After PMAD: Reclaiming Your Intimacy

This post is part three in a three-part series on how to rebuild the relationship between partners after a perinatal mood and anxiety disorder (PMAD), which includes postpartum depression and anxiety.

According to marriage therapist and researcher Dr. John Gottman, it is common for there to be sexual disconnection following the birth of a baby, with men wanting sex a lot more than women.

We learned earlier (see Part 1 in this series) that it is common for marital satisfaction to dwindle after baby arrives. This often means emotional disconnection, which in turn fuels the sexual disconnection. Before tackling your sex life you may want to revisit these other areas of your relationship to make sure you are connecting more emotionally and communicating more effectively.

Foreplay starts outside the bedroom

Once you have decided you are now ready to work on improving your sex life, the first important note is that sex begins well before intercourse. Foreplay is an important part of connecting sexually. As Dr. Gottman writes in his book And Baby Makes Three:

“All positive interactions are foreplay.”

Positive interactions can include…

  • Complimenting your partner
  • Doing the dishes
  • Taking the baby so the other can get rest
  • Giving your partner a nice backrub

With my couples I use the analogy of a fundraiser thermometer, the kind where the red line goes up with each additional donation. Men are typically quicker to fill this meter, and sometimes just stating “let’s have sex” sends that red line straight to the top for men. For women, and especially new moms, it may not be that easy.

The alternatives to sex mentioned above (hand holding, back rubs etc.) may fill the meter. Doing an extra chore, taking the baby an extra shift can all fill the meter. This analogy may give you a way to talk about sex and foreplay, and praise each other at the same time. “Thanks for doing the dishes, I appreciate it and it definitely is filling my meter.”

Keep in mind this is just a metaphor, so to expect a detailed account of what percentage of the meter is filled may be somewhat unrealistic. An important caveat of a woman’s meter is that while it may fill slowly, it can empty in an instant. A man could be on the verge of “reaching the fundraising goal” when he, with the best of intentions, suggests it may be time for her to start going to the gym again. Even if it took him hours or days to fill the meter, it has now been emptied in a second.

Don’t take changes personally

If you’ve mastered foreplay and are ready to move on to intercourse, an important thing to remember about post-baby sex is things change including a woman’s hormones and her body. She’s likely gained weight during pregnancy and does not feel her post-baby body is particularly attractive.

As her partner, you can give compliments on her assets you find attractive. It is also important to remember her hormones are continuing to change and may mean a legitimate decrease in desire unrelated to you or the amount of sleep she is getting. Sleep does play a role, however, and a sleep deprived parent may not always prioritize sex over that extra bit of sleep.

The reality is…a woman may have physical changes above and beyond hormonal changes. Acts or positions she may have enjoyed before may now cause pain or not be enjoyable.

It is important not to take these changes personally, but rather gently have a dialogue about what she would like. This means re-learning each other and going slowly at first. Communicate what you enjoy. A lot of couples have a hard time talking about sex, but it is a vital part of a relationship and an important topic for discussion. If you have difficulty having these conversations in person, try an email or text.

Men feel disconnected, too

There is no timeline for when is the right time to start having sex again after baby or a guideline for how much sex is enough. Men often are looking for an answer or a specific date that their sex life will return, which makes sense since many men give and receive affection through physical touch.

Men may feel overwhelmed by work, baby care and lack of sleep. When you add to that a partner who no longer has time or attention for him, a man can be feeling just as disconnected as their partner. This disconnection can feel insurmountable when the woman knows that she wants to connect but is not capable of physical connection.

Plenty of sexual alternatives can help men feel more physically connected. Women can make sure they still offer praise, give hugs, give kisses or offer a pat on the butt as he walks by. It is important to communicate to your partner that you do still find him desirable and he isn’t the reason that you don’t want sex.


You are not alone! Perinatal Mood & Anxiety Disorders are the #1 complication of pregnancy. Pine Rest has innovative, proven programs to help you feel like yourself again.

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