Pregnancy loss is one of the most emotional and physical ordeals that a woman can endure. “The psychological impact of a miscarriage can be detrimental for some people. It can have a mental and emotional impact, varying in duration from one person to the next,” Dr. Janette Nesheiwat, a family and emergency doctor and the medical director at CityMD, tells Scary Mommy. “It can cause anxiety and depression, which needs to be addressed. That’s why it’s important to have a primary care doctor to help you through the process.”
It’s also why it’s not uncommon that sex is a touchy subject for women who have gone through miscarriage or a dilation and curettage (D&C). Some women might question their fertility after such an experience while others might be scared of having sex because it could lead to another loss, while others might be wondering when, or if, it will be safe to be intimate with their partners again. Which is why, according to the latest search data available, sex after miscarriage is searched for nearly 6,000 times per month. It’s a loaded subject with tons of questions. If you’ve recently suffered a miscarriage and have questions about sex, you can learn more from our expert, ahead.
What is a miscarriage? What is a D&C?
“Miscarriage occurs when there’s a loss of pregnancy, usually before 20 [to] 24 weeks of pregnancy,” says Nesheiwat. “Sometimes there can be abdominal pain; Usually, vaginal bleeding occurs. Also, low blood pressure from bleeding can occur, which can be the result of genetics, chromosomal factors, or an ectopic pregnancy.” Miscarriages are common. According to Nesheiwat, about 30 percent of all pregnancies end up in miscarriage, and there is vaginal bleeding associated with it. “Medical or surgical intervention is sometimes needed when the pregnancy is no longer viable.”
A D&C, says Nesheiwat, stands for “dilation and curettage to remove any placenta remnants or fetal tissue out of the uterus after a miscarriage.”
When can you have sex after a miscarriage and D&C?
Sex after miscarriage depends on the individual as well as the couple, and there are both physical and emotional factors to consider.
Physically speaking, Nesheiwat says that “after bleeding resolves and the miscarriage is completed, which is usually about two weeks, it’s safe to engage in sexual activity.” According to the International Society of Sexual Medicine (ISSM), after a miscarriage, the uterus and cervix stay partially dilated, which makes these organs more prone to infection until they completely heal. Which is why women are advised not to insert anything into their vaginas, including tampons, until they have completely healed, and all fetal tissue has been removed. The ISSM also advises for a woman to have a thorough pelvic exam before having sex again. Upon an examination or a consultation with your OB-GYN, your doctor should be able to clear you for sexual activity.
But just because you are cleared by your doctor to resume regular sexual activity doesn’t mean that you are emotionally. Dealing with the emotional side-affects of pregnancy loss is not as black and white, so sex after a miscarriage is dependent on the woman and couple. It’s normal for grief, depression, and anxiety to set in for either or both partners, which might result in a low sex drive and arousal. The ISSM recommends keeping the lines of communication open between you and your partner; support is key. Counseling might be another option. It’s important to give yourself as much time as you need and you should certainly never let outside pressures (perhaps from a partner) push you to do anything you are not quite ready for.
Can you have unprotected sex after a miscarriage?
It depends on your situation. If you’re not looking to get pregnant or if you’re not in a monogamous relationship, you should definitely be on some type of birth control and practice safe sex to avoid STDs, says Nesheiwat. “STDs such as chlamydia and gonorrhea can cause scarring of the fallopian tubes and may result in complications with future pregnancies.”
If you’re in a relationship and hoping to conceive, Nesheiwat says fertility should not be affected after a miscarriage. According to the Mayo Clinic, if you’ve had one miscarriage, there might not be any need to wait to conceive and that most women who miscarry go on to have healthy pregnancies after miscarriage. So, basically, you can definitely get pregnant again if you have unprotected sex after a miscarriage.
However, says Nesheiwat, “if surgical intervention is required due to heavy bleeding such as a D&C, or if too much of the uterine tissue was removed, it can potentially make it more difficult to become pregnant.” Speak to your OB-GYN about any questions or concerns you might have specific to your health.
How soon can you get pregnant after a miscarriage?
According to Healthline, ovulation can happen as early as two weeks after the loss of a pregnancy with most women returning to their normal menstrual cycles four to six weeks following a miscarriage. If your health is in check and you’re emotionally ready for it, then it’s likely you can get pregnant any time after a miscarriage. While there’s been some back and forth within the medical community about when is the best time to conceive after miscarriage (the WHO recommends six months while the American College of Obstetrics and Gynecology doesn’t recommend waiting), its said that waiting at least one full menstrual cycle is advisable. Some doctors recommend three menstrual cycles. If you’re unsure, speak with your OB-GYN.
Does sex hurt after a miscarriage?
The short answer is: No. “Sexual activity after a miscarriage should not be painful,” says Nesheiwat. “If surgical intervention is required, your surgeon may want you to abstain from sexual activity for longer than 2 to 3 weeks, depending on the type of miscarriage and the gestational period of when the miscarriage occurred.” If you are experiencing pain after sex, then it’s wise to see your local health practitioner.
No matter when you decide to have sex after miscarriage, Nesheiwat says it’s crucial to make your health a top priority. “It is very important to have routine physicals,” she says. “Make sure you’re up-to-date with your Pap smears, which checks for cervical cancer, and to practice safe sex when applicable.”
But most importantly, go at your own pace and listen to your body at every step of the way. Even if your body has healed it doesn’t mean you are emotionally ready to go back to life as it was before. Remember that your grief is real, no matter how far along you were. Take time to grieve if you need to, reach out to your support system among friends and family, and seek counseling if you need to.
If you have waited the recommended amount of time for you to stop bleeding but notice brown discharge following intercourse, that may be remnants of blood in your cervix and should be fine. However, if you are heavily bleeding, or spotting bright red blood, you should reach out to your gynecologist to make sure it’s not a sign of something more serious.
What can you do if you aren’t quite ready for sex?
Everyone grieves differently, and it may take you a bit longer to process your emotions after a miscarriage. That’s entirely understandable. Honor your feelings however they come — including finding other ways to be intimate until you’re ready to have sex again. There are myriad ways to kindle intimacy without intercourse, including:
giving each other massages
taking a bath together
outercourse (sexual activity sans bodily fluids)
What are the long-term mental effects of pregnancy loss?
Per the study, about one month following a pregnancy loss, nearly 29 percent of women suffered post-traumatic stress while 24 percent reporting moderate to severe anxiety, and 11 percent had moderate to severe depression. Nine months after pregnancy loss, many women still reporting struggling, with 18 percent reporting post-traumatic stress, 17 percent had moderate to severe anxiety, and six percent reporting moderate to severe depression.
Written by Brianne Hogan.