Rita and Andrew were at their lowest in their relationship when I met them at the Sexology Clinic. She felt there was nothing that would save her marriage. It was three months after she delivered and Andrew was pushing her to have sex yet she did not feel like.

"Last night he said that he had confirmed what he had been suspecting all along," Rita said, "that I had been unfaithful and got pregnant from an extramarital affair and that the baby was not his."

Andrew had incidentally found a cultural explanation for their debacle. According to their culture if a woman is impregnated by someone else other than her husband they have to wait until breastfeeding stops before resuming sex with the husband otherwise the baby dies mysteriously.

"Look here doctor," Andrew butted in, "we were told by the gynecologist that Rita will be well enough to have sex six weeks after delivery, it is now twelve weeks and she wouldn't allow me to touch her."

The couple had been married for only two years. This was Rita's first delivery. The pregnancy had gone well but there were a few problems at delivery and the doctor had to cut her vaginal opening and pull out the baby using a vacuum. Healing after this traumatic process does take time.

Previous research studies have shown that women who get cuts and bruises in the vaginal area at delivery and those who undergo cesarean section do take time to get comfortable with sex again. In one study it was found that up to 30 percent of first-time mothers had not resumed sex eight months after delivery and because of the traumatic events at delivery and the after pains.

Hormonal changes following delivery also do not favour resumption of sex. Female hormones fall drastically after delivery. As a result, the woman goes into a state that resembles menopause where vaginal dryness and thinning occur. Under such circumstances, penetration can be painful.

Prolactin, a hormone that enhances milk production, also rises to high levels after delivery. Prolactin inhibits sex desire and sex responsiveness. As such the woman has low libido.

The body changes following delivery do not make the situation any better. The colour of the skin, the shape of the tummy, and new-look breasts make some women feel that they have lost their beauty. Negative body image does not only make self-esteem and self-confidence crush but also interferes with interest in sex, making affected women keep off.

In all these difficult circumstances there is also a demanding baby. Babies can be stubborn in their early days. They wake up when everyone goes to sleep. They want to breastfeed at the weirdest hours of the night. The cries from colic can keep everyone awake and no medicine causes relief.

"Do you know I struggle with the baby alone all night as Andrew enjoys his sleep?" Rita reveals.

"But I have to go to work so I cannot keep awake," Andrew defends.

The result of all these changes is that sex sometimes becomes impossible. Sex desire is at its lowest even six months after delivery for some women. Some women feel pain. Most describe their sexual experience as unsatisfactory. Most relationships are troubled because of poor sexual experience. Some women feel guilty and inadequate because they are unable to live up to the expectations of their men.

While all women are affected, the situation is worse for first-time mothers. Many women feel that they need professional help to resume sex after delivery. Unfortunately, little or no help is forthcoming from their health provider.

"They talk to us a lot about contraceptives and the need to plan the next pregnancy but that is just how far it goes," Rita says, "they seem to imply that a woman will soon be all over the place enjoying sex again and will instantly conceive."

I booked Rita and Andrew for sex coaching lessons and slowly they got back into their sex routines. Andrew apologised for implying that Rita had conceived from an extramarital affair.

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What to do if your sex drive goes off after birth - Daily Nation

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