Sexuality and birth control

The birth of your baby will bring many changes. The postpartum period is hectic and it will take some time to get back to everyday life.
Birth control or contraception is often not immediately a topic that comes to mind. Your sex drive may also be affected. Nevertheless, it is important to pay attention to these matters. We would like to give you some more information below, but please also feel free to ask us in case of any questions.

Sexuality

So short after giving birth, many couples do not think about making love yet. Still, it is important to be informed well about sex after childbirth.

It is perfectly fine to have sex again if you feel like it. This feeling, however, is very different for everyone. Not everyone feels like having sex again just as quickly. Childbirth, fatigue, and your new role as a parent can affect your libido. Don’t have sex until you feel like it.

To almost everyone, having sex for the first time after childbirth feels exciting, both men and women. Take your time and if it doesn’t feel good, stop and try again a few days later. Having sex after giving birth shouldn’t be painful!

What, of course, plays an important role is whether any scars in your vagina have healed properly. Typically, a scar has grown together within 10 days after childbirth. But scar pain may last longer. The scar tissue is often somewhat harder and stiffer. This can be sensitive during, for example, sitting, cycling and making love. During intercourse, the skin may stretch around the scar or you may feel a “bump”. By only having sex when you are really aroused and by using lubricant you can ensure that you have less or no problems. Over time, the scar will heal more and more and the scar tissue will become more flexible, until you no longer feel any difference from before delivery.

It is also good to know that your vagina may be a bit drier if you are breastfeeding. Many women need lubricant until the moisture in the vagina returns to normal. This takes an average of 2-3 months.

Always use contraception if you are having sex and do not want to get pregnant! Childbirth or breastfeeding is never a form of contraception!

Birth control

You may ovulate again four weeks after giving birth and you may therefore be fertile again, even if you are breastfeeding. Menstruation often starts later, but ovulation can indeed occur during that time. It is important to know that if you are breastfeeding, it is wise to not just any birth control method, as some can affect the amount and quality of breastfeeding.
Contraceptives that contain estrogens can lower your milk production. The progesterone hormone has less influence on breastfeeding. We will inform you during your maternity period about what contraception you can use while breastfeeding. These are products with only progesterone or even without any hormones.
If you do not breastfeed, you can choose any type of contraceptive after delivery, but it is always important to look carefully at what suits you.

Below we have already provided some information:

Hormone-free birth control

Condoms or other barrier methods

Using condoms is the simplest way of birth control. The reliability of a condom strongly depends on correct use.

Copper IUD

An IUD (intrauterine device) is a very reliable form of contraception that can be combined with breastfeeding. There are two types of IUDs: the hormonal IUD and the copper IUD. The below pertains to the copper IUD, the ‘T-safe’.

The T-safe gradually releases some copper over a period of up to 10 years. Copper makes the sperm cells inactive, which prevents fertilization. If a copper IUD is placed within five days of unsafe sex, it can also be used as a morning-after IUD.
The T-safe is freely available and costs € 70.95. However, it is important to check with us whether you qualify for this from a medical point of view. You can choose who places the IUD. This can be done by your GP, a gynecologist or with us. If you choose us, we will ensure that it is ordered so that the IUD is ready with us. Most health insurance companies reimburse a copper IUD when you have an additional package (‘aanvullende verzekering’). You may want to check this beforehand.

Sterilization

Sterilization is a definitive method of contraception that is usually only used when there is no longer any desire to have children.

Estrogens-free birth control

Mini pill

The mini pill, called Cerazette, is a pill that only contains progesterone. This means that this pill can be used during breastfeeding, because progesterone has no influence on the quality of breast milk.
Because there is no estrogen in the pill, it works differently from the more famous combined pill. You will take the pill every day without breaks. Your menstrual cycle is the same as if you were not taking a pill, because you cannot influence this with this pill. You may, however, suffer from breakthrough bleeding more often.

Hormonal IUD

The Mirena coil gradually releases a little hormone (levonorgestrel) into the uterus over a period of up to 5 years. It thins the lining of your uterus. In addition, the mucous membrane in the uterus becomes tougher, making it difficult to access for sperm cells. In addition, it also suppresses ovulation in some women. Because the endometrium is thinner, the bleeding during menstruation is about 80% lighter.

A Mirena spiral costs € 147.47. However, it is important to check with us whether you qualify for this from a medical point of view. You can choose who places the IUD. This can be done by your GP, a gynecologist or with us. If you choose us, we will ensure that it is ordered so that the IUD is ready with us. Most health insurance companies reimburse a copper IUD when you have an additional package (‘aanvullende verzekering’). You may want to check this beforehand.

Etonogestrel

Better known under the brand name Implanon, this is available as an implant placed under the skin of the upper arm. Similar to the IUD, this is a contraceptive solution for a longer period of time and can remain in place for at least 3 years.

DMPA injection

This DMPA injection (depot medroxyprogesterone acetate) is a reliable form of contraception. This hormonal medication is injected into your muscle once every 12 months. It forms a long-lasting depot from which it is slowly released, so that it often takes longer before you are fertile again. If, however, you appear to be sensitive to one of the hormones, it takes a while for the injection to wear off and the complaints to diminish. For this reason, this is not the most recommended form of birth control.

Birth control methods with progesterone and estrogen

Combined pill

The combined pill is the best-known form of contraception and therefore the most commonly prescribed. You take the combined pill for 3 weeks, after which you can plan a week’s break in which you will have your period. You can also continue taking the pill so that you will not have your period for a longer period of time. If it turns out you are sensitive to hormones, this can be a reason to no longer choose the combined pill or to choose a different combined pill.

Contraceptive ring

The contraceptive ring is a method of contraception in which you insert a vaginal ring yourself. This can be compared to inserting a tampon. It sits inside your vagina for 3 weeks where it releases hormones. Then you remove it and have a 7-day ring-free break during which you get your period. If you use the NuvaRing you have a higher chance of getting thrombosis. For this reason, there is a reluctance to prescribe this form of contraception.

Contraceptive patch

The contraceptive patch is a weekly method of contraception, i.e. you apply a patch once a week. It is a type of contraception that can be pleasant for women who want to control their periods but forget to take the pill and prefer not to have a long-term form of contraception such as an IUD.

Prescribing contraception

We can inform you about all types of contraception. As of 2015, all midwives are authorized to prescribe the pill and to prescribe/place an IUD. Hence, you can also contact us for a prescription for the pill, an IUD or another contraceptive. You can also choose to have an IUD placed by us. You no longer have to go to your GP for this.

If you are already a client of ours due to a pregnancy, we will inform you about contraception during the maternity period and during the follow-up session as part of our aftercare. We are aware of your medical data and we provide tailored advice. We also include your previous experiences with contraception. Once you have made your choice, we will write you a prescription (if necessary). You do not have to go through your GP or any gynecologist.

If you are a new client and are interested in an IUD, we would like to meet you first. We can have a conversation either by telephone or during a consult at the practice. We will ask you specific questions about your medical history. We do this to give you tailored advice, because an IUD is not suitable for everyone.
If it turns out an IUD will suit you, then we will write a prescription for you and we will schedule an appointment for its placement.

IUD placement

We schedule an appointment at our practice. Beforehand, we would have had contact by telephone or in person and we would have ordered and delivered the IUD at our practice. You can have it placed at any point in your cycle. If you have never given birth, we prefer to place the spiral within 7 days after your period because your cervix is slightly open. This makes the placement easier and it is then certain that there is no pregnancy at that time.

We can place a spiral from 10 weeks after childbirth. Then the cervix and uterus are back to their old state. After a caesarean section this is after 12 weeks.

Before placement, we will do an internal (transvaginal) ultrasound to check the position of your uterus. Then we can place the IUD. This may be sensitive and will take a few minutes. We therefore advise you to take 2 paracetamol about an hour in advance; if you are not breastfeeding you can take 1 ibuprofen. Immediately after the placement we will make another internal ultrasound so that we can immediately see whether the device is in the right place. A follow-up check is then no longer required. Sometimes an additional check-up is done on indication.

After the placement, you may have a nagging feeling in the lower abdomen, which is usually short-lived. In addition, you may have some irregular bleeding for the first three months. We provide you with instructions on when to call us, in case of persistent complaints.

Of course you can always contact us in case of questions or complaints.

IUD removal

Of course you can also reach out to us to have your IUD removed. A copper IUD may remain in place for 5 or 10 years and the hormonal IUD for up to 5 years. After this, it must be removed or replaced with a new one. Of course, you can always remove your IUD earlier if you wish to do so. Feel free to call for an appointment. Removal is quite easy.

Costs

The costs for having us placing an IUD are always reimbursed by your health insurance. Some insurance companies, however, may require some monetary contribution from your end. We can look at this together, or you can check this with your insurance company yourself.

Purchase of both types of IUD goes through us. We create a digital prescription and after online payment it is delivered to us. This way, the IUD is ready for you during placement and you do not have to take any further action. The digital invoice will be available to you so you can submit it to your health insurance yourself. If you have the appropriate additional insurance package (‘aanvullende verzekering’), you will then be refunded the insured amount.

Information session:	No costs
Placing IUD and aftercare:	€67,01 (always reimbursed by the insurer, sometimes out of your own risk)
Removing IUD:	€67,01 (always reimbursed by the insurer, sometimes out of your own risk)
IUD:	Mirena: Kyleena: T-Safe: Ballerine:	€147,47 €147,47 € 70,96 €119,00
	(reimbursed by your insurance if covered by your package)

Would you like more information or make an appointment? Feel free to give us a call or send us an email. We are happy to help you!