After Abortion, Intimacy Can Change

It's estimated that nearly 1 in 4 women in the United States will have an abortion by age 45, a safe procedure that, even in the face of recent legislation and ongoing court cases, remains legal in much of the country.

If you've recently had an abortion, you may have spent significant time and energy evaluating your options and choosing the best procedure. What you may not have spent much time thinking about was your sex life afterward. While sex after an abortion might feel anything from normal to different to absolutely terrifying, some prior knowledge and advice can help you reframe your approach.

How soon after an abortion can you have sex?

After an abortion of any type, including procedural and medical abortions, pregnancy symptoms can last for up to six weeks. These symptoms can include bleeding, cramping and breast tenderness.

These symptoms may affect your decision about if and when to resume having sex. Although some sources suggest waiting for two weeks after ending a pregnancy, medically speaking, you can have sex whenever you feel ready, according to Meera Shah, M.D., M.P.H., chief medical officer at Planned Parenthood Hudson Peconic, based in Elmsford, New York. You don't need to wait until bleeding, breast tenderness and cramping subside or disappear; the most important aspect is that you feel comfortable.

In fact, Shah has seen a wide range of attitudes toward sex among her patients who have had an abortion.

"Some patients will ask, 'When can I have sex again?'; some patients will say to me, 'I never want to have sex again,'" Shah said.

There is no right or wrong way to feel about sex after an abortion.

How is sex different after an abortion?

While you are pregnant, your body experiences certain physical changes. For example, the size of your uterus increases throughout pregnancy, so sex may feel different after an abortion. This phenomenon can affect all kinds of sex, including vaginal and anal sex. Within six weeks of ending a pregnancy, your uterus returns to its normal state, and sex may feel more like it did before the pregnancy.

If sex feels painful or uncomfortable for this reason, communicate with your partner to find a position that feels better for you, suggested Nika Vizcarra, M.D., M.S., an OB-GYN at the University of Nevada, Las Vegas.

"It's really individualized and depends on each person," she said.

You may experience other physical symptoms, as well. If you are bleeding, you can opt to lay down a towel and have sex as usual. You may also have breast tenderness and liquid leaking from your nipples, especially if your breasts are squeezed. Communicate with your partner throughout the act to express if you feel any pain or discomfort.

Emotionally, the feelings around your abortion may be complex and, by extension, affect sex. For some people, it can be very easy to handle; for others, it can be difficult. Again, there is no right or wrong way to feel.

If you'd like support to process your emotions after an abortion, it can be helpful to speak with a trusted family member or friend about what's going through your head. If you'd prefer to use an online resource, Shah recommended Exhale, which has a call line at 1-888-493-0092 and a text line at 617-749-2948.

What about birth control?

If you ended your pregnancy because it was unwanted, contraception will be front of mind. Maybe you want to start taking birth control because you weren't before; maybe you want to switch your method of contraception if it failed, resulting in the pregnancy. On the other hand, maybe you want to stop using birth control altogether.

Keep in mind it is not a requirement to use birth control after an abortion. In fact, if you have just ended a pregnancy and would like to become pregnant again right away, your doctor may recommend prenatal vitamins.

If you'd like to start using birth control, you can begin very soon after an abortion. For a procedural abortion, you can start any method of contraception the same day you have the procedure. For medication abortion, you can start most methods of contraception on the same day. The exception is the intrauterine device (IUD), which can be inserted only after your medication abortion is complete.

To consider various options for birth control, Shah recommended Planned Parenthood or Bedsider.

Shah also suggested evaluating the contraceptive method you were using before, if any, in the context of your lifestyle. For example, do you tend to neglect using a condom in the heat of the moment? If so, maybe taking the pill every morning would be better. Do you have trouble remembering to take the pill every day? In that case, maybe getting a low-maintenance contraceptive like an IUD or the Nexplanon arm implant would be better. Evaluate your own habits and needs, seeking advice from your doctor if needed.

"Catering the method to the individual patient is the approach that is best," Shah explained.

"If you do have an unintended pregnancy again after an abortion, try not to blame yourself. Having multiple abortions is common and should be normalized," Shah added.

Keeping your abortion private and embracing your sexuality

There are many reasons for wanting to keep your experience to yourself, from having an unsupportive partner to identifying as transgender to engaging in sex work.

If you'd like to hide bleeding that may result from an abortion while you are having sex, try using a menstrual cup or menstrual disc that you can wear during intercourse. If used correctly, this can prevent blood and other fluids from leaving your body and provoking unwanted questions from your partner.

Having sex after an abortion isn't just about navigating the potential hurdles. It's also about embracing your sexuality in whatever way feels right to you. Remember that however you feel and whatever period of time you need to feel comfortable, having sex is normal and acceptable.

One strategy Vizcarra suggested is to frame your mindset to be amazed by all the changes your body goes through during pregnancy. Afterward, when you're not pregnant, you can start to realize that the entire process is normal and really quite incredible, she added.

Talking with your partner about what feels good and what doesn't, and explaining the changes your body is going through, can be helpful, if your partner is open to listening.

"Remember to communicate clearly with your partner and let them know if you want to stop," Vizcarra explained. "To set the mood, you can try playing your favorite music, lighting some candles and taking it slow. Your body has done a lot, and whenever you're ready to have sex again, you deserve the most pleasurable experience possible."

Abortion is a medical procedure that is currently illegal or restricted in some portions of the United States. For more information about the legality of abortion in your area, please consult a local healthcare provider.