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Sex and the Breastfeeding Mother
I think my greatest accomplishment in life (besides figuring out what shoes work with skinny jeans) is the fact that I nursed each of my kids for three years. Yep, for six years of my adult life, I was a nursing mother. And now I am left with warm, (and sometimes frustrating memories.)
So, congrats girlfriend! You got that baby out safely and now you're giving it the best food on the planet --- liquid gold. That is, human breast milk. I have three words for you: Keep it up.
However, if you've noticed that your libido has taken a dive since the all-night milk parties have launched, you're not alone. Fatigue is certainly a big factor in an ailing post partum sex life, but so are some other very real bodily reactions to breastfeeding. Not the lest of which could be your partner's befuddled approach to amore with a Madonna (the real one, not the rock star.) So here is a short run-down of all that could be putting sex on hold in your breastfeeding household --- and some tips on how to get your grove back on.
The Desert Down Under
Hormone changes in a woman postpartum are enormous. Duh! The two swings that have the greatest impact on sexuality, though, are a decrease in estrogen and an increase in oxytocin and prolactin.
Potential problem number one: That decrease in estrogen, combined with a lactating mother's propensity for dehydration, can result in problems with vaginal lubrication and vaginal atrophy --- the walls of the vagina actually become thin and lovemaking can be very painful. In extreme cases the dehydrated vaginal walls can even fuse and require minor surgery to open again. Don't even hold that thought for long. That's rare. Note: This is most common during the first six months of breastfeeding, when the milk supply is very high-fat due to the nutritional needs of a newborn. After six months, to meet the changing nutritional needs of a baby, the milk spontaneously changes in composition, becoming higher in protein and lower in fat, and many women report an increase in vaginal lubrication at this time. So, if this is your problem sometimes a little passing of time will heal all.
However, if the desert down under persists or you and your man just can't wait, there are a couple other options. Since a nursing mother is very limited in any hormone replacements or pharmaceuticals that can be safely ingested without contaminating your breastmilk, medical treatment involves local applications. Many gynecologists safely prescribe estrogen creams that can be applied to the vulva and vagina. Recently introduced is the new E-ring, a diaphram-like plastic ring approximately 2.5 inches in diameter that is inserted into the vagina and placed around the tip of the cervix. The ring can remain in that position for up to three months while it releases a constant low-dose of local estrogen replacement to the vagina. Patients have reported a return of vaginal lubrication within twenty-four hours after insertion. Yippee!
The other big hormonal change during breastfeeding, is the level of oxytocin. Referred to at times as the female nurturing hormone, oxytocin still being debated as to its effect on human sexual desire and arousal. Animal studies suggest that oxytocin induces a variety of reproductive behaviors, including grooming, sexual arousal, orgasm, gamete transport, nesting, and specific maternal behaviors such as breastfeeding and bonding between mother and infant. However, in humans, three separate studies conducted in the 1980's of lactating women, a majority reported a decrease in sexual desire and sexual satisfaction. Severe reduction of sexual desire occurred during the amenorrheic period, which can last for a year or more.
I must add her, though, that several investigators, in the 1960's and early 1970's observed the opposite phenomenon, that women who breastfeed show a more rapid return of sexual interest and behavior postpartum. The paradox between physiological inhibitors of sexual desire and reports of increased desire could be explained by something called erotophilic personalities. A 1988 study found that erotophilic mothers (those with a learned tendency to respond to sexual cues with positive affect) were both more likely to breastfeed and to resume coitus more rapidly. So, if your brain is wired to love, love, love sex and you have few inhibitions, then you will also be more likely to breastfeed. And, that's a good thing.
Good News: No Periods Can Mean No Pregnancies
Regarding amenorrhea, or the absence of ovulation and menstruation that occurs with breastfeeding, it is important to note that for millions of years this "side effect" of breastfeeding was the only means of birth control that humans had and in many cultures today, it still is the only available contraceptive. Sucking on nipples stimulates production of the hormone, prolactin, which suppresses estrogen and progesterone -- the hormones necessary for ovulation. NOTE: In order for breastfeeding to function as a contraceptive, a woman must space feedings not more than four or five hours apart. When the period between feedings increases in duration, a signal is sent to the body that the baby is older and more self-sufficient and that it is reproductively safe for follicular activity to resume. So watch out, if your baby sleeps through the night, your eggs will be dropping!
Breastfeeding Can Be Arousing, or Not --- and that's Confusing!
The same hormones that manufacture milk and increase nurturing behavior, prolactin and oxytocin, are also closely linked to sexual arousal. In it not uncommon for women to have sexual feelings while nursing and many women, in a culture that abhors pedophilia, have anxiety about such feelings. This is one area where a sex therapist can have be of great help through permission giving. To add a personal anecdote, my own brain rarely allowed me to feel arousal during breastfeeding while awake, but during sleep I would be awakened by spontaneous orgasms to find my baby nursing on her own. Talk about feeling freaked out! In hindsight, I say enjoy the feelings, if your body experiences them. Just don't brag too much about it.
On the other hand, many nursing mothers have their own secret whore/Madonna syndrome and, well, feel more like a dairy queen than a porn queen. The answer might be to evaluate your attitudes and get real with yourself. There are a number of creative solutions, not the least of which is to talk out your prejudices with a caring therapist. I've even know women who resolved their inner conflict by making breasts off limits during sex and engaging only their southern regions. Whatever works.
Sleep: A Nursing Mother's Aphrodisiac
Besides having a physiological effect on sexual desire, breastfeeding can create serious fatigue that also decreases desire. To give one an idea of the enormous burden on a woman's body, consider this: The average newborn nurses 9 -14 times in twenty-four hours, consuming 800 -1000 calories a day. This can go on for months on end. In terms of time commitment alone, an infant spends between 8 -20 minutes on each breast at each feeding. The average duration of a complete feeding (both breasts) is about 28 minutes. That means, if the child also nurses fourteen times a day, then the woman is actually nursing for nearly seven hours a day! This is no mention of the amount of eating she has to do to keep up with the baby's demands. Nursing mothers require more calories than even pregnant women.
There is a light at the end of the tunnel. Perhaps it's encouraging to note that one study has shown that a significant decrease in fatigue, improvement in mood, and an increase in sexual activity, all occur soon after weaning. Significant changes in fatigue and mood occurred for a study group during the second week after weaning, and frequency of intercourse increased in the fourth week. However, a caution to you: This is no good reason for a conscious, thinking woman to practice premature weaning. Instead, put your liquid gold in tiny bottles and ask your partner to do a night shift. Your might wake up feeling less like Queen Victoria and more like a Victoria's Secret model.
Your Guy's Attitude
One might assume that a male living with a postpartum woman takes the role of high-desire partner in a high/low dynamic. Lactation aside, one study of 570 pregnant woman indicated that the percentage of couples who had resumed lovemaking at one month postpartum is only 19%. It also showed that at four months postpartum women who were breastfeeding showed significantly less sexual activity than those who were not breastfeeding. Yikes.
However, it is not clear if females alone show a decrease in desire during this period. One study of expectant fathers showed a decrease in testosterone during the last eight weeks their partner's pregnancy. Anthropologists speculate that this phenomenon could have a reproduction advantages by redirecting a man's sexual energy toward more nurturing behavior. This drop in testosterone is nature's cold shower when he's needed to be a protector/provider.
Another factor that might affect a man's desire during lactation is the cultural notion of the female breast as primarily a sexual object. Yep, your guy may have a "Whore/Madonna Complex" and have great difficulty dealing with this ambivalence. One Canadian study pointed to the difference between erotophobic and erotophilic partners during postpartum and found that men who were determined to be erotophilic (showing more positive responses to sexual stimulation) reported more frequent postpartum masturbation and more frequent receipt of oral-genital stimulation from their partners. Erotophilic men were also more likely to have attended the delivery of their baby than were erotophobic men.
American culture's emphasis on breasts as sexual ornaments has given breastfeeding a controversial reputation and women site this as the number one reason to not breastfeed or to impose premature weaning on their infants -- anxiety about public nursing. But feelings of shame about nursing in public may be experienced by either partner. I have personally witnessed many a husband frantically holding a blanket over a nursing mother's chest while she appears quite content to nurse without camouflage. So, is not always safe to assume that the male is the high desire partner during his wife's period of lactation.
Finally, not all breastfeeding women have reported a decrease in sexual desire, although recent studies indicate that many women do experience a decrease in desire and arousal. If that's you, the most basic solution is to talk out all these feelings with your partner and and/or a therapist. Let me assure you, this too will pass.
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Dr. Wendy Walsh's interest is Attachment Theory, a psychological, evolutionary and ethological theory for understanding interpersonal relationships. Dr. Walsh's mission is to help people find true emotional intimacy, have satisfying sex lives, and raise healthy children, in a world where the shape of families, couplings, and communication styles has changed dramatically.
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