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of pain, I wasn’t able to just click back over to pleasure or wanting to have sex freely.”

Women in this mindset see sex—and masturbation, for that matter—as a self-indulgent act that symbolizes an erasure of their grief in favor of emotional or physical or personal gain. These feelings are, of course, compounded by societal messaging that pigeonholes women as maternal, not sexual. In a culture that already discourages women—especially moms or those who will one day become moms—to embrace and express their sexuality, how can we possibly feel free to return to our sexual selves in the midst of our grief? We are judged under the best of circumstances.

Aliyah, a member of my online community who had a stillbirth at thirty weeks, said her sex life with her partner was difficult for the next two years. But she couldn’t be alone either. “Masturbation felt selfish. Something so sacred [my stillbirth] happened there, so it felt selfish to not include my husband there too. I felt alienated from my body. I had to rebuild a relationship with my body all over again.”

In contrast, for some women, masturbation was the only available kind of sexual expression. Libby messaged me after her termination, which was due to life-threatening preeclampsia, and we discussed this exact reaction.

“Masturbation was the only way I could reach orgasm, actually, because I wasn’t performing, it was just for myself,” she said. “After my loss, it was very difficult for me. My husband had taken care of me in a new way—taking me to the bathroom, helping me out. It was so vulnerable and—not in a sexy way—very intimate. Masturbating, I didn’t have to think about him or his thoughts. I could cancel out the noise of what he might be thinking or seeing after watching me lose our baby. I was too afraid to ask him what he saw. What he thought. My self-esteem was already so compromised. And I was worried that my anxieties would become his too. But I had a lack of self-consciousness when it came to masturbating. It was a step toward self-care to masturbate.”

This is not to say that anyone should feel inhibited, embarrassed, or guilty if they do want to have sex. As Libby points out, masturbation and sex can be compassionate acts of self-care and restorative for romantic relationships. Take this message from Trina, a member of the Instagram community: “I felt like my body had failed me in losing my son three days after he was born. I’m single, but I sought out sexual partners because sex was a way to gain that back—to feel powerful in my body again. There was some guilt that came with the pleasure in the early days, but finding joy while navigating the self-facing, negative self-blame helped me navigate in a more clear-minded and balanced way. Sex helped me remember who I was.”

Each time the concept of sex and sexual pleasure would come up—whether in sessions with my patients where I could sit and discuss it with them, or through a direct message on Instagram—I’d encourage those who shared to trust their feelings, to honor their instincts, and to abide by the schedule that felt right. It was rarely straightforward, of course. Some were afraid sex might lead to another loss, which oftentimes led to feelings of guilt that arose over abstaining from intimacy with their partners. Then guilt would compound further, as they found themselves swirled up inside a narrative that was wholly destructive: Stricken by the loss of a future they’d envisioned and immobilized by the bone-shattering grief that ensued, they believed that they were somehow to blame for what had happened. That these unthinkable circumstances had come about as a result of something they’d done. Or not done. That their bodies had failed. If they couldn’t trust their bodies to carry out the very thing they were purportedly designed to do, they reasoned, why should they allow themselves to feel pleasure?

The return of joy can take time, of course. Pleasure and grief, after all, might never have been considered mutually exclusive if not for the harmful cultural stigmatization surrounding pregnancy loss. Tapping back into our sexuality is certainly not the only way to reconnect with our deeper selves and regain confidence in our sensuality, but it undoubtedly holds the power to offer the comfort and encourage the connection that our minds and bodies so often crave.

Amelia confided in me via direct message that she cried the first time she had sex with her husband after her pregnancy loss. “It was about six weeks later, when we returned to penetrative sex. I cried right after because I finally felt really connected to my husband again. With my loss, I felt like I was on an island—water between me and everybody. When we had sex, I cried with relief to be connected to someone again. Because of that, I think that pleasure and grief must coexist.”

Surveying the emotional damage that can occur after a loss and realizing the extent of mental labor that must go into processing it, these women would oftentimes shelve sexual engagement until they could find their footing. And understandably so. Sensuality took on new meaning. And pregnancy too. So, no matter where a woman was in her grief process, my advice to her during our sessions would remain unchanged: “If you don’t want to have sex,” I would tell them, “then don’t. If you do, then you should.” And of course, this advice applied to nonpatients too. It certainly applied to me.

• • •

A month after my miscarriage, I returned to my obstetrician’s office for a follow-up appointment. She took a look at my uterus and cervix to be sure they looked normal, and we discussed whether Jason and I wanted to try again. Her recommendation was to wait three cycles before trying to conceive—if we decided to—and she otherwise checked in on my emotional state.

I felt a dozen emotions all in synchronicity when I got that first period following

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