Yes, I know that this topic is a bit dicey and not one often discussed in public, but I get so many blushing questions from my pregnant patients about sex and the surrounding myths, that I thought it very important to address it here. Sex is normal, and honestly without it, none of us would be reading this right now. So let’s dig in, no pun intended, and see what is true, not true, recommended, normal, or requires further analysis about sex during pregnancy. Of all the important questions that arise during pregnancy, sex is one of the most delightful to answer.
Might I suggest you read this blog and then show it to him. Better yet, read it together, feel sexy, stay close, and be excited about all the incredible changes about to happen.
Sexual activity in pregnancy generally decreases in the majority of women, although there is individual variability. Reports show a decrease in desire, frequency and satisfaction. Third trimester is the most remarkable with approximately 90% of women reporting a decrease in frequency of intercourse, especially in women having their first babies. However, women do not report a total loss of sexual desire and satisfaction or complete avoidance of intercourse. Relationship satisfaction can actually improve in couples who are extremely happy with increased emotional closeness accompanying the anticipation and preparation of the birth of a new child. With the decline in sexual desire, some women feel an increase and desire for nonsexual physical contact.
Couples can generally resume sexual activity 6 weeks after delivery. However, most postpartum women continue to experience a decline in sexual activity and desire. Reports show that 84% of women had reduced frequency of intercourse at 4 months postpartum. This can be due to fatigue, episiotomy discomfort, incontinence, and breast tenderness. In comparison, other studies have shown that 75% of women reported their sexual function to be essentially the same as before pregnancy by 4 weeks postpartum. By about 12 weeks postpartum, 2/3′s of women are finding sex enjoyable again although some still have difficulties.
Changes in social roles (mother role vs work role), marital satisfaction, fatigue, mood, physical changes associated with childbirth, and breastfeeding can all contribute to the decrease in sexual activity during pregnancy and after birth.
The sudden transition from sudden confinement from a previous active life, inability to pursue personal interests, inactive social life, and inability to deal with a child’s sleeping and feeding schedule all contribute to the stress and fatigue. Approximately 35 to 40% of all postpartum women experience some measure of depression due to the sudden dramatic drop in hormones after removal of the placenta. Although it may not qualify as criteria for a diagnosis of postpartum depression, this may also contribute to the decrease interest in sexual activity. The physical changes such as episiotomy discomfort, perineal pain, and changes in hormones which can cause a thinning of the vaginal wall mucosa can cause physical discomfort which will reduce their desire to have sex. Breastfeeding reduces prolactin concentration which reduces estrogen production causing decreases in vaginal lubrication making sex less comfortable. Also, breastfeeding has been found to provide sexual fulfillment for some women leading to decreased levels of sexual activity with their spouses.
The transition to parenthood often redefines the roles between a married couple with added and changing responsibilities. Satisfaction in the relationship directly corresponds to sexual activity — those with a higher relationship satisfaction having more frequent sexual activity.
First trimester: Couples experience different emotionality during pregnancy but literature supports a slight decline in sexual desire and satisfaction for women in the first trimester. This may be due to breast tenderness along with nausea and vomiting commonly experienced during this time. Men however, do not report the same finding. Some report no change in sexual desires, some men withdraw from sex for various fears, and loss of interest due to a woman’s body changes, and others feel heightened desire with increased emotional closeness.
Second trimester: Literature has reported increased sexual activity and desire for some women during the second trimester due to increased vascularity and blood flow to the pelvis. Feelings of large weight gain and mechanical discomfort can cause others to feel less sexual desire.
Third trimester: Sexual activity and desire is reported to markedly decline during third trimester in both men and women. This can be due to physical discomfort, feelings of loss of attractiveness, and emotional distractions in preparation for childbirth and the arrival of a new family member. There is also concerns from both partners of causing trauma to the fetus, bleeding during intercourse, rupturing membranes due to mechanical trauma, or possibly initiating labor.
- Can intercourse during pregnancy result in miscarriage?
For the normal low risk pregnancy, sexual activity does not cause an increase in the miscarriage rate. The majority of spontaneous abortions in the first trimester are related to genetic defects, not to any trauma related to intercourse. The uterus is located deep in the pelvis and the fetus is amply protected by amniotic fluid. Uterine anatomic anomalies, painful fibroids, cervical incompetence, placenta praevia (placenta lying across the cervical opening) or abruption (placental separation) may be reasons for an obstetrician to advise patients to refrain from coitus. Other reasons for avoidance may be a possibility of transmission of a sexually transmitted disease such as syphilis, herpes, listeria, condyloma, or mycoplasma in pregnant women who have new or multiple partners.
- Can oral sex cause air to get into the uterus causing an air embolism?
Maternal deaths from air embolism have occurred following forceful blowing of air into the vagina during the second and third trimester of pregnancy. Vaginal douching during pregnancy is also contraindicated due to the risk of air embolism.
- Is there an association between coitus and premature delivery, premature rupture of the membranes, or uterine infections (chorioamnionitis)?
There is generally believed to be no association between coital frequency, premature labor, and premature rupture of membranes. However, coitus can cause maternal and neonatal infections secondary to sexually transmitted diseases.
- Can maternal orgasm cause pregnancy complications?
The overall consensus is that there is no relationship between orgasm and prematurity. Transient fetal heart rate decelerations have been observed with pregnant women experiencing orgasms but no fetal compromise or hypoxia has been attributed to this.
Conclusion: Due to the physical, chemical and hormonal changes that a woman experiences during pregnancy, it is normal for sexuality to be adversely affected in many couples. However, this is not universal and some pregnant women may appear to be more satisfied and more attractive in their marital sexual relationship. Open communication between couples during this stressful time is highly important for maintaining a strong relationship. Accommodations in position during intercourse and type of sexual activity may change for a couple due to the pregnancy. Discussion with your obstetrician or specialized counselor should be sought if problems in the relationship suddenly appear or preexisting relationship issues become magnified by the pregnancy or the birth of a child.
Overall, normal sexual activity in an uncomplicated pregnancy appears to pose no risk to the pregnancy.