Miscarriages are heartbreaking for couples. For those determined to become parents they can be particularly hard to overcome because the effort to conceive complicates the work of healing. Still, research shows that the sooner people have sex after a miscarriage (within doctor’s recommendations) the more likely they are to conceive again. For couples, this represents an emotional and physical trial. Sex is not necessarily different after a miscarriage, but the emotional context of the act changes in irreversible ways. It’s natural for couples to be tentative or sad. It’s natural for real intimacy to feel unreachable.
READ MORE: The Fatherly Guide to Sex After Kids
“The typical recommendation is that sex is okay two weeks after bleeding stops,” says Dr. Mark Trolice, a fertility specialist. “But we’re dealing with a tragedy. Men make mistakes if they’re not sensitive to that devastation.”
Medically speaking, Trolice and doctors want couples to wait until the cervix is dilated as inserting anything into the vagina raises the risk of infection. Though recovery may take longer if the miscarriage took place after the first trimester, miscarriages that occur earlier in pregnancy are often medically resolved while emotions remain fresh. This is a common predicament: Approximately one in six pregnancies ends in miscarriage. But just because it’s common doesn’t make it any easier for would-be parents to try again.
Unfortunately, many men and women assume that they should be emotionally ready for sex when they are physically ready. There is no reason to suspect that this will be true. It often isn’t, which is one of the reasons Trolice does not recommend that men approach their partners sexually. He suggests finding other ways to bond and waiting patiently. Courtney Watson, a sex therapist who endured a miscarriage herself, says that it’s potentially a good idea to make both patience and desire known.
“You can lead with support and say ‘I know this is really tough for you and when you feel like being intimate, please know that I’m here,’” Watson explains, noting that it’s critical to lead with your partner’s needs, rather than your own. Although she echoes Trolice’s sentiments about expanding the definition of intimacy, Watson warns that physical touch in general can be as triggering as sex itself.
“If a person associates physical touch with sex and sex with babies, touching them can make them think about the loss of the child,” she says.
Whether discussing sex or actually having it, the key for partners who have endured a miscarriage is that they acknowledge their ignorance of their partner’s triggers. Perhaps they were on the same page before the miscarriage, but the impact of loss is not predictable. That’s why Watson advises men and women to be prepared for unexpected emotions to come up when they decide to have sex again and to discuss that possibility directly beforehand, preparing to take a break during the act or break it off if it’s not working. Watson says that it can be helpful to remember that sex doesn’t have to end in an orgasm. Managing expectations to perform or to feel pleasure while managing loss is a juggling act.
There is no timetable for having sex again, but Trolice notes that if, after three months, a couple is still struggling with sex than there might be a bigger problem. In this case, Trolice and Watson recommend counseling — not because of the lack of sex, but because of the lack of healing. Sex is not just a goal, it’s a stand-in — to a limited extent — for resolution.
It’s important to note that every couple is different and there is no right way to deal with something as difficult as a miscarriage other than to be compassionate with yourself and partner if you’re going through it. In their careers, Trolice and Watson’s have encountered many men who’ve taken the loss worse than their partners. Watson has also encountered homosexual couples who’ve miscarried through adoption and struggled with intimacy afterward as a result. After her miscarriage, Watson says she was able to bounce back quickly. She became pregnant with her daughter not long after.
“I don’t necessarily think my situation is super common, but I also know that miscarriage doesn’t look like any one thing for women,” she says. “There can be a range of experiences.”