesarean delivery.

After 24 hours, a doctor or nurse will often recommend getting up and gently moving around, even just to go to the bathroom. A nurse may also demonstrate ways of moving that are less likely to cause pain from the incision site.

A doctor may leave the dressing on the incision site for at least 24 hours after the surgery.

Most cesarean delivery incisions are between 10 and 20 centimeters long. They run horizontally across the abdomen, usually just above the underwear line.

Before a woman leaves the hospital, the doctor will give instructions to ensure that the wound heals properly and remains free from infection.


Takeaway

There is no right time to begin having sex again after cesarean delivery.

However, the cervix needs time to heal, and the incision site will be more prone to infection in the initial weeks, so it is best to wait until a doctor says it is safe.

A doctor will usually give the go-ahead close to the 6-week checkup, but many women prefer to wait longer.

Take things slowly and communicate what feels pleasurable and what does not. If sex is painful, it is essential to say so. People may choose to stop or try a different position or activity.

If sex becomes more painful over time instead of less, speak to a doctor.

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