Everything changed when you saw the two pink lines show up on that pregnancy test—but here you are in the confusing space after a miscarriage with a thousand thoughts swirling around your brain: How soon can I try again? What if this happens again? And, let’s be honest: What does this mean for my sex life?
First, know that whatever you’re feeling is completely okay. “Women can have such different reactions to a miscarriage,” says Dr. Catherine Monk, professor of medical psychology at Columbia University Medical Center. “I hope that women and their partners understand that the range of feelings are normal.”
Sex after miscarriage is a complicated topic - and what’s “normal” when it comes to feeling physically and mentally ready for sex again can vary widely. Still, there are a few general guidelines that may help make this difficult time in your life a little less confusing.
Your body isn’t ready for sex immediately after miscarriage.
The big concern is that your cervix should be closed to prevent any potential infections, says says Dr. Zev Williams, chief of the division of reproductive endocrinology and infertility and associate professor of obstetrics and gynecology. He notes that, after a miscarriage, your cervix opens up (a.k.a. dilates) to let the fetal tissue out. And depending on how many weeks along you were when you miscarried, the closing process can take anywhere from a couple weeks to a couple months.
Your gynae can check your cervix via a physical exam, so be sure to get the go-ahead from her before having sex again.
The one exception here: If you had what’s known as a “chemical pregnancy” - meaning you got a positive pregnancy test but an ultrasound didn’t confirm it, something that can account for as many as 75 percent of miscarriages - you don’t have to wait to have sex.
Many women find that their libido takes even longer to bounce back.
Just because you’re physically ready to have sex post-miscarriage doesn’t mean you’re ready emotionally. You may be struggling with a sense that your body has failed you somehow—or feel like you’re to blame for your miscarriage (likely not true, by the way, as most first trimester miscarriages are due to chromosomal abnormalities, according to the American Pregnancy Association).
“It can be tough to turn on your intimate side when you’re dealing with these feelings,” says Monk.
You have to give yourself room and self-compassion to mourn in the way that’s right for you, she adds.
If your experience makes you want to avoid sex for right now, that’s okay. If you’re counting down the days until the doc gives you the go-ahead to get busy again, that’s fine, too. Or, you may feel both: wanting to try sex again, but also being totally freaked out by it.
There’s no shame in seeking help from a qualified therapist, particularly one who has experience with women and this type of loss. They can help you work through your feelings on the topic and give you tips for communicating with your partner.
After all, they’re likely mourning in their own way, too (and may not feel ready to have sex again themselves). Openly talking about it may help you both set expectations for intimacy and what each of you are comfortable with.
READ MORE: 3 women describe what it’s actually like to have a miscarriage
What do I need to know about getting pregnant again?
You’ve probably heard the oft-given guideline to wait three or six months after a miscarriage, but there’s little data to back that up. “Research comparing waiting three months or trying sooner [shows that] women who waited longer ended up taking longer to get pregnant,” says Williams.
That doesn’t mean you should necessarily try right away, though. “After a loss, you want to make sure your body returns back to its pre-pregnancy state,” he says.
In addition to verifying that your cervix has closed, you’ll want confirm (via a blood test) that your levels of hCG, or the “pregnancy hormone,” are back to baseline. This ensures you don’t confuse a potential new pregnancy with your old one.
One caveat: If you’ve had multiple losses, you’ll want to consider getting an evaluation from a reproductive endocrinologist to identify if there’s an underlying problem - many of which can be dealt with effectively via treatment.
Regardless of your exact circumstances - and how you’ve reacted so far - “miscarriage is a mourning process, and we all cope differently,” says Monk. “There’s no right or wrong way to do it.”
This article was originally published in Women's Health SA.