Postpartum Low Desire: Physical Causes

Before I was a therapist, I was a midwife, so when a therapist friend recently asked me about postpartum low desire in women, I couldn’t resist digging in and blogging about it.

Low desire after the birth is a VERY common experience. You’re not alone. And your partner is not alone in their experience of this either, in part because there are few written resources and little social support for partners. With this short series of blog posts, I hope to start a conversation that can help therapists, mothers, and partners.

In this first post, I will address some of the causes, and give some idea of how you might begin to address them. My next will go more deeply into how to work with postpartum desire issues specifically in intimate interactions.

There are MANY reasons a woman might experience low desire postpartum; physical, emotional, and relational factors may entangle and overlap. Treating low postpartum desire often requires confronting the emotional and relational along with the physical.

This series will discuss each of these factors in turn, and give some insight into how to begin the process of reconnecting with your body, your self, and your relationship. First, let’s delve into some of the physical factors behind low postpartum desire, and start talking about how to address them.

Hormone fluctuations are a major cause of postpartum low desire. For as long as 18 months after the birth of the baby, estrogen, progesterone, prolactin, and oxytocin (among others) are all undergoing a major shift. Usually this sorts itself out on its own, and desire gradually returns, although there certainly are non-hormonal causes that may still affect desire levels long after. If you are experiencing significantly reduced desire 12 months after the birth of the baby, you might benefit from a visit with your MD, who can help determine if there is a residual hormone imbalance or identify and treat other related issues.

Anemia can be another culprit. Again, a visit to the doctor is in order.

Depression or anxiety postpartum are common, have many causes and can go on for quite a long time. Both contribute to low desire. If you lack motivation and energy, have difficulty feeling connected to your baby, are excessively worried, have racing thoughts, a sense that something is wrong, or just feel sad for no reason, this is a reason for a trip to your MD. A therapist may be able to help too. Postpartum depression and postpartum anxiety, whether mild or severe, are likely to have both emotional and physical causes, so a double-team approach might be most helpful.

Sleep deprivation can go on for years. Although nobody feels sexy when they desperately need a good night’s sleep, you and your partner might have vastly different responses to sleep deprivation. Some people are completely undone by sleep deprivation, while others are still able to function. Keeping this in mind can help you avoid unnecessary recriminations if you and your partner respond differently to this unavoidable stressor.

Physical changes can have a profound effect on desire. You might have changes in sensation, including pain or discomfort, you didn’t used to experience. One very common postpartum symptom is vaginal dryness. This is a temporary result of hormone fluctuations and is not necessarily a sign of “not being into it”. It can usually be remedied by use of a high-quality intimate lubricant. If that doesn’t do it, or if you experience other kinds of pain, PLEASE talk to your physician right away and also discuss it with your partner. Too often, people hide their sex-related pain from their partners, hoping to save their feelings, but such a choice can ultimately do much worse damage, physical and emotional. In this case, a sex therapist can be a great resource, both for helping you resolve the issue and helping you have those difficult but necessary conversations with your partner.

All these factors can interact and overlap, reinforcing one another; they can also interact with and reinforce emotional and relational factors. Next week, I’ll delve into some of those emotional and psychological stressors that lead to postpartum low desire. In the meantime, check out my post When Sex Doesn’t Go As Planned for tips on adjusting to changes in your sex life with grace and openness.

When Sex Doesn’t Go as Planned

This week, a therapist friend asked me how to help a client enjoy sexual interactions when things don’t go as planned. This is such a universal experience that I think it merits a blog post.

There are about a million ways in which sex might not go as planned, so let me start by normalizing that. Sex very often doesn’t go as planned. Sex is an improvisation, not a script. If either or both partners need sex to proceed like a script in order to feel it was successful, one or both partners is probably personalizing something that is not actually about them, and then reaching problematic and likely incorrect conclusions about what it means about them, or about their partner.

Here’s an example of how this might play out: a heterosexual couple is having a sexual interaction, and the male partner loses his erection. His partner thinks this means something about her. She’s worried, maybe, that she is not attractive or not a good enough lover. She doesn’t check that assumption with him, because that would be a very vulnerable conversation to have. Instead, she distances herself a little. Her partner assumes that means something about him–that he is a big disappointment to her, perhaps, or that he’s is flawed in his manliness. He doesn’t want to risk the vulnerability of checking that assumption with her; as a result, both partners feel awful and disconnected. Over time, if they have enough interactions like this one, they’ll begin to see sex as a disconnecting activity, rather than a connecting one.

If the marker of success for a sexual interaction is that the couple is able to achieve penis-in-vagina sex (PIV), followed by one or both reaching orgasm, that is problematic. PIV and orgasm both require MANY body systems to be working in two different bodies, not to mention the multiple emotional and relational aspects that need to be in alignment. I wish we talked, as a culture, more openly about sex because then perhaps everyone would know that the people who have consistently great sex especially over long periods of time also have an improvisational sexual style that includes adjusting in the moment to whatever emerges either physically or emotionally.

What if the goal of sex was to experience pleasure while staying emotionally connected? With this in mind, let’s replay the above example:

The same couple begins a sexual interaction, and the male partner loses his erection. They both notice it, and accept it as the reality of the moment, and move to stimulate one another in other ways. Let’s imagine as they are doing this, one of them can’t stay grounded and gets taken over by negative self-talk. For instance, he feels bad about himself because he lost his erection, or she feels bad about herself because she fears she somehow caused the loss of his erection. Now, they decide to share that information, even though it is vulnerable to do so. They perform an act of courage, and say something like “I can’t keep up with the negative thoughts I’m having with myself about this.” Their partner responds in a supportive manner while initiating a mutually soothing activity like cuddling or holding hands. They have a conversation where they intentionally choose to lift their connection above their scripted performance. Perhaps they acknowledge this is hard for both of them. Perhaps they help one another remember that the meaning they make about loss of erection is optional. Perhaps they remind one another of non-erection-dependent sexual activities they would still like to enjoy together. They both experience vulnerability, and through that, connection. Their emotional safety increases, their resilience strengthens, and whether or not they return to sexual touching is nearly irrelevant. They have had a positive interaction when sex didn’t go as planned.

With practice, most couples I work with get better at this, and the negative self-talk become less powerful as they learn how to redirect the interaction. They are able to develop a flexible sexual repertoire; when one activity they both enjoy is not possible for any reason, they have others to choose from. They have ways to experience the creative flow of improvisation together, and are able to see that they can choose connection intentionally no matter the circumstances.

Sexual Intimacy and Vulnerability: Paths to Personal Growth

I strongly believe it is important for therapists to welcome discussion of sex and sexuality as part of the material of therapy. There are many reasons this is important, but first and foremost, it is important because sexual intimacy is
vulnerability, and intimate vulnerability is a powerful path to personal growth.

Sexual relationships beckon us to reveal our deepest selves even from within the dangerous safety of another’s arms. I think we all have a deep awareness of the dangers inherent in revealing our desires, our preferences, wishes, and fantasies, particularly to someone we really care about. If we tell our lover what we want, they might leave, confirming what we feared all along, that loneliness is inevitable. And we ask ourselves in retrospect, was it worth it, that telling? Better by far, many people decide, not to reveal the secret desire, or the hidden truth.

Understandable. Emotional vulnerability is a risky business. We all know it.

But the shadow side of that seemingly safe decision emerges months, years, or decades later. Symptoms include but are not limited to deep unmet longings, intense unfulfilled wishes, depression, loneliness, a flat sex life, illicit flirtations that bloom into illicit relationships, an impulse to run away to pursue long-abandoned dreams, an irrepressible need to explore possibilities previously compromised away. A life lived without emotional vulnerability eventually tends to feel dull and empty; a relationship lived that way, devastatingly lonely.

Consider the personal growth process involved in becoming able to reveal yourself to another. There you are with your new lover, full of hopes and dreams of what an intimate relationship can be. What truths about yourself might you be willing to share with your lover? What might you long to tell, but feel afraid of sharing? What might you be able to encourage them to tell you about their preferences and desires? Consider a conversation about the dishes. Parenting. Orgasm. Pornography.

Can you relate to the fear of disclosing personal truths or deep desires? Not disclosing is also risky, but the risks are different. The ultimate risk of disclosure is weathering the storm of your partner’s emotional response, or possibly even being left. But the ultimate risk of NOT disclosing is ending up with the wrong partner or living an inauthentic life.

What if we could learn to lean into the natural urge toward vulnerability (and from there to deep connection) with less fear? We might audition our lovers for signs of being wonderful partners not by scouting out how similar we are and can become, but by observing how kind they are when we are different, how able they are to listen even when it is hard, and how encouraging they are able to be when we reveal vulnerable truths about our sexual preferences.

Of course, we would then need to challenge ourselves to be what we want in a partner: someone who listens without judgment, holds steady when the going gets rough, admits their part in the problem, holds steady while exploring finicky orgasmic response, stays with the discomfort of the conversation about pornography, keeps loving despite differences and shows love through curiosity.

This is exactly the intersection between sexual relationships, personal growth, and therapy. It is differentiation of self, a term I use often both when teaching and in my work with clients. It describes a three-part project: becoming able to figure out what you think, feel, need, prefer…becoming able to share it with another person, even if you think they might not feel comfortable hearing it…and becoming able to remain grounded and present when they share something vulnerable about themselves you might not feel comfortable hearing. This is the foundation for maintaining a deep intimate connection over time.