December 14, 2023

Sexual Health and Body Image Post-Pregnancy Loss

Pregnancy loss is a topic that is talked about sparsely in the media due to the taboo that surrounds it. Similarly, conversations about the intricacies of sex tend to be censored. This censorship results in misinformation regarding both topics. Therefore, sex after pregnancy loss is loosely talked about. There are limited articles and studies on the subject and most of the ones that do exist do not go into great detail. This can be incredibly harmful to people who experience pregnancy loss and are trying to navigate their sexuality after such a traumatic event. Without proper literature to provide a guide for post-pregnancy loss sexual activities, people and their partners can go through further emotional and relational turmoil.

The bodily effects of a pregnancy loss can add some physical difficulties to sex depending on when the loss occurred. In the case of a miscarriage, a person should typically wait until the miscarriage symptoms are gone before having sex again. Waiting until the first period after a miscarriage is not necessary as the American College of Obstetricians and Gynecologists recommends waiting one to two weeks before it is safe to have sex. This waiting period can help to reduce the risk of infection. Important signs to look for before having sex are waiting for the bleeding to stop and for vaginal pain and tenderness to subside. Pelvic rest is usually recommended for two weeks after a miscarriage which includes sex and tampon use. The cervix and uterus are more dilated in the weeks following a pregnancy loss which can make the risk of infection more likely. For cases of stillbirth or live birth ending in loss, a person may need to wait six weeks before having sex again to allow their body to properly heal. Ultimately, it is important to get cleared by a provider before trying to have sex again.

Physical changes that happen during pregnancy typically take time to disappear after a pregnancy ends. If experiencing a later-term pregnancy loss, breast milk and postpartum hormones can still come in. With any stage of pregnancy loss, there is a period of hormonal rebalancing that follows. Hormonal changes can affect physical changes, emotions, and libido. An increase or decrease in sex drive is often triggered by the hormonal response. Progesterone levels tend to be high during pregnancy and then drop after a miscarriage which can increase a person’s libido. Moreover, estrogen levels drop which can make testosterone levels more dominant, resulting in an increased sex drive. Oxytocin, also known as the love hormone, is released during sexual activity and can create positive feelings. However, a common response post-pregnancy loss is a decrease in libido due to the emotional toll of the loss. In the same way that hormonal changes can cause an increased sex drive, they can also cause a decreased sex drive in addition to physical discomfort or pain during sex. There is also a significant difference between sex drives postpartum compared to post-miscarriage. Different hormones are released according to how far along someone is in their pregnancy when they experience loss. Whereas post-birth hormones come after a postpartum loss, there is a hormonal shift back to a pre-pregnancy state after a miscarriage. The hormones released postpartum and post-miscarriage can both cause an increased sex drive.

Another aspect that plays a significant role in sex after pregnancy loss is the emotional impact of the loss. Grief is a powerful emotion and there is no one way to move through it. Every person is different and needs varying time and support following a pregnancy loss. Partners should be respectful and understanding of each other during the healing process. Many people struggle with sexual activity after a pregnancy loss including both couples and individuals. Communicating feelings of grief and accepting these feelings are steps towards feeling more comfortable while grieving. Having some type of closure after the loss can help resolve some negative feelings related to the pregnancy loss. Commemorating the loss is one way to receive this closure and feel more secure in feeling pleasure after loss. It is a common theme with any loss that people are reluctant to feel positive feelings amid their grief. This is the case with pregnancy loss as well and can lead to hesitancy towards sexual activity out of a feeling of betrayal to the loss.

Sexual activity after pregnancy loss is a personal and individual experience that can be further complicated by emotional and/or physical difficulties. There tends to be more fragility in sexual standards and the relationships of people with partners. Sex can be triggering while grieving, especially considering that the body itself is the center of a traumatic event. Our brain tries to protect us from experiences that are marked in the past as traumatic and threatening which can cause reluctance to re-approach sex. However, expressions of sexuality can go hand-in-hand with grief in the aftermath of pregnancy loss. Grief and pleasure can coexist and sex can bring emotional relief in a time of anguish. Sex is used as a coping method after various types of loss and can be used as a way to feel present and reconnect with one’s body. On the other hand, sexual intimacy can trigger heartache from the pregnancy loss and even a joyful sex experience can be traumatic while grieving. Honoring feelings after loss and being open about them can aid in a better understanding of what sexuality personally looks like and what level of comfort a person has with sex.

Bodily changes that occur post-pregnancy loss can cause a feeling of disconnect between the person and their body. For people whose bodies started to change when their loss occurred, there can be grief with the body returning to its pre-pregnancy state. Feeling physically unrecognizable, also known as body dysmorphia, is a very common experience after a pregnancy loss. Along with this may be feelings of betrayal by their body and not feeling at home in their skin. Body shame and low self-image are themes that many people speak about their pregnancy loss experience. Weight gain, change in shape and size of breasts, and swelling of labia majora and minora are common side effects after going through pregnancy loss. Despite these being completely normal, societal expectations of femme bodies push a narrative that does not support the changing of bodies. As a result, people tend to feel uncomfortable in their clothes and have trouble looking at themselves in the mirror due to their bodies changing after a loss. Furthermore, the sexism that exists in our society tells all women and femme-bodied people that their value lies in having babies. With this ingrained mindset, people who go through pregnancy losses tend to feel like less of a woman and defective in their birthing abilities as it does not align with their assigned role in society as a birth giver.

A further challenge to sexual activity following pregnancy loss is the difference in emotions and libido between the person who experienced the loss and their partner. There tends to be a gendered difference in the way that loss takes a toll on men versus women. Men typically feel as though they need to be a supporter of their partner and give an outward appearance of strong and stoic. This goes along with a hesitance to share the emotional impact and their grief so as to not burden their partner. However, keeping emotions a secret can lead to miscommunications and a guessing game of feelings. It is not uncommon for fights to arise after a pregnancy loss out of not knowing how to respond and support each other. Likewise, miscommunication about sexual desires can lead to mismatched expectations. Communicating about grief and sex drives (or lack thereof) among partners can be helpful to embrace alternative forms of intimacy and to develop boundaries surrounding sexual activity. It is essential to wait to have sex until both partners are physically and emotionally ready.

When people are engaging in sexual activity following a pregnancy loss, there are phases of sex that partners can move through. The most common reaction is disinterest in sex and sometimes even a repulsion to it. This connects back to the emotional toll and physical trauma that result from a pregnancy loss. Similarly, some people are emotionally ready to have sex but physically cannot due to the healing process post-loss. The rest of the phases are divided between family planning and emotional intimacy. Some people want to have sex without getting pregnant again while others are ready to try for a baby and will have casual unprotected sex. Furthermore, people who are actively planning to get pregnant will start checking their ovulation once they get their period again to increase the likelihood of pregnancy. People without a focus on a subsequent pregnancy may try to have sex and get emotional during or afterward due to being triggered. Since the body itself was where the traumatic experience occurred, interacting with one’s body again can bring about a lot of memories and feelings. Many people feel numbness while grieving and sex can be something that helps them feel something and be present for a period of time. Sexual activities can also bring a sense of intimacy among partners and create space for them to reconnect and be close again following a pregnancy loss. Finally, a complicated relationship with one’s body can affect how one feels about sex. Most people who experience pregnancy loss struggle with their body looking and feeling different. At times they can feel as though they do not deserve joy or pleasure because of their “failure” at pregnancy. Anger towards the body can effectively muddle sexual intimacy whether it turns the person away from sex completely or they crave sex more.

The way that our society shapes pregnancy contributes greatly to feelings that often arise after a loss. Deaths are already minimally discussed in the media and within general conversations and when they are, they tend to exclude the grieving process and how dealing with loss affects emotional stability. Considering that we live in a capitalist society, grief is typically not dealt with or talked about due to the push to get people back to work. When value lies in work and profit, the effects of pregnancy loss on mental and physical health are not brought up to ensure people return to work as soon as possible. There is a belief that if people ignore their emotions, they can do better work and return sooner after a loss. However, I argue that this is not the case. The suppression of emotions does not get rid of them completely but rather pushes them down until they come up again. When they do come up again, which they do, it is not any easier since the feelings were ignored rather than processed through. But if proper time is taken off of work with support from employers to rest, feel, and process such complex emotions, work productivity can increase since healing from trauma can improve general mental health.

The existence of patriarchal capitalism diminishes the experience of people who go through pregnancy loss by placing a role on femme-bodied people at birth. In a society that prioritizes labor and workers, wombs become commodified for that very reason. People who choose not to have children are still stigmatized to an extent and questioned about their decision to not be a parent. Birthing babies is labeled as normative behavior for people assigned female at birth and people who deviate from it are considered out of the norm. The pressure to have children comes from the need for workers in order for a capitalist society to survive. This is also why when people announce they are expecting, there is a celebration and congratulations to follow. Becoming pregnant is rewarded by gifts, cards, and parties to build up excitement around the pregnancy and reinforce that having children is a good thing. People who choose to not have children are then burdened with explaining themselves as to why they are not reproducing. Pregnancy loss falls into a gray middle area where the person wanted to give birth to kids but was unable to. These people are celebrated and supported if/when they share news of their pregnancy but are quickly dismissed when the pregnancy ends spontaneously. Although they were doing the “right” thing by becoming pregnant, they did not end up producing a baby to be commodified and groomed for labor. Thus, people who experience pregnancy loss are given little societal support as they are no longer of interest once the pregnancy ends.

When re-engaging with sexuality after pregnancy loss, it is recommended to wait and give time to process feelings and heal, both mentally and physically. Self-care following pregnancy loss can help one to reconnect with their body and deal with any negative emotions they may have towards themselves. Treating negative body feelings with compassion can aid in healing the relationship with self. Sex can be triggering while grieving but when it comes to the question of if someone can and should experience pleasure while grieving, the answer is yes. It is common to feel guilty for being sexual at all but this does not mean that people do not deserve to feel pleasure. Fears of getting pregnant or not getting pregnant can bring up vivid details of the pregnancy loss. It is vital to communicate with any partners and ensure that all parties are ready before having sexual intimacy. Different bodies require different things and support should be seen and heard between partners. While women tend to desire sex less after a loss and men tend to desire it more, there is no shame in changes in sex drive. Sex is a part of grief and having sex does not betray the lost pregnancy. Increased sexual desire tends to be based more on intimacy and comfort. Some people feel a heightened sense of connection with their partner while engaging in sexual activities. There is no correct way to feel about sexuality after a loss. Perinatal loss is an embodied and personal experience so reactions and feelings that arise in the aftermath are likely to vary on the individual.

Listening to bodily needs can open the door to trying alternative forms of intimacy. This could look like cuddling, holding hands, hugging, massaging, or trying new experiences with a partner for a feeling of romance. Discussing emotions openly is important to set boundaries and expectations for what intimacy looks like for the individual and as partners. Balancing an honor for grief and recognition that sexuality is natural and healthy takes time following pregnancy loss. Allowing self-permission to feel pleasure amidst grief can help to feel less guilty in engaging in sexual practices. Sex can be a way to focus on positive emotions and bring back a feeling of control in life which can have a positive impact on mental health and well-being. Sex is also a common way to process grief through bodily expression and to use it as a way of managing emotions. While emotional conflicts are bound to come up when returning to sex, patience and communication can help to confront these issues. Partners who talk about their grief can understand each other better in the healing process. Practicing listening and showing kindness to oneself and their partner can lead people to feel more comfortable in exploring their sexuality after pregnancy loss.

As mentioned earlier, sex following pregnancy loss is a topic with limited articles written on it and even fewer studies done. This is harmful for several reasons; First, it can create further isolation that many people who go through pregnancy loss already feel. Looking for answers in the media and finding none can reinforce the mindset that they are alone in their experience when it is the opposite. Secondly, a lack of representation of the intersection of sexuality and pregnancy loss stigmatizes the experience as not worthy of studies, therefore deeming that people who have lived through this do not deserve the effort to get better support. The invisibility of this issue causes both the public and people who experience pregnancy loss to be undereducated and base their knowledge on societal perceptions.

Those who have pregnancy losses already tend to struggle with physical, emotional, and mental effects due to the trauma of embodied loss. In addition, they are left with little to no guidance on engaging in sexual activity and reconnecting with their body. Following pregnancy loss, fragility can become present in one’s sexual life and romantic life. When discussing sexuality and body image after perinatal loss, it is important to include partners in the conversation of grief. Moving through the different stages of grief requires adjusting expectations accordingly. Nonetheless, sex can be a part of the grieving process as they are not mutually exclusive. Prioritizing clear and open communication can help partners and individuals stay on a path toward healing rather than going down one toward self-destruction and resentment. Treating one’s body with compassion when it seems impossible can transform relationships between body and self. Sexuality can aid compassion and be used as a way to feel positive emotions again after pregnancy loss.

References

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