Just Do It! Sexuality and Pregnancy

by Michele Brown, OB/GYN

couple embracing pregnant bellyI get so many questions about sex from my blushing, pregnant patients that I'm addressing this slightly dicey, usually private topic and its surrounding myths.

Sex is normal, and honestly, without it, none of us would be here reading. So let's dig into sex during pregnancy, and see what's true, myth, recommended, normal, or requires further thought.

Read this and then show it to your partner. Better yet, read it together, feel sexy, stay close, and be excited about all your body's incredible changes.

Pregnancy Affects Sexuality

Most women are less sexually active in pregnancy -- reports show a decrease in desire, frequency and satisfaction. during the third trimester 90% report less intercourse, especially those having their first babies.

However, women don't report a total loss of sexual desire and satisfaction or complete avoidance of intercourse. Relationship satisfaction improves in couples excitedly anticipating and preparing for the birth of their baby. With the decline in sexual desire, some women feel an increase and desire for nonsexual physical contact.

Decreased Sexual Activity

Changes in social roles (mother role versus 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.

Transition from pre-baby lifestyle, inability to pursue personal interests, inactive social life, responsibility for a child's sleeping and feeding schedule all contribute to the stress and fatigue. For Thirty-five to 40% postpartum women, the dramatic drop in hormones causes some measure of depression. Although it may not qualify as criteria for a diagnosis of postpartum depression, it may contribute to the decrease interest in sexual activity.

Physical changes such as episiotomy discomfort, perineal pain, and hormones (which can cause a thinning of the vaginal wall mucosa) can cause physical discomfort. Breastfeeding hormones cause 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 have more sex.

Common Myths

Can intercourse during pregnancy result in miscarriage? For the normal low-risk pregnancy, sexual activity doesn't cause an increase in the miscarriage rate. The majority of first trimester losses are related to genetic defects, not to any trauma related to intercourse. Your uterus is located deep in the pelvis and your baby is amply protected by amniotic fluid.

Uterine anatomic anomalies, painful fibroids, cervical incompetence, placenta previa (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 and cause 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 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.

After Delivery

Couples can generally resume sexual activity siz 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 four months postpartum due to fatigue, episiotomy discomfort, incontinence, or 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 four weeks postpartum. By about 12 weeks postpartum, two thirds of women find sex enjoyable again although some still have difficulties.

Conclusion

Physical, chemical and hormonal changes a woman experiences during pregnancy may adversely affect sexuality for many couples. However, this is not universal and some pregnant women may be more satisfied and feel 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.

Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.

Copyright © Michele Brown. Permission to republish granted to Pregnancy.org.