Mr and Mrs X came to me with C/O reduced sex desire in the woman for 9 years

She was 36 years old, married for 12 years , Post graduate and running her own business  at home. 

The husband was 38 years, professional, working in a company requiring frequent travel , occasional alcohol abuser & a smoker. 

Morning erections were occasional. Initial time , for around 3 years were good , had sex every night. They had a 9 years old son 

. The husband could recollect that it all began after the birth of son. But since then, Mrs. X would avoid intimacy, would sleep early or would tell that she had headache.Post delivery, there was no sex for 1 year  . when they attempted sex, there was poor erection so it was not satisfactory. He tried to have sex with another woman where it was good. Next time, Mrs X felt a lot of pain , vagina was dry and she  presumed that it was due to operation ( baby was born after LSCS) The man would request for sex, but she would repeatedly  take one plea or the other to avoid it.

Physical examination was normal, lab investigations were normal as well. The woman was found to be having moderate depression  with sadness ,disturbed sleep, reduced energy, headache and getting no pleasure from any source.

MWe put the woman on antidepressants, gave them sex counseling with emphasis on spending quality time together, start touching, fondling and going for outing once a week. The man was suggested life style changes like quit smoking . It had magical effect in 6 weeks time.  Now they are having sex 3-4 times a week and happy

This case shows effect of the birth of a child on a  couple,s sexuality. Here the sex was very good for 3 years when Mrs. X got pregnant. Doctor advised them to abstain from sex and initial post birth time is crucial. The woman is getting bigger tummy, may have body image issues, multiple physical problems of pregnancy  plus naturally high progesterone lowers the libido considerably. Post delivery time is characterized by heavy burden of child rearing, poor sleep and self care, smell of child rear, and high prolactin level produce reduced sex desire . High prolactin produces dryness of vagina so sex is painful as well. It is always better to continue to be intimate and spend time together, if vaginal sex is not possible .