Postpartum Intimacy

Welcome to what we are calling, Fit Mama After Dark. Cari came across Dr. Emma Schmidt on her Church’s podcast and felt she was the perfect person to bring on. She is a sex therapist and clinical sexologist. She started her practice about 12 years ago after a struggle she and her husband experienced with not being able to have intercourse due to sexual pain called Vaginismus. They didn’t understand and couldn’t find help for it.

She figured if they were struggling with it, other people have to be struggling with this as well. So, she took a deep dive into understanding her own sexual functioning and her goal was to provide quality sexual health care for the Cincinnati area when it didn’t seem accessible to a lot of people at that point.

She became trained in sex therapy and started her practice. Once she got traction going, she realized if she want to be able to help the community, she need more people on her team to be able to provide more sex therapy for people. They started a group practice last year and were able to provide 11,000 sex therapy sessions. Now they have over 5 different locations (Westchester, Hyde Park, Northern Kentucky, Indiana, and Chicago). They also help out in Nepal with an organization called Mukti, a home for girls around 17 years and younger, that they rescue from sex trafficking. Dr. Schmidt’s team provides these girls with free sex therapy education, sex therapy training, and really work with their care team there to be able to help these girls.

Join us, in this episode, where we and Dr. Schmidt talk about sexual health, her own personal struggles, sex drive after postpartum, sex not happening at all, keeping sex alive with little ones, and more. 

Sexual Health as a Conversation

Sexual health has become a more prominent conversation but in reality, it is still a taboo topic. Dr. Schmidt is here to continue the conversation and normalize the situations we all probably go through but don’t know the language or who to ask about what we’re experiencing. 

As mentioned, she had started out with her own struggles. Last year, Dr. Schmidt had surgery for endometriosis and that affected both her sexual health and quality of life. But she felt it has made her become a better advocate for this field. 

Cari agrees it is a taboo topic because even in women’s pre and postnatal health no one wants to say the word pelvic floor and that’s not even talking about sex, just the muscle. 

Dr. Schmidt adds that her husband’s from Germany and over there it’s required that you get pelvic floor therapy after birth. And here in the U.S. a lot of people don’t even know that there’s a doctor that exists to be able to help with the postpartum physical pain that you experience such as tearing to losing nerve endings from scar tissue in your clitoral area. And not knowing how it impacts your quality of life and sexual health. 

We’ve mentioned in a previous podcast episode as well that we still have a long way to go postpartum in accessibility and finances but we are getting there. 

Sex Drive Postpartum

This led us right to our first question from a listener. They’re struggling with being a mom (whether staying at home or working) and being a good spouse. Their sex drive is basically non-existent because there is so much going on in their lives. Is this normal postpartum, especially in the early postpartum stages? And what can they do to increase their overall sex drive? 

The first thing Dr. Schmidt recommends is a book, The Fourth Trimester, a great read for all care postpartum needs. She points specifically to an excellent chapter in there around sexual health “because in reality almost all of us struggle with this postpartum sexual health phase and not having libido. So yes, it’s normal.”

And she continues, “So, this is normal and also it’s part of our script that happened to us over the years where sex has been narrated to us that it’s something that we give to our partner, not something that we receive for pleasure. Or if it is something we receive for pleasure it’s usually because our partner is only doing it to receive pleasure for themselves. And so yes, this is normal. Libido-wise, there are a lot of different impacts that can happen, whether you’re nursing, breastfeeding, or pumping. Libido goes down because of the estrogen levels that are taking place especially postpartum. And what happens is that when our estrogen levels decrease, our lubrication in our vaginal canal and in our vulva will also decrease.”

“So when the vulva doesn’t have space or have the hormones to engorge for that arousal or to get lubricated then pain can happen because when estrogen is in the vaginal canal it also makes the vaginal canal kind of like a rubber band so it’s squishy and it’s elastic. But when estrogen is taken out of that it becomes more rigid and feels like sandpaper whenever you have penetration that happens. And it’s difficult for arousal to happen. So, when we think about a male counterpart who can get an erection from arousal, usually women actually also get erections through their clitoris. So, if you’re not able to get that, then arousal is difficult to happen. And usually, for women, it takes about 35 to 40 minutes to actually feel that full state of arousal whereas it takes only around 30 seconds for a male to feel that.”

Dr. Schidmt makes additional points here:

1. How are you and how did you typically end up having sexual interactions prior to kids? 
2. It’s going to take time for you to feel aroused and be able to get in a state where your nervous system is in a place to shift from doing all the things that you’re doing with your kids to an erotic type of experience. Your mind, your body, there needs to be a transition period usually for your state to get there. 

And then when you’re in this postpartum state, depending on where your experience is, you might…

• Have breast engorgement that hurts
• Feel uncomfortable in this new body that you have
• Have fluids that are still happening through your vaginal canal that feel unknown to you
• Or not having lubrication there

And Dr. Schmidt continues, “what’s difficult is the message of my partner needs this and it’s my responsibility to give this to them and so I feel like I’m failing as a partner.” Another message is, “if I don’t do this for them they’re just gonna go find it somewhere else so I need to go above and beyond, deny my own needs, feelings, and experiences to keep providing for everyone else in my immediate circle. Which leads to burnout, then leads to us feeling exhausted and that is not healthy for arousal anyways.”

She mentions a book by Emily Nagoski Ph.D., Come As You Are, that talks about breaks and accelerators around sexual health. “So, when thinking about getting aroused and wanting to have libido we have to recognize what are the things that make my libido or sex drive break. What are the things that accelerate my arousal and desire?” 

One thing that can be really helpful is to think about the state you are currently in and how that’s going to be different than pre-birth. 

• What feels arousing, like an accelerator and a break now
• How do I communicate that to my partner and how can my partner communicate their breaks and accelerators to me

Some accelerators might be…

• Your partner running you a bath
• Giving you a full-body massage 
• Scratching or playing with your hair

Where a break might be…

• Coming up and grabbing your butt
• Throwing you on the bed
• Feeling guilty and looking really sad after they leave if you say no to sex

The other piece is being able to start to incorporate sexual experiences that don’t lead to penetration or orgasm.

• What is it like to just be able to be together for even a three-minute experience to make out, or caress each other’s hands?
• What would it be like to explore each other’s body without breasts and genitals?

Dr. Schmidt carries on, “being able to identify can we and how can we be playful together where we’re not having the expectation of what I call A plus B equals C. So, penis gets hard, insert into the vagina, orgasm. A lot of times that doesn’t work for someone postpartum anyways. So, what would it be like to slow down and really start to explore and get to know your sexuality as an individual and then in your relationship as well? And one of the biggest pieces postpartum I think is just getting used to your sexuality again.” 

Not only that but she adds, “things move around down thereafter. Your clitoris changes, the size of it changes, your labia can change, and your inner labia can actually become longer than your labia majora (the external lips). Being able to explore, look at a mirror and see what does my vulva look like? What does it feel like to touch it now and how is it different than before? And the nerve and things might be different. How can I explore my body? What is it like to touch my stomach, my breast, and my arms? What does all of this feel like? How do I get back into my body? How do I know my own sexual health and sexual functioning individually first and then invite my partner into that?”

This can feel like a better transition. But how do we flip the script and allow our partners to take care of us without being so transactional? What would it be like to be explored and be taken care of without also this idea of there needing to be an orgasm or penetration? That can actually feel really powerful to some women.

Change that mindset and re-message this idea that it’s no longer a task on the to-do list and it might be nice!

Sex Just Isn’t Happening

This brought us to our next question, sex isn’t happening. Someone is just not there yet but they want to rebuild intimacy with their spouse. What are some things or ways that you can start to feel connected that do feel intimate that aren’t physical or all the way physical?

Dr. Schimdt leads the conversation, “intimacy sometimes gets linked to sex, like intimacy is sex, but intimacy is really knowing and being known. Intimacy can be broken down into a lot of different things. So, it can be relational intimacy, art intimacy, play intimacy, recreational intimacy, or work intimacy. It’s all about, am I feeling known by my partner and do I feel like I know my partner in a deeper way?” 

She suggests one thing you can do is list out a bunch of different ideas like what was mentioned above and talk about how can you engage in intimacy in these different ways. 

• What would it look like to play together? 
• What would it look like to feel known when playing together?

For example, Dr. Schmidt and her husband like golfing. This is something she grew up doing and he did not. It’s a way for them to be known.

• How do we play together and create these fun experiences?
• What would it be like to have aesthetic intimacy where we go for a walk and notice the beauty around us or go to an art museum?
• Do something like 21C. What would it be like to take time to have a room just to yourself, go around the museum that they have there, enjoy that together but also have a space where you can get away, just sleep together and maybe hold hands?

Another thing she suggests if you want to start to increase sexual peace without being physical is starting a sex conversation experience. 

• What do I like about sex?
• What do I not like about sex?
• What do I want to incorporate right now in our life around sex?
• What am I not ready for?
• What do I fear about sex moving forward?
• What was my favorite sexual experience that I had with you?
• What is uncomfortable to me about talking about sex with you?

You are able to get to know each and have a sexual conversation to understand each other when it comes to this as for many, it’s not discussed in the first place.  

And have this conversation often, the idea is to have frequent conversations about it. Not just one big conversation but ongoing conversations because where you are initially postpartum is going to be different than where you are a year from now. 

Another activity that you could do is called Sensate Focus, as Dr. Schmidt points out,  “So if you want to start and you don’t want to get involved completely sexually with your partner, but you want to start some of the physical activity. But you’re scared and it feels overwhelming, of course, your body, your nervous system is kind of in a hyper mode because you’re trying to figure out how to take care of this kid. A lot of times we’re living in this fight or flight mode. Am I going to keep this kid alive? I have postpartum anxiety or depression or psychosis and my world just feels a little like on alert right now. So when my partner touches me, it is almost painful or I tense up.”

One activity that you can do is starting with just your hand where you’re caressing the other person’s hand and just getting to know it.

• It’s not a massage or petting but what is it like to just touch your partner’s hand for 15 minutes without talking?
• What is it like to get to know it? For example, they have calluses
• What do the calluses mean to you?
• What does the wedding ring mean to you?
• What is it like to get to know their hand?
• What is it like for you to touch their hand?
• What is it like for you to be touched?
• Are you waiting for the clock to be done?
• Am I waiting for the situation to be out?
• Do I feel very uncomfortable?

This helps give you information on where you’re at touch-wise and physical-wise. Once that feels good then you can move on to the feet.

As Dr. Schmidt mentions, “starting slowly, it doesn’t have to be zero to 100, right? You can start to warm your body up. Going at your face, that one’s always a really interesting one. Looking at yourself in the mirror with your partner, doing a full body caressing without breasts and genitals, and then slowly incorporating the other pieces. What is it like that we take sex off the table, we’re just focusing on being together and being in each other’s bodies in an intimate, just knowing each other’s bodies. So, a lot of us don’t even take time to explore the body. It’s just kind of like you just get into it. So what would it be like just to slow down? Having space, even 10 minutes a day, 10 minutes a week, sometimes we don’t even get that with our partner, but having that intentional time to sit or do something intimacy-wise where you’re getting to know your partner and being known.” 

There are definitely other ways that you can engage in intimacy that don’t have to do with what we think of as sex but can still feel like we’re moving in the right direction in terms of connecting with each other.

Keep Sex Alive Postpartum with Little Ones

We’ve talked about increasing the overall sex drive in the postpartum phase. But this brought us to our next question for Dr. Schmidt, what advice does she have to keep the sex alive postpartum when there are little ones? Having babies in the house can make it a little bit more challenging than pre-babies. 

And she responded with an answer most don’t love, scheduling it. Anything that we find a priority, especially when our schedules get busy, whatever it may be we make a priority and schedule it. 

So, when we’re not doing that with sex, it’s likely that we’re not going to be having sex. So, one thing that Dr. Schmidt created that her clients like is a spontaneously scheduled sex jar.

What you do is write down different ideas of ways that you feel connected sexually, things you enjoy, and ways that you feel intimately connected with your partner on a piece of paper. Then tear them off and put them in your own sex jar. These can be jars for different things, whether it’s just intimacy or sexually related.

And you can do this for example, once a week when you plan to pull from your jars. One of you will go first. Say the wife goes first, she will go and pull from her husband’s jar and she would then schedule whatever that act is for him. So, it’ll feel spontaneous for him and it feels scheduled on her end, but it’s making it an intentional priority that is decided once a week to do this. And then the next week he would pull from her jar. 

This can be a great way to make it a priority and create some intentionality around it but also not make it feel like a task to mark off in your Google calendar. 

One thing to note: things that you wouldn’t put in the jar are things that are already off the table. You wouldn’t want to surprise them because that can feel triggering.

This can be a great way to connect in some way and still leave that little spontaneity in there. 

Sex Toys

On that same spicy topic, there were a lot of listener questions about sex toys. So Cari asked Dr. Schmidt, are toys good for your relationship? Is it something she would encourage, to stay away from, or is it what works for the relationship? 

And she says, “really it’s about what do you want in your relationship, how do you all define this and how do you all create a contract around like, okay, we’re entering into this relationship together. What does sexual health look like for us and what are we looking for? And so it’s going to be different for everyone. Some people are going to say sexual health is exciting to me when I know that you’re off using a toy by yourself. That feels arousing and then maybe I come in later. Or maybe sexual health like that feels too triggering for me because of an experience I had in the past or based on my religious experience or whatever that looks like. How do we talk through those things? How do we really challenge our messaging around this?”

She doesn’t think they are necessarily bad or good. It just depends on the narrative that you have around them. As well as the consent and agreement that has been made in the relationship. She makes the point, “without consent it can feel like a betrayal and I think that’s when it gets a little sticky. Or if there is like some forcefulness that happens or some guilt.” 

But at the same time, she thinks “toys can help definitely enhance and make things more fun. It’s the number one way to help someone who has Anorgasmia, someone who’s never been able to have an orgasm, be able to have an orgasm. And it’s a way that can help spice up some of your sex life if you’re wanting something different.”

So, Dr. Schmidt recommends if you are interested in trying it out talk to each other, do some journaling of your own, and ask yourself…

• What would this be like to use this?
• What messaging have you heard around this?
• What negative feelings are coming up for you around this?
• Do those feel like facts to you now?
• Is this something that you’re interested in?
• What fears do you have moving forward with this?

This doesn’t mean you have to come to a different conclusion it can just be part of the conversation. 

Body Changes after Postpartum

To tag onto the previous discussion, Cari brings up another question from listeners. As Dr. Schmidt mentioned, she had personal experience with pelvic pain postpartum. She also brought up a lot of things change and what was working before might not work anymore. So, do orgasms feel different postpartum? Are toys one of those ways that can help bring new sensations?

Dr. Schmidt agreed, “Yes. So, bringing back some of the sensation and just wakening up the nerve endings in your pelvic floor can be really helpful with a vibrator, especially around your scar, if you had a C-section. That can be a really important way to bring back some of the nerve endings and get that kind of woken back up from the scar tissue. And then of course like inner labia, around the vulva area and the clitoral area can be really really good and important too.”

Another thing she suggests aren’t necessarily toys but can be used as such are dilators. “These are if you have tearing in the vaginal canal down the perineum area so that’s the area from your vagina to your anus. If that area tears you’re gonna typically have some pain associated with that because of scar tissue that develops. Or if you’ve had a full tear, you’re definitely going to want some pelvic floor therapy.” 

Not only that but, “being able to have different sizes where you can test out what it would be like for insertion and to start to stretch out that area again and to work with the scar tissue is going be really important, but I would always do that with a pelvic floor therapist to help you have an assessment of when to start that and how that would look. And then also just knowing how estrogen and the lack of estrogen would impact your pelvic floor as well, and it creates some more tension there.”

She also found that EMDR therapy can be really effective to help relieve sexual pain, “if it comes down to, I’m just really nervous or I have a lot of anxiety or I have a lot of messaging around sex now as a mom compared to, pre-mom. And the messaging we get when to be a sexual human being as a mom can be really difficult. So sometimes it takes going to therapy from a mental health therapist to help work through some of that to release that sexual pain as well that can actually travel down your spinal cord into your pelvic floor from your fight or flight part of your brain.” 

The example she uses is similar to touching a hot stove. “Later when you go, you’re not going to touch the hot stove or you will tense up. If you’ve got a certain messaging like I’m not supposed to use a toy or I’m not supposed to engage in sex pre-marriage or whatever the things are I can naturally start to tense up my pelvic floor and a lot of us don’t even know what it feels like.”

We here at Fit Mama in 30 are big on that. We have an entire course on how to engage all four corners of your pelvic floor. It’s important.

Advice for Improving Sexual Experience

Another topic that comes up a lot especially newly postpartum (and postpartum in general) is low self-esteem and poor body image. Bailey asks Dr. Schmidt if she has any advice for overcoming this since it can affect your overall libido, frequency, and desire to want to have sex. What’s some advice she has for moms that might be experiencing this?

Dr. Schmidt gives a shout-out to the Rosy app, a sexual movement app. A lot of it is around our own messaging and our generational messaging around our bodies. 

The way we talk about ourselves is horrific. So, do some messaging around how do you start to identify…

• What is negative body image?
• What is neutral body image?
• What is body liberation?
• How do you get from a place where you can identify and write out all the things that you feel about your body in a negative way?
• And how do you start to go through those and question where did you even receive that message from?
• How did you even get there? Because when you were a baby, you didn’t have that message.
• Where did it come from?
• How do you start to re-script and create a new narrative for yourself around what you want to believe and how you want to move forward?
• Sometimes it takes bringing up a picture of your younger self and looking at that little girl and saying, “how do I wanna see you?” 

It’s very challenging, you’ve learned this, we see it in our culture and it’s perpetuated on social media but there’s a movement happening. It takes us being brave to choose to do something different than we have. You deserve to have that freedom to not care.

Final Thoughts

It can be hard to master being free but Cari feels like she has started to get it down over the last two years. Some things that have helped her are thinking about what is truly important and where you’re spending your time and energy. It’s freeing to say “I’m going to live my life”. 

Try to do the work, try to challenge yourself on the messages, and get to a place of allowing just a little bit, you don’t need to go from zero to 100. Just to have body neutrality and be okay with your body just the way that it is. There’s so much freedom in it. 

This is only the beginning of our conversation on Postpartum Intimacy with Dr. Emma Schmidt. Listen to the full episode wherever you listen to your podcasts.