M. Clarke, a bookkeeper living in California, was very early into her pregnancy when she woke up feeling deliriously ill and bleeding. "I was barely able to make it to the restroom before fainting because the bleeding was so heavy," she tells InStyle. "It just wouldn't stop and I didn't realize what was happening until the cramps were unbearable and suddenly the blood was chunky and dark."

Clarke had miscarried, and while the loss was physically painful and emotionally devastating, she only waited two weeks before returning to having sex with her partner again.

"For me, jumping back into sex immediately after my loss was a sort of weird coping mechanism," she explains. "Having sex was an attempt to distract myself from my overwhelming grief."

There are myriad ways to respond to a pregnancy loss, yet only a few are, rarely, discussed openly. As a society, we have a singular, linear idea of what grief should look like and how it should be expressed. It's not uncommon for people to prescribe erroneous timelines to grief, and become impatient, cold, and even cruel to those who do not adhere to them. But grief is not linear, it is circuitous — an unpredictable emotional contortionist that can begin and end and begin again; bubbling under the surface or erupting at a moment's notice.

Often, people judge, shame, and otherwise condemn expressions of grief that are not deemed "appropriate." And when it comes to sex, an already taboo topic in this country, rarely do people consider expressions of one's sexuality to go hand-in-hand with grief. But, of course, it can, and it does. People return to sex amid grief in an effort to reconnect with themselves, their partners, and their pleasure. It can be a much-needed relief to feel something other than anguish, and sex has the potential to catapult us into another mindset completely, even if only temporarily.

In my recently published book, I Had a Miscarriage: A Memoir, a Movement, I highlight the various ways those who undergo pregnancy and infant loss experience, digest and express their grief. And yes, sexuality is certainly one of those ways. I investigate whether or not, and how, grief and pleasure can coexist in the aftermath of loss — be it for connection, pleasure, distraction, try to conceive again, or otherwise.

Reengaging in sexual intimacy can come with a slew of unforeseeable feelings, as it can sometimes trigger the heartache resulting from the miscarriage. Upon returning to the very site of the loss to engage sexually, some women report feeling a sense of relief to be present in their bodies while others express feeling terrified of getting pregnant again, not getting pregnant again, vividly recalling details of the miscarriage, and then some. Suffice it to say, navigating the return to sex after miscarriage can be fraught, and even sometimes reveals aspects of the loss previously unexplored or unarticulated.

For starters, the physical changes of pregnancy, including when that pregnancy ends, can create some complications. Clarke says that while she thought she was emotionally ready to start having sex with her partner again, it took actually having sex to realize that her body wasn't. "I honestly wish I would have waited, because not only was I emotionally unprepared, but I had no idea what affect miscarriage has on the body, so the bleeding resumed right afterwards and continued for months."

In most cases, it's considered safe to have sex once the miscarriage-related bleeding has stopped, but that isn't always the case. To make sure your body is physically ready for sex, it's best to consult your doctor so that they can best assess your post-loss physical needs. If your body isn't yet ready, that doesn't mean it has somehow failed — just that, like pregnancy itself, different bodies require different things.

Complicated feelings regarding body language can also present a barrier to a pleasant and fulfilling sexual experience. In a culture that refuses to celebrate the physical proof of pregnancy, common physical side effects of pregnancy — weight gain, a change in the shape and size of a person's breasts, swelling of the labia majora and minora — can leave someone feeling uncomfortable in their own body. And those physical changes certainly do not immediately disappear the moment a pregnancy ends, be it via a live birth or a pregnancy loss. Instead, they can linger, and with them can come complex feelings about how your body looks and feels.

K.S., a stay-at-home mom in Los Angeles, was 17 weeks along when she lost her pregnancy. "I hadn't felt the baby move in a while, and I felt like my belly wasn't growing," she tells InStyle. "I went in for my routine visit at 17 weeks, where they check for the baby's heartbeat, and when the doctor placed the Doppler on my belly, there was nothing. So they tried another spot and nothing. And another and nothing."

After undergoing a D&C, K.S. said she waited about three weeks before having sex again. "I wanted to have sex and wanted to be close to my husband," she says. But the physical changes of pregnancy remained after the loss, and her feelings about her postpartum body complicated sex.

"I had a pregnant and postpartum body still, and it was impossible to lose the extra weight from pregnancy," she explains. "It was and is the worst. I came into this new pregnancy with the weight I gained from my miscarriage pregnancy."

Of course, how your partner responds to the pregnancy loss versus how you respond can also present some challenges in the bedroom. While studies have shown that miscarriage and infant loss does take a toll on men's physical and mental health, they often react to losses differently than women. One 2019 study found that men felt it was their role to be the 'supporter' for their partner, and as a man they had to be 'strong and stoic'. As a result, many men reported a hesitation to express or share the emotional impact of pregnancy loss, saying they feared "their emotions and grief would only further burden their partner."

Not expressing their own emotional reaction to a loss openly, or simply having one that isn't similar to their partners, can leave those who endured the loss feeling as if their partner does not care as much, was not impacted as much, or simply doesn't understand, at a time when understanding is often necessary to feel seen, heard, and supported.

Clarke says that she and her partner started fighting immediately after her miscarriage, and the fights increased in frequency and intensity. "Looking back now, I realize we had no idea how to navigate the situation and were grieving so differently, on opposite sides of the spectrum even," she explains. "I grieved outwardly and he inwardly, pushing me away in the process. He avoided acknowledging our loss when I begged him to meet me halfway, then became angry when I sought that support from close friends."

Studies have long shown the mental health ramifications of pregnancy loss. One in six women who miscarry will experience long-term post traumatic stress disorder symptoms, according to a recent 2020 study, and another study found that 20% of women will become symptomatic for depression and or anxiety. Those symptoms can persist for up to three years. Which is why talking about pregnancy and infant loss with a mental health professional can be so beneficial — for the women and their partners those losses affect. Psychotherapy can help a couple navigate the complex mental health outcomes of miscarriage, and provide tools to help them better understand and support one another.

For many, sex after loss can bring up unresolved feelings. This was the case for Clarke, who says as she continued to have regular sex with her partner she realized that she had not processed her loss, nor had she acknowledged the ways in which it was impacting her mental health.

"After I began to process what had happened to me — to my baby — sex became so triggering," she shares. "I began to associate intimacy, both emotional and physical, with the miscarriage. The triggers only grew more powerful with my grief, to the point that whenever my partner initiated anything sexual I would feel sick to my stomach." Clarke says that not being able to control this reaction would often lead to a panic attack, and as a result, her partner's desire to have sex dissipated. "Thinking back, I feel like I can attribute that anxiety to fearing that I would disappoint him or cause further damage," she says. "That allowing myself to express my sexuality would lead to another heartbreak."

Others may experience guilt for feeling sexual at all — especially when that guilt is compounded by the guilt of having not carried a pregnancy to term, a common feeling among those who experience pregnancy loss. And for those who return to sex with the goal of trying to conceive again, it can easily become more of a "job" than an expression of their sexuality and a way to connect with their partner in an intimate way.

"After my first period returned we decided to try again for another baby because we read that it's easier to get pregnant after loss," K.S. explains. "That feeling of trying brought up so much guilt, because I was still heavily grieving the loss and it didn't feel right to try to 'replace' her space with a new baby. That was her place, and she should still be there."

Just as there is no "one way" to experience pregnancy or the loss of it, there is no "one way" to experience the return to sexual intimacy after a miscarriage, whilst traversing the sullied landscape of grief. For some, leaning into their sexuality helps. For others, it can bring about a plethora of mental roadblocks. But there is one universal truth that applies to every single person that experiences pregnancy loss: no, you cannot just "get over it." And telling anyone they should does not help, it hurts. A lot.

Jessica Zucker is a Los Angeles-based psychologist specializing in reproductive and maternal mental health and the creator of the #IHadaMiscarriage campaign. Her first book is now available I HAD A MISCARRIAGE: A Memoir, a Movement (Feminist Press + Penguin Random House Audio).