Breastfeeding, Sex and Intimacy: The Conversation We're Still Not Having
In this article we'll look at:
How breastfeeding and hormonal changes can affect sexual function
Why pain and vaginal dryness can become part of a wider cycle
The impact of exhaustion, physical contact and the mental load of new parenthood
Why changes in desire aren't always simply a "libido problem"
When it may be worth seeking medical, psychosexual or relationship support
Breastfeeding is something we talk about a lot. We talk about the benefits for babies, the practicalities of getting started, milk supply, pumping, latching, mastitis and the relentless logistics of feeding another human being, often at all hours of the day and night. We talk about how exhausting it can be, and we talk - increasingly, and rightly so - about the importance of supporting people to breastfeed rather than simply assuming that it will all come naturally.
What we talk about considerably less is what breastfeeding can mean for the person's sex life.
That is rather strange when you think about it. Breastfeeding is a physiological process involving significant hormonal and bodily changes, and those changes don't conveniently stop at the bedroom door. They can affect vaginal lubrication, genital comfort, body image, energy levels and yes - for some people, sexual desire too. Add in the realities of recovering from pregnancy and birth, interrupted sleep, the mental load of caring for a baby and the enormous identity shift that can accompany becoming a parent, and it would perhaps be more surprising if sexual function and intimacy were completely unaffected.
Yet this is still an area that people are often left to work out for themselves.
The NHS guidance on sex and contraception after birth acknowledges that hormonal changes after birth can make the vagina feel more dry than usual, and that this can make sex uncomfortable. It also advises that there is no fixed timetable for returning to sex after having a baby, and that people should seek help if pain persists. NICE's guidelines for postnatal care similarly recognise sexual intercourse as a topic that may be discussed alongside physical and psychological wellbeing.
That matters, because I think we have a tendency to treat changes in sexual function after having a baby as either something that should simply be tolerated or something that will inevitably resolve if you just give it enough time.
Sometimes it does. Sometimes it doesn't.
And even when something is common, that doesn't mean you should have to put up with it indefinitely.
"I just don't feel like having sex anymore"
This is a sentiment I hear in various forms from people who are struggling with changes in their sexual lives after having a baby. Sometimes the concern is straightforwardly about desire: they don't seem to want sex in the way they used to, and they're worried about what that means. Sometimes they still want to want sex, but the desire simply isn't appearing. Sometimes they are experiencing pain or dryness, which has gradually made sexual activity less appealing. And sometimes they are struggling to work out whether they actually miss sex itsself, or whether what they really miss is feeling close to their partner, feeling attractive, having time alone together or simply feeling like themselves again.
Those are not necessarily all the same problem - far from it.
I think this is one of the reasons I'm cautious about immediately labelling every postpartum sexual difficulty as "low libido". Low desire is a description of what someone is experiencing; it doesn't tell us why they are experiencing it. If sex has become painful, for example, it would be rather strange to focus exclusively on increasing desire without first asking what is happening physically. Likewise, if someone is chronically exhausted, touched all day and carrying the majority of the mental load at home, there may be rather more going on than a simple failure of their libido to cooperate.
Sometimes, the symptom is not the problem.
And that distinction becomes particularly important when we're talking about sexuality after childbirth.
Breastfeeding can affect sexual function - but it isn't the whole story
There are physiological reasons why breastfeeding may affect sexual function. Hormonal changes associated with lactation can contribute to vaginal dryness, and dryness can make penetration uncomfortable or painful. The NHS specifically lists breastfeeding as one of the circumstances in which vaginal dryness can occur, and notes that hormonal changes can affect the amount of vaginal fluid that is produced.
But even that explanation is more complicated than it might initially appear.
If sex becomes uncomfortable, your experience of sex may change. You may begin to anticipate discomfort before anything has even happened. You may find yourself becoming tense or reluctant to engage. You may start avoiding penetration, perhaps quite sensibly, because you have learned that it is likely to be unpleasant. Over time, what began as a physical problem can become intertwined with anticipation, anxiety, avoidance and relationship dynamics.
That doesn't mean the issue is "psychological". It underlines that bodies and brains are not separate systems that politely take it in turns having problems.
The same applies to low desire. Hormonal changes can certainly be relevant, but so can exhaustion, pain, mood, medication, body image, relationship stress and the sheer cognitive load of caring for a baby. These factors can interact with one another in ways that make it almost impossible to identify a single cause.
This is why I think the more useful question is often not simply, "Why don't I want sex?", but "What has changed, and what might be getting in the way?"
Then there’s the exhaustion…
There is a tendency to talk about tiredness as though it is a minor inconvenience that new parents should simply expect to endure. In reality, chronic sleep disruption can have a profound effect on how we function, emotionally and physically, and it is difficult to separate sexual desire from the circumstances in which that desire is expected to emerge.
Breastfeeding can mean being the person who is physically responsible for feeding your baby throughout the day and night. Even when a partner is wonderfully supportive, there may be a particular kind of physical and mental availability that comes with being a breastfeeding parent. Your body is not entirely your own for much of the day, and your attention is repeatedly drawn away from yourself and towards somebody else's needs.
Desire, meanwhile, tends to be rather less cooperative when you are exhausted.
That doesn't mean that everyone who breastfeeds will experience low desire, or that breastfeeding itself is the reason someone isn't interested in sex. We just need to stop pretending that desire exists in isolation from the rest of a person's life.
If you are exhausted, uncomfortable, worried about your baby, struggling with your body image and haven't had an uninterrupted night's sleep in months, it may be worth asking whether you actually have a "libido problem" - or whether you are simply trying to experience sexual desire in circumstances that are not particularly conducive to it.
Sometimes the answer will be both.
..And then there's the constant touching..
There is another aspect of breastfeeding that I think deserves considerably more attention: the experience of being touched.
When you have a baby, you may spend an enormous amount of time in physical contact with another person. You feed them, hold them, settle them, carry them and sleep beside them. Your breasts, which may previously have been a big part of your sexual identity, may now feel entirely functional. They may be sore, leaking, engorged or simply associated so strongly with feeding that the idea of experiencing them sexually feels completely disconnected from your current reality.
Some people describe feeling "touched out". I think that phrase can sometimes sound trivial, but the experience behind it can be anything but.
You may love your partner deeply and still not want them to touch you.
You may want affection but be reluctant for it to become a prelude to sex.
You may want to feel close to your partner while simultaneously feeling as though you cannot tolerate one more physical demand of your body.
None of this necessarily means that something is wrong with your relationship. It may mean that your capacity for physical contact has been exhausted.
And there is a difference between wanting intimacy and wanting sexual activity that can become particularly important during this period of life. You may miss laying together, kissing, cuddling or feeling emotionally connected without necessarily wanting to have penetrative sex. You may want to feel desired without wanting to be touched. You may want to be touched in ways that feel pleasurable, rather than functional.
Your body image has probably changed
There is also something psychologically complicated about the transition from pregnancy to breastfeeding and parenthood. Your body may have changed in ways that you weren't expecting, and you may be adjusting to the fact that it is now being asked to do things that have nothing to do with sexuality.
NICE's postnatal guidance explicitly recognises that breastfeeding can affect body image and identity, which I think is important because the conversation about breastfeeding is often so heavily focused on the baby's needs that the person actually doing the breastfeeding can disappear from the picture.
For some people, there is no particular conflict between feeling like a parent and feeling sexual. For others, the transition is much more complicated. You may find yourself wondering where the person you were before the baby fits into your new life. You may feel disconnected from your body, uncomfortable in it or simply unfamiliar with it. You may find that your breasts, once part of your sexual identity, now feel more like a piece of equipment that has been commandeered for another purpose.
That doesn't mean you can't experience yourself as sexual again. But it may take time to work out what sexuality means to you now.
Your relationship changes too
The physical aspects of postpartum sexual difficulties are important, but they are only part of the picture.
Having a baby changes the architecture of a relationship. There is suddenly another person whose needs have to be considered, and the ordinary opportunities for privacy and spontaneity can become considerably harder to find. Conversations that once revolved entirely around your plans, your interests and your relationship may now be dominated by sleep, childcare and who is going to get up for the next 3am feed.
You may still love each other very much. You may still be hugely attracted to one another. And yet you may find that the conditions in which your relationship previously flourished have changed considerably.
Sometimes the person who says, "I don't want sex," is trying to communicate something more complicated.
Perhaps they are saying, "I miss you, but I don't know how to find you in all of this."
Perhaps they are saying, "I don't feel attractive anymore."
Perhaps they are saying, "I'm frightened that sex will hurt."
Perhaps they are saying, "I want affection, but I don't want every affectionate interaction to become an invitation to have sex."
Or perhaps they are simply saying, "I am exhausted."
So.. is it normal?
This is where I think we need to be slightly careful with the word "normal".
It is certainly common for sexual function and desire to change after having a baby. Breastfeeding can contribute to vaginal dryness, and the combination of hormonal changes, physical recovery, fatigue and the realities of new parenthood can all play a part. The NHS advises that people should not feel rushed into sex after birth and that persistent pain should be discussed with a healthcare professional.
But "common" and "something you simply have to live with" are not synonymous.
If sex is painful, you deserve the opportunity to find out why.
If dryness is making sexual activity uncomfortable, you can ask what might help.
If you are worried that medication or contraception is affecting your sexual function, you can absolutely discuss that with the person prescribing it.
If you feel persistently low, anxious or unlike yourself, that deserves attention in its own right.
And if the impact of all of this is beginning to affect your relationship, you don't have to wait until you are both deeply unhappy before acknowledging it.
The NHS advises speaking to a GP or health visitor if you have concerns, and NICE's postnatal guidance emphasises that postnatal care should be responsive to the individual's physical and emotional needs.
You don't necessarily need to know exactly what is wrong before you ask for help.
Sometimes you just need to be able to say, "Something has changed, and I don't know why."
Perhaps the question isn't "How do I get my libido back?"
I think this is the part of the conversation that we most often get wrong. Someone says, "I don't want sex anymore," and the immediate response is to focus on desire. How do we increase it? How do we get it back? How do we make ourselves want sex again?
But perhaps the more useful question is: what has changed?
Has sex become painful?
Are you experiencing dryness?
Are you exhausted?
Are you feeling overwhelmed by physical contact?
Has your relationship changed?
Are you struggling with your body?
Are you taking medication that may be affecting sexual function?
Do you miss sex, or do you miss intimacy?
Do you want more physical closeness but feel anxious that it will create an expectation of sex?
Or is there a combination of factors that have gradually accumulated until the end result is simply, "I don't want sex"?
This is why I am reluctant to treat low desire as though it is always a problem located within the libido itself. Sometimes the desire system is responding perfectly rationally and proportionally to everything else that is happening.
The symptom isn't always the problem.
Want to know what to ask your healthcare professional?
If your sexual function, desire or comfort has changed since having a baby, it can be difficult to know where to start.
I've created a free guide with 5 questions you can take to your healthcare professional to help you start a more useful conversation.
What about partners?
It is important, too, to acknowledge that this transition can be difficult for partners. You may also miss sex. You may also miss physical closeness. You may feel rejected or uncertain about whether it is okay to initiate anything at all. Those feelings are completely valid - but they don't mean that your partner's body should be expected to return to its previous function simply because you are ready for your sex life to resume.
The aim isn't necessarily to recreate the sex life you had before your baby arrived. In some cases, that will happen naturally; in others, it may not. What matters is finding out what intimacy and sexuality can look like for you now, rather than treating the pre-baby version of your relationship as the only acceptable destination.
That might involve sex. It might involve other forms of sexual pleasure. It might mean rebuilding affection and physical closeness without an expectation that it will lead anywhere. It might mean talking honestly about what each of you misses and what you would like to find again.
And sometimes, it means recognising that there is a physical, psychological or relational difficulty that needs some professional attention.
You don't have to wait until you're really struggling
I would like to see more people feel able to talk about sexual difficulties during the postnatal period, before those difficulties have had years to become entrenched.
You don't have to wait until you and your partner are resentful. You don't have to wait until sex has become something you dread. You don't have to wait until you no longer recognise yourself. If something has changed and it matters to you, it is reasonable to ask about it.
Sometimes the answer will be medical. Sometimes it will be hormonal. Sometimes it will be physical. Sometimes it will be psychological or relational. Very often, there will be several factors interacting at once, which is precisely why I think a more nuanced approach is needed.
Breastfeeding may be part of the explanation, but it isn't necessarily the whole explanation. A change in desire may be the symptom, but it isn't necessarily the problem.
And perhaps the most important thing to remember is that you don't have to want more sex simply because you have had a baby. There is absolutely no obligation to return to your previous sex life on anybody else's timetable. But if you are unhappy with what has changed, you are equally entitled to ask questions, seek appropriate healthcare and explore what might help.
Your sexual wellbeing deserves to be part of the conversation, too.
If this sounds familiar
If you've noticed changes in your sexual function, desire or relationship after having a baby, you don't need to work out the answer on your own.
A GP or other appropriate healthcare professional can help explore physical symptoms, medication and hormonal factors. Depending on what you're experiencing, pelvic health support may also be appropriate. Psychosexual therapy can provide space to explore changes in desire, arousal, pain, sexual confidence and intimacy, while relationship therapy may be useful when the wider relationship has been affected.
Sometimes you need one of these things. Sometimes you need more than one. Sometimes you don’t need any.
The important thing is that you don't have to assume that because a difficulty is common after having a baby, it is therefore something you simply have to accept.
If something has changed in a way that matters to you, it's okay to ask for help.
The key takeaway
Changes in sexual desire or function after having a baby can have many different causes. Breastfeeding and hormonal changes may be part of the picture, but so might pain, fatigue, medication, body image, mental health and relationship changes.
The symptom isn't always the problem.
Sometimes the most useful first step is simply working out what has actually changed.
Nia Jane
Clinical Psychosexologist | Registered Nurse
I work with individuals and couples experiencing sexual and relationship difficulties, including complex presentations where physical health, medication, disability, hormones and psychological factors overlap.
References & further reading
NICE. Postnatal care (NG194).
Guidance on postnatal physical and emotional wellbeing, including discussions around sexual health.NHS. Sex and contraception after having a baby.
Information about returning to sex after birth, contraception and changes in sexual function.NHS. Vaginal dryness.
Information about causes of vaginal dryness, including hormonal changes and breastfeeding.