Intimacy After a Hair Transplant: When and How to Resume Sexual Activity?

According to recent medical studies, resuming sexual activity too soon can compromise your results. You see, any sexual activity involves physical effort that increases blood flow. Thus, the increase in blood pressure and sudden head movements during intercourse can dislodge the healing grafts. The upshot? You could lose up to 30% of the grafts, which might lead to a failed hair transplant, significantly reducing the effectiveness of your procedure.

These precautions may seem a bit frustrating, but they’re absolutely essential to preserve your investment. Specialists recommend abstaining for at least 7 to 10 days, depending on the technique used and your surgeon’s instructions. These few days of effort are a necessary and beneficial compromise to ensure impeccable and lasting hair results. The social perception of hair transplant before-and-after results can be quite positive, with notable improvements in perceived appearance, attractiveness, and even perception of success (Bater et al., 2016).

The Risks of Resuming Sexual Activity Too Early

Hair transplantation is a meticulous procedure that requires rigorous follow-up, especially during the first few days. Understanding how your grafts settle in might convince you to put your sex life on pause.

How Do Your Grafts Settle into Your Scalp?

The process unfolds in three essential phases:

1. Days 0-3: Inflammatory phase and coagulation After implantation, each graft is held in place only by a slight blood clot. This inflammatory phase is crucial to initiate healing.
2. Days 4-7: Formation of granulation tissue From the 4th day, your body creates granulation tissue to stabilise the grafts and begin their integration. However, they remain vulnerable to any external disturbance.
3. Days 8-21: Re-epithelialisation and permanent anchoring It’s during this phase that the skin reforms around the grafts and they become firmly anchored thanks to neovascularisation (formation of new blood vessels).

The first 10 days are critical, as neovascularisation is a fragile process that determines the survival of the grafts.

What Happens in Your Body During Sexual Intercourse

Sexual activity mobilises numerous physical resources. During intercourse, your heart rate increases from 60-80 to 120-130 beats per minute on average. Your blood pressure can peak at 170/100 mmHg, increasing pressure in the capillary vessels. Finally, your body temperature rises by 1 to 2°C, increasing body perspiration. These physiological variations, although normal, are rather daunting for healing grafts. They have a strong impact on your grafts, endangering your new transplants in several ways:

• Risk of bleeding: Increased arterial pressure can cause bleeding in the micro-incisions, compromising graft fixation.
• Dislodgement: Excessive sweating weakens the coagulation process and can lead to graft dislodgement.
• Infections: Intense activity quadruples the risk of infections, which can hinder healing and jeopardise the entire transplant.

The Intimate Calendar After Your Transplant

A hair transplant isn’t just about hair, but also about discipline. To ensure the survival of your grafts and optimise your results, a precise calendar must be followed. Here’s how to manage your intimacy after the procedure, step by step.

Weeks 1-2: The Mandatory Abstinence Period

During this critical period, the grafts are at their most vulnerable. Any activity that could cause an increase in blood pressure or sudden movements must be strictly avoided. All sexual intercourse is thus strictly forbidden, as well as masturbation and/or viewing content that excites your libido, to avoid passive excitement that can influence your heart rate. The first 10 days are essential to allow your grafts to anchor properly in the scalp.

Days 10-15: The First Steps Towards a Gentle Resumption

The resumption of intimate activity can begin under strict conditions. Masturbation is tolerated, provided that the ambient temperature does not exceed 20°C, to avoid any sweating, particularly of the scalp. It should not exceed 10 minutes, and only in a seated position to avoid any sudden movement. Finally, pornography is banned, as it can lead to uncontrolled reflex movements…

Intimate relations must also resume gradually. The transplant patient must absolutely avoid any physical effort and will limit themselves only to a passive position, with slow and cautious movements, with a maximum duration of 10 minutes and in a cool and controlled ambient temperature, to limit sweating.

Days 15-21: Expanding Your Possibilities

After two weeks, your scalp is on a better path to healing, but caution is still advised.

• Authorised positions: the patient is either lying on their back, sitting, or in a lateral position (spooning).
• Forbidden positions: on all fours, in the missionary position (patient on top) and any position involving direct pressure on the head.

After 3 Weeks: Gradual Return to Normal

You can resume normal intimate activity provided that the scabs have completely fallen off, if you notice no redness or pain, and if the sensitivity of your scalp has returned to normal. Ideally, you should validate the resumption of sexual activity with your doctor during your post-operative check-up. A well-managed intimate life ensures impeccable hair results!

After the Transplant: A Practical Guide for Safe Intercourse

Protecting your grafts while resuming an intimate life is a delicate balance. Here’s a practical guide for safe intercourse, respecting the specific needs of your freshly grafted scalp.

Creating an Optimal Environment

To limit the risks of sweating or discomfort, the environment must be carefully controlled:

• Keep your room at a cool temperature, between 18 and 20°C maximum
• Ensure a humidity level between 40 and 60% to avoid excess dryness or perspiration
• Ensure gentle ventilation, for pleasant air without draughts
• Favour breathable fabrics and cotton sheets to avoid irritation

Hygiene Before and After Intercourse

Strict hygiene is essential to protect your grafts against infections and irritations. It is advised:

Before the act:

• Take a lukewarm shower (max 37°C) to avoid any increase in body temperature
• Gently dry your scalp by patting with a soft towel, without rubbing
• Apply a saline solution or any product prescribed by your doctor to maintain good hydration and protection

After the act:

• Gently clean your scalp with lukewarm water to remove sweat
• Let your scalp air dry, without using a towel or hair dryer
• Conduct a visual inspection of your grafts: check that they are in place and that there is no bleeding or abnormal redness

Warning Signs: When to Stop Immediately

If you experience any of the following symptoms, stop all activity and consult a doctor if necessary:

• Significant redness of the scalp, a possible sign of inflammation
• Sensation of local heat, which may indicate the onset of infection
• Bleeding, even minimal, which could compromise the grafts
• Intense itching or major discomfort
• Acute pain, which may reveal excessive pressure or local tension

Special Cases and Specific Situations

Some situations require adjustments in your resumption of intimate activity to protect your grafts. Here are the precautions to adopt.

-Large Transplants: Adapt Your Resumption

If you’ve had a large transplant (more than 4,000 grafts), the scalp is subjected to more stress.

• Extend each phase of the resumption calendar by 5 days to allow optimal healing.
• Be attentive to signs of tension, such as a feeling of tightness or redness.
• Perform more frequent medical check-ups to monitor progress.

Patients on Medication: Additional Precautions

• Minoxidil: Stop application 48 hours before resuming to avoid any irritation or increased sensitivity.
• Finasteride: No direct impact on resumption, but continue your treatment normally. However, the medical journal Prescrire considers that Propecia and its generics are “not very effective”, and have so many side effects that it has been classified, since 2019, in its list of drugs “more dangerous than useful”. Moreover, according to the French association for help to victims of finasteride (AFVIN), these side effects persist after stopping treatment… Finasteride can cause sexual side effects in some patients, including decreased libido and erectile dysfunction (Mysore, 2012). An in-depth discussion with your doctor about the risks and benefits is crucial before starting or continuing this treatment.
• Antiplatelet drugs (aspirin or others): Consult your doctor to assess the risk of bleeding.

Each patient and each case of hair implant is unique: always follow your surgeon’s specific recommendations to maximise your results!

Medical Follow-up: Keep in Touch with Your Surgeon

Rigorous follow-up with your surgeon is essential to ensure the success of your hair transplant. Your post-operative diary should thus be marked by two key appointments:

• Day 10: Initial evaluation to check healing and proper positioning of the grafts.
• Day 21: Validation of the normal resumption of activities, including intimate relations.

Consult urgently if the following physiological signs appear:

• If you have a fever above 38°C, a potential sign of infection
• If you observe bleeding or visible loss of grafts
• If you feel persistent pain despite treatments

Stay attentive to any unusual signs and keep open communication with your surgeon for optimal and lasting results.

Patience and caution are your best allies. Respect the post-operative instructions: they guarantee optimal and lasting results. To preserve your new hair, a pause in your intimate life is well worth it!

It’s worth noting that hair treatments, including hair transplants, can have a significant impact on patients’ quality of life and sexual functioning. A recent study showed that innovative treatments for androgenetic alopecia can improve not only physical appearance, but also psychological well-being and sexual satisfaction (Krefft-Trzciniecka et al., 2024). This underscores the importance of a holistic approach in treating hair loss, taking into account both physical and psychological aspects.

Sources

Bater, K. L., Ishii, M., Joseph, A., Su, P., Nellis, J., & Ishii, L. E. (2016). Perception of Hair Transplant for Androgenetic Alopecia. JAMA Facial Plastic Surgery, 18(6), 413-418. https://doi.org/10.1001/jamafacial.2016.0546

Krefft-Trzciniecka, K., Cisoń, H., Pakiet, A., Nowicka, D., & Szepietowski, J. C. (2024). Enhancing Quality of Life and Sexual Functioning in Female Androgenetic Alopecia: Therapeutic Potential of Hair Follicle-Derived Stem Cells. Healthcare, 12(6), 608. https://doi.org/10.3390/healthcare12060608

Mysore, V. (2012). Finasteride and sexual side effects. Indian Dermatology Online Journal, 3(1), 62-65. https://doi.org/10.4103/2229-5178.93496