feet_smSex is a miraculous and fantastic aspect of life, and as an OB/GYN, it never ceases to fascinate me as I watch the point of sexual engagement evolve from recreation to procreation.

For women especially, our approach to sex, as well as our need for it, changes over time. For example, female-initiated sexual encounters peak around ovulation and also with new relationships. While men need a place, women need a reason. This usually means that at the start of a relationship there are more frequent sexual encounters, as both people want to learn about each other. But as time goes by and the novelty fades, new patterns set in. Maintaining a healthy relationship may take time and effort both inside and outside of the bedroom. External variables, like contraceptive pills, can suppress ovulation and lower free testosterone levels. So while the Pill is a great way to prevent pregnancy (not to mention treat acne and prevent facial hair growth), this form of contraception may also lower sexual desire.

When a young couple decides that they are ready to start a family, it is essential that both partners be on board so that they can ensure sexual frequency at the right time in the cycle to conceive. If one partner is too involved in his or her career path or educational goals, then s/he may not make the time to be together and thus fertility may suffer. Delaying having children may also mean lowered fertility for a number of biological reasons, but there is one additional reason that you might not guess: couples who are older and have been together longer often have sex less frequently.

So when it comes time to start a family, the role that sex plays in a relationship naturally evolves. Whether the couple finds that having unprotected sex is freeing and exciting so they want to have it more often, or whether having sex becomes more frequent simply in order to achieve a pregnancy, the period of time when couples are trying to get pregnant is a particularly sexually active phase of life.

Infertility can put a special burden on couples, as the precise schedule of intercourse can make having sex feel like hard work. I always remind my patients that sex should be fun, and when it becomes only about procreation, it may actually negatively impact a woman’s ability to get pregnant. I recommend several strategies to keep sex feeling as engaging and emotionally satisfying as it is at any other time in life. I tell my patients to designate one bed in their home for conception and another for relationship rejuvenation. And when the emphasis on procreation becomes too much, I tell couples to take a month or two off from fertility treatments to reconnect and appreciate each other. Shifting the emphasis from stress and worry to deep emotional connection helps support both partners during this transitional phase of life.

Once the baby arrives, many aspects of parenthood conspire to tamp down sexual interest. From sleep deprivation to struggles with time management and making child care fit with the normal routine of life and work can leave little or no time for sexual connection. Adjusting to a new body image and also a new self-image as a mom or dad can also radically shift the dynamic in couples’ sex lives.

During this crucial transitional phase, it’s extremely important that both partners make conscious efforts to maintain an emotional and physical relationship their significant other.  It is also essential to give the primary caregiver a break by hiring a baby sitter or having a friend or family member watch the baby so that there is time for romance. For “date night” and beyond, I advise making physical space in your home for intimacy. If you believe in a family bed, then find another room in the house or elsewhere to have the privacy necessary to relax and enjoy sex. If you want to lose the baby fat, remember sex is exercise — so it can help. And if you are having issues changing the post-childbirth sexual dynamics, then consider reaching out for therapeutic help.

While fertility is the focus of my practice, I also want to help support my patients in having a happy, healthy, and fulfilling sex life. At this precious stage where procreation is the focus, it’s important to remember that having sex has many essential side effects beyond making a baby including stress reduction, greater intimacy and closeness, and above all, a continued connection with your partner.

Next time we’ll talk about Part III of the Sex Trifecta: Beyond the childbearing years: from procreation back to recreation.