Toolkit Items
Nurse Nikki shares a checklist for health care teams to use while speaking with new moms about sex and intimacy.
As health care providers for pregnant and postpartum families, we often stick to what we know. Maybe your job is helping families get pregnant, stay pregnant, and have a healthy birth. Or maybe you assist with infant feeding. That’s your comfort zone. But here is a question to ponder, who helps a newly postpartum parent that is seeking advice about intimacy. Do you feel comfortable doing that? Do you know who to refer them to? (I will wait).
Ahhh, I have stumped you. It’s okay because when we learn better, we do better, right? We should start by acknowledging that as it currently stands, the traditional six-week postpartum visit is not helpful. It is an awkward conversation and/or exam that leaves a postpartum parent confused and mentally exhausted. Many postpartum parents find it pointless and unnecessary. In my humble opinion, it’s in dire need of an overhaul.
Allow me to offer you a few tips on how I have approached this topic of postpartum intimacy. I hope that you find it helpful. Let’s go.
- Check your bias: Let’s do a deep dive into if and why talking about intimacy is uncomfortable. Because trust me if you are uncomfortable or brush over talking about the “post-birth birds and the bees” which is slightly different than the original birds and bees, your patients will notice and avoid the topic. Maybe you had an unpleasurable postpartum experience or you are unfamiliar with the most recent practices or positions. That is okay. It is not okay to continue to live in ignorance for fear of uncomfortable conversations. The more you know and explore your own biases and shortcomings, the more you will grow as a provider.
- Get to know your patient: When was the last time you stepped away from the script and had a real non-automated conversation with your patient? Be personable. Be a little vulnerable. When we get to know our patients outside of the paperwork we get more information. May I suggest a new script? I call it my “B” assessment. Each question gets more personal and should increase the patient’s ease in being honest and open. It also gives you, the clinician, more historical information to provide a better plan of care
- Brain: Ask about mental health. A client’s mental health sets the stage for the whole conversation. This is the foundation for our treatment plan, regardless of what we are treating. I usually start this conversation by asking about hydration. I usually educate my clients about how drinking water can improve brain fog. They are all ears now. (Need more information, check out this article that suggests dehydration leads to impaired cognitive function.)
- Breasts: Whether they are breastfeeding or not it is imperative that we ask about breast health. The breasts undergo initial changes with the onset of pregnancy and even more changes with the birth of the placenta. The body prepares for breastfeeding regardless of the parent’s decision. Remember a parent that has chosen to formula can still experience leakage. Also, keep in mind often when a parent is primarily using formula they still may nurse their baby. While they may not call it breastfeeding; they are breastfeeding. They may experience a decline in estrogen and hence have vaginal dryness and decreased libido. This phenomenon is not reserved for exclusive nursers or pumpers.
- Belly: Body dysmorphia is not just for teens. The postpartum body and its ability to “snap back” is constantly scrutinized. The simple question of “How does your belly feel?” can open the door to some very transparent dialogue. This is also a great opportunity to ask about postpartum nutrition. What are they eating? What are they not eating that they need to be eating? This a great segway into maintaining healthy bowels and discussing the health of their perineum.
- Bottom: This includes both the perineum and anus. “How does it feel? Describe your bleeding. Are you having stress-free bowel movements. “How would you describe your pain when either of them are touched?” Bingo. Now, we are by no means tricking our clients into divulging intimate experiences. We are simply, again, opening the door to a safe space of speaking about these issues.
Now that your history and assessment is complete: Remember if you are an OB or midwife you actually have to look at their breasts and vulva and vagina if necessary. Also before you blurt out the infamous postpartum one-liner “you can resume sex,” I challenge you to pause and redefine “you can resume sex”.
What does that even mean? The most common definition of this statement is “you can now allow a penis to penetrate your vagina”. We are making a lot of assumptions with this statement. Step outside of the cis-gendered heternormative box that mainstream medicine often lives in and first ask your patient what does intimacy looks like for them.
You will be surprised to discover how many patients want information about other forms of intimacy. For example, a client shares that she is not in a relationship but wants information about self-intimacy. Yikes, that wasn’t in any textbook you read.
Pause, collect yourself.
Share information about perineal massage (this was in your medical textbook). It is a great way to locate pain and pleasure spots. Your client may find it helpful to have a mirror handy to get a visual of where the spots are and if any trauma exists. They will report back to you during the follow-up call you are going to make (clears throat).
- It’s okay if you don’t know how to explain the nuts and bolts. Pictures describe what we can’t. Similar to my lactation and pregnancy support advice, I have curated an album of my favorite visual aids. Maybe you are stumbling through describing non-penetrative forms of intimacy. Share this recent article in Women’s Health Magazine. It offers pictures and details for how to accomplish the positions you are blushing about. You are officially off the hook…for now.
- Refer to the experts because let’s face it, we are not. There are a host of health professionals that specialize in this area that we can refer our patients to. For example, pelvic floor physical therapists are worth their weight in gold. If a patient complains of pain with penetration the source of the pain is either mechanical (muscles, nerves, etc) or hormonal (increased prolactin and decreased estrogen). It is helpful to rule out the mechanical issues before we dive into the hormonal stuff.
I hope I didn’t overwhelm you. It took me years to get educated and then to get comfortable speaking with patients about some pretty personal issues. Feel free to share the following resources I find helpful in my practice.
- Rosy, created by an OB/GYN, offers erotica, educational videos, and coaching to improve sexual wellness. www.meetrosy.com
- Ferly offers what they call “sexual self-care” via guided meditation. www.weareferly.com
- Emjoy: “is an audio well-being app” specializing in female pleasure. www.letsemjoy.com
- Come As You Are: The Suprising New Science that Will Transform Your Sex Life by Emily Nagoski Ph.D offers insight into the psychology of sexual pleasure in a way that may change the way you feel about self-intimacy and shared sexual pleasure.
- Sexual Health and Wellness From Conception to Postpartum
- Postpartum Sexuality Resources
- Postpartum Recovery & Sexuality Handout
This was written by Nurse Nikki Greenway. Connect with her.
If you haven’t seen Nurse Nikki’s Postpartum & Intimacy video for new parents – a must see, watch, and share for your clients.
