Pregnancy and Sex
From Encyclopedia of Sex and Sexuality
Sexual intercourse is the primary road to pregnancy, but once there, couples find there is little discussion of sex during pregnancy in the public or scientific media. While no two couples react in the same way, most note a change in their sexual activity during pregnancy. In general a decrease in frequency of intercourse is reported. Pregnancy is a time of many dramatic changes—in hormone level, appearance, and mood—all of which can affect one’s sexual feelings or libido.
There are many important changes in a woman’s physiology that may influence her sexual activity. Early in pregnancy, she may experience nausea, breast tenderness, and fatigue. There is an increased blood flow through many parts of the woman’s body due to hormonal changes. Breasts are vascular tissues and become engorged and tender, making breast stimulation more painful. The increased flow in the pelvic area, especially the vagina and outer genitalia, may lead to a swollen and uncomfortable state. There is also an increase in vaginal secretions. These secretions improve vaginal lubrication, but they also may have odors that may make oral sex unpleasant for the partner. Many women find that as the uterus increases in size as pregnancy progresses, sex in the usual position becomes uncomfortable.
The frequency of intercourse during pregnancy varies from one couple to another. Patterns of sex during pregnancy have been reported differently by several studies. One study showed a steady decline in sex throughout pregnancy. Another showed an increase in sex during the first two trimesters and a decrease in the last trimester. Yet another study showed a decrease of sexual interest during the first trimester, followed by an increase of interest in the second trimester and a decrease in the last trimester. However, nearly all studies agree that there is a decrease in coital frequency during the last months of pregnancy.
Many couples fear that they may harm the fetus or cause a miscarriage by making love during pregnancy. Late in the pregnancy there may be fear of delivering prematurely or of breaking the amniotic sac.
Doctors advise women to abstain from sex early in pregnancy, if they experience vaginal spotting or bleeding. However, most miscarriages occur not because of sex, but because there is something wrong with the fetus. No study has shown conclusively that sex early in pregnancy contributes to miscarriage.
Most doctors agree that vaginal intercourse in the latter part of pregnancy in low-risk women does not seem to lead to any significant problems. Intercourse should be avoided, however, in the latter part of pregnancy by women with poor reproductive histories, such as those who have experienced placenta previa, prior premature deliveries, premature ripening of the cervix, ruptured fetal membranes, and those women who have experienced contractions. There is a strong feeling that women should not have any objects placed inside the vagina during pregnancy for fear of injuring the vagina, cervix, or fetus.
Little information is available about anal intercourse during pregnancy. Some studies, however, have suggested that rectal examinations during pregnancy may lead to an increased transmission of potentially harmful organisms from the rectum to the vagina, and this can, theoretically, lead to an amniotic fluid infection. The same would be true of anal intercourse.
Oral sex during pregnancy is safe as long as no air is blown into the vagina. Forceful blowing into the vagina during oral sex has been proven harmful to the mother. It may lead to forced air entry into the mother’s vaginal blood vessels, which are dilated during pregnancy.
Orgasm during pregnancy may lead to contractions of the uterus. These contractions may be stronger with masturbation than with vaginal intercourse and are sometimes felt very strongly. Most physicians are not concerned about these contractions, unless they last for longer than thirty minutes. Women at risk for premature delivery should discuss this with their practitioner.
Nipple stimulation during pregnancy may release a hormone called oxytocin. This hormone is known to lead to uterine contractions, sometimes leading to hyperstimulation of the uterus and fetal heart rate abnormalities. Some studies have shown that nipple stimulation can be used to induce labor. Most physicians therefore suggest that the nipples should not be rubbed or stimulated during pregnancy.
To avoid infections to the fetus during pregnancy, as well as exposure to potentially harmful prostaglandins (hormone-like substances that can cause uterine contractions) in the semen, some physicians advise the use of condoms during intercourse in pregnancy.
The weeks after birth are a very sensitive time for women. Doctors usually advise against vaginal intercourse for several weeks. The cervix remains open for several weeks after either vaginal delivery or cesarean section, and this open cervix may increase the chance of infection from the vagina into the uterus. If there was a vaginal delivery, a cut may have been made in the area between the vagina and the rectum (episiotomy) to facilitate delivery. The episiotomy is usually sewn up right after birth, and it requires many weeks for healing. Vaginal or anal intercourse during the postpartum period may injure the episiotomy site and tear the sutures.
