The data from the WMLH Project indicate that sexual patterns are remarkably similar at the fifth month of pregnancy, 4 months postpartum, and 12 months postpartum, but that sexual expression is considerably reduced at 1 month postpartum, when the majority of couples have not resumed intercourse. On average, couples resumed intercourse at about 7 weeks postpartum.
There were significant differences between breast-feeding and nonbreast-feeding women, both at 1 month and 4 months postpartum. The sexual relationship looks more positive for non-breast-feeding couples than for breast-feeding couples, although husbands seem more sensitive to the differences than wives do. Our results are consistent with those of Alder and Bancroft (1988). However, our results are not consistent with the assertions of Masters and Johnson (1966), who reported that sexual responsiveness returns sooner after childbirth among women who breast-feed than among women who don’t. Again, the Masters and Johnson results seem to be the outlier, probably because of their peculiar methods of sampling.
There are three possible explanations for decreased sexual activity and satisfaction among breast-feeding couples compared with non-breastfeeding couples. The first is biological. Estrogen production is suppressed during the period of lactation. Decreased levels of estrogen result in decreased vaginal lubrication, making intercourse uncomfortable. Physicians and therapists working with women during pregnancy or the postpartum period should discuss this issue with their clients. Generally women are reticent to bring up this topic, so practitioners need to be responsible for taking the initiative. Much of the difficulty can be overcome with the use of sterile lubricants.
The second possible explanation involves psychological factors. Masters and Johnson (1966) reported that breast-feeding is erotically satisfying to some women, and a few women are even stimulated to orgasm by it. It may be that breast-feeding mothers derive some erotic satisfaction, or at least have their needs for intimate touching met, by breastfeeding and therefore show less interest in sexual expression with their husband or partner. Men, in contrast, do not receive this satisfaction from the baby and continue to seek sexual intimacy with their wives or partners, who are less interested than usual. This leads husbands of BF women to report less sexual satisfaction than husbands of NBF women, whereas there are no differences in satisfaction between the two groups of women.
A third possibility is that BF women are more fatigued, which puts a damper on sexual desire. They may be more fatigued because they must do all the feeding and therefore may have fewer opportunities to sleep through the night. Greater fatigue also may result from the metabolic demands of breast-feeding. Support for the hypothesis of greater fatigue while breastfeeding comes from a study by Forster et al. (1994), which found that, after weaning, women reported a significant decrease in fatigue as well as an increase in sexual activity and sexual feelings.
The BF and NBF groups did not differ on some variables: incidence of masturbation, performing fellatio, and engaging in cunnilingus.
The data reported here show that women have similar patterns of sexuality—perhaps their ordinary pattern—during the fifth month of pregnancy and at 4 and 12 months postpartum. At 1 month postpartum, however, sexual expression is markedly reduced. This reduction occurs not only in vaginal intercourse, but in masturbation as well. The data also show a more positive sexual relationship for NBF women and their partners, compared with BF women.
Biological factors surely play a role in these phenomena. At 1 month postpartum, women may still be healing and sore and are likely to be fatigued, which may contribute to a lack of enthusiastic sexual expression. Breast-feeding women have reduced vaginal lubrication, making intercourse uncomfortable.
Earlier in this chapter we identified both pregnancy and postpartum sex taboos that are found in many cultures around the world, supporting the notion that women’s sexuality during this time is socially constructed. Here we consider the nature of these social constructions in the United States, focusing on four factors: physicians’ pronouncements, the invisibility of sexuality during pregnancy and postpartum, the incompatibility of motherhood and sexuality, and the impact of Masters and Johnson’s (1966) research.
Pregnancy and childbirth have been medicalized in the United States. In that climate, advice from physicians constitutes an important component of the social construction of sexuality during this period. No doubt the comments given by individual physicians vary greatly and are not always completely consistent with the official position of Williams Obstetrics. The 6-week postpartum check-up is itself a kind of ritual. Traditionally, physicians have told couples not to engage in intercourse until after this check-up. In addition, even if some physicians do not prescribe such a taboo today, couples themselves may think that they must wait until the woman’s health is certified by the check-up. It is probably not accidental that couples in our study resumed intercourse on average at 7 weeks postpartum, that is, in the week following the 6-week check-up.
Sexuality during pregnancy and the postpartum period has been largely invisible. When actress Demi Moore appeared nude and quite visibly pregnant on the cover of Vanity Fair magazine in August 1991, the event was claimed to be a first and there was much public discussion— and considerable disapproval. Thousands of women had posed nude on thousands of magazine covers prior to Demi Moore’s disrobing, but none had been visibly pregnant. The combination of sexually suggestive nudity and pregnancy had apparently been unthinkable. Insofar as sexuality during pregnancy and the postpartum period is invisible, this time in a woman’s
life may be construed as asexual by the women herself and by others close to her.
There exists in the United States a cultural heritage of dichotomizing women into two groups, madonnas or whores. Virtuous motherhood and exuberant sexuality are seen as incompatible, an irony given that sexuality is precisely what causes motherhood. During pregnancy and the year following birth, a woman’s status as mother is especially salient, perhaps making the expression of her sexuality seem inappropriate, both to her and to her husband or partner.
It is also worth considering the possibility that Masters and Johnson’s (1966) well-known research and writings have created a cultural climate in regard to sexuality during pregnancy and the postpartum period. Masters and Johnson, for example, stated that intercourse is safe until the last few weeks before delivery, and the results from a number of studies show that couples engage in intercourse at fairly constant rates until the ninth month of pregnancy. Moreover, Masters and Johnson stated that sexual responsiveness returns earlier for BF women than for NBF women. Several physicians with whom we have shared the results of the WMLH study have expressed surprise about the results for BF women. They generally consider BF women to be more at ease with their bodies (and therefore sexier) and likely to be more sexually interested and satisfied. Physicians’ views have been shaped by Masters and Johnson culture. This does a disservice to BF women, who would be better off with an explanation of why they don’t produce much vaginal lubrication, and therefore may feel discomfort during sex, and with advice on how to use lubricants to ease the problem.
Pregnancy and childbirth are major reproductive events in a woman’s life. They carry with them certain biological correlates, but also a thick overlay of cultural meaning and taboo. At this juncture in research and theorizing the field needs (a) an analysis of pregnancy and postpartum sex taboos—which have been fair game for study among non-European Americans—in the United States today; and (b) qualitative research designed to understand the symbolic meaning to the woman and her husband or partner of sexuality during pregnancy, as well as the reasons for and meanings of the reduction in sexual activity that couples experience in the month or more postpartum.