Dear MD,

Q. HELP. I’m having major, MAJOR anxiety around having sex for the first time postpartum. I think I’m super tight and that it’s going to feel awful. Not to mention, I don’t even really want to have sex, but knowing that I physically can, I feel like I should.

Sincerely,

I’ll never be horny again, Philadelphia, PA.

A. “So the answer to this one is YES,” says Dr. Shieva Ghofrany, an OB-GYN based in Stamford, CT. “Have the anxiety, it is rightfully deserved. I have two feelings on this. One, is that the answer has to do with physical pain depending on how soon after you delivered. If you delivered vaginally, then your vagina is literally beat up. Even if you didn’t deliver vaginally, but you’re nursing, your vagina is less elastic, and it hurts like you’re in menopause. What’s even more important is your total lack of libido for many reasons. You’re exhausted, you’re in love with someone else, you’re nursing, and your hormones actually don’t want you to have a libido. You have a decrease in estrogen because nature wants you to spread your babies out by at least a year.

The other feeling is that I believe it’s really unfair in the modern world that there is this six week mark when you can suddenly do all the things. Go exercise! Have sex! One, it gives women the impression that they should want to, and if they don’t, then they must be broken. First and foremost, we need to educate men and partners on nature and how natural it is for postpartum women not to want to have sex. Let’s talk more openly about it. I see women at their six month postpartum checkup and they’re embarrassed to report they haven’t had sex yet. Why? It makes total sense. Let’s not put that added pressure on ourselves or our loved ones. But, if you are going to have sex, then I recommend vaginal estrogen cream. It’s completely safe and helps your vagina become more elastic and it doesn’t affect your milk supply whatsoever.”