Let’s Talk about Sex {While Pregnant}, Baby!

As an OB/GYN and high risk pregnancy specialist, there is one topic that my pregnant patients rarely ever discuss with me. It is a topic that I am sure every woman thinks about during pregnancy.

Sex!

I don’t blame them, though. During a routine prenatal visit so many other things are being discussed that I am sure talking or asking questions about sex might feel not only awkward, but maybe even a little inappropriate. So many women go to Dr. Google to get those burning questions answered. I have seen what information is available on the internet regarding sex and pregnancy, and to be quite honest, it is oftentimes inaccurate.

I am going to break a few things down for those interested in an effort to give accurate and medically sound information on having sex while pregnant.

Pregnancy can affect a woman’s desire for sex :: both negatively and positively

Because of the hormonal fluctuations and physical changes a woman experiences during pregnancy, sexual desire can be significantly affected. Many women say their sex drive is low or even nonexistent, whereas others may have increased sexual desire. Every woman is different.

The first trimester can have the most dramatic effect on sexual desire due to nausea, fatigue, and those early body changes like breast enlargement and tenderness and lower abdominal cramping and fullness. In addition, although sex does not cause miscarriage, many women still worry about early miscarriage and are hesitant to have sex due to fear of harming the pregnancy in those first few months. For many reasons, the first trimester is not the best time in a woman’s pregnancy for sexual intimacy.

When the second trimester rolls around, many women start to feel better physically and emotionally and sex is back on the table. Sex can still be comfortable because the baby bump isn’t too large yet, and the increased blood flow to sexual organs can assist in the return of sexual desire as well as increase pleasure by augmenting a woman’s ability to orgasm. The second trimester is also a time when women really start to bond with their partners and are happy and excited about the pregnancy thus making intimacy more enjoyable. The third trimester typically mimics the first in terms of decreased desire due to the growing baby bump, mental preoccupation and preparation for delivery, general discomfort and planning for life after baby.

Throughout pregnancy, the lines of communication should ideally remain open between a woman and her partner. Having conversations about your needs and other ways to satisfy them if sexual intimacy is not an option is necessary. More often than not, though, partners or significant others may also be experiencing low or mismatched sexual desire as well. An open dialogue will ensure that both parties know where the other stands and can bring the couple even closer during this time.

Not wanting to have sex at all during pregnancy is normal, too. Fortunately, there are other ways to share intimacy and a couple can still remain close. Again, talk with your partner and let them know how you are feeling and what you need or want.

Sex can be physically uncomfortable 

Let’s just put this out there…Sex can hurt, especially in the third trimester.

The baby bump is large and in charge, weight gain is hitting an all-time high, and having sex quickly takes a back seat to nesting, setting up the nursery, cat napping and just simply surviving. The normal physical and physiological changes a woman’s body experiences during pregnancy often causes back pain, pelvic discomfort, and increased urination and vaginal discharge, especially in the latter stages of pregnancy. Such changes can make intercourse more uncomfortable or unpleasant. The increased blood flow to the pelvic area and genitals can also cause engorgement, swelling and even varicose veins of the labia making intercourse painful. Although an increase in vaginal discharge may aid in lubrication during sex, some women find it to be a turn off or even embarrassing during those intimate moments.

It is very common for women to experience contractions or cramping during or after sex, after orgasm or with nipple stimulation. The female orgasm and nipple stimulation {through the release of oxytocin} can elicit contractions of the pelvic muscles and uterus, and male semen contains prostaglandins, which can make the uterine muscle contract. In fact, prostaglandins can be used to induce labor. Finally, while a woman’s breasts may be more attractive to her partner due to their increasing size and fullness, they can be quite painful, sore, and sensitive to touch. Some women may even express milk from their breasts during sex when being touched or after orgasm.

I generally tell women that if it hurts or is not pleasurable, don’t do it. Tell your partner if something doesn’t feel right. There are other ways to share sexual intimacy besides intercourse and there are other sex positions that may be more comfortable for both you and your partner. While it may be difficult for either party to refrain from actual intercourse altogether, pregnancy doesn’t last forever and things can get back to normal with time.

In an otherwise normal, low-risk pregnancy, sex will not harm the baby or cause miscarriage or preterm labor

It is very important for both women AND men to know that a penis CANNOT directly reach a baby inside the uterus. Thankfully, the uterus is well protected!

There is a wall of muscles and connective tissue called the pelvic floor that supports the uterus, bladder and vagina. The pelvic floor muscles and the thick muscle of the uterus itself help to protect the pregnancy during intercourse. In addition, the cervix not only acts as a physical barrier of sorts, but the canal of the cervix becomes filled with mucus {i.e. the mucus plug} which serves as an additional barrier to infection. Finally, the uterus is composed of smooth muscle and is designed to contract {like any other muscle in the body} without causing pregnancy loss or preterm labor. The contractions that a woman may experience with orgasm, nipple stimulation or sex are similar to the Braxton-Hicks or “practice” contractions a woman has during pregnancy. As long as the contractions are not painful, do not last more than an hour or two after sex, and are not in a regular pattern {every 5-10 minutes for 2 hours}, they are very unlikely to cause any pregnancy complications.

Despite these reassurances, many women are still very hesitant to have sex in the first trimester, especially those women who have suffered pregnancy loss. While sex does not cause miscarriage, and most early miscarriages are due to chromosomal defects and not anything a woman did or did not do, I understand when women are especially concerned in the first trimester. In fact, a woman who has gone through fertility treatments may be told to be on pelvic rest in the first trimester, mainly for her own piece of mind. Overall, I feel a woman’s mental well-being and complete comfort with having sex in the first trimester are more important that my trying to remind her that the physical act of sex does not cause a miscarriage.

It is best to keep in mind that the vaginal vault and labia have significantly more blood flow during pregnancy and can become engorged, as mentioned above. If aggressive or rough sex acts are attempted and a woman is not used to such activities, there is a risk of suffering a tear of the vaginal vault or labia. The cervix can also become friable or fragile during pregnancy and may bleed a little after intercourse because the vessels of the cervix become engorged much like the vaginal vault and labia.

If bleeding occurs during sex a woman may not know if the bleeding from the pregnancy or not. It is best to stop and call the doctor’s office if the bleeding is limited to spotting or go to the emergency room if bleeding is heavier than spotting or like a period.

There are situations where sex during pregnancy is NOT recommended

The list below includes some common reasons why your obstetrical care provider may recommend that you NOT have sex during pregnancy ::

• First trimester bleeding, which is referred to as a “threatened miscarriage” or any other significant bleeding during pregnancy
• Significant varicose veins of the labia {they can bleed during sex}
• Preterm premature rupture of membranes {rupture of the amniotic sac with leakage of fluid before 37 weeks of pregnancy without the onset of  labor}
• Incompetent cervix {the cervix is dilated early in pregnancy}, short cervix {the cervical length is shorter than normal} or placement of a cervical cerclage {a stitch surgically placed in the cervix}
• Preterm labor with or without cervical dilation in the current pregnancy
• Placenta previa {the placenta covers or lies very close to the opening of the cervix} or vasa previa {the umbilical cord lies over the opening of the cervix}
• Multiple gestation

A general rule of thumb for sex during pregnancy is the following :: The sexual acts you were comfortable with and used to before pregnancy can typically be continued during pregnancy. However, if you contract painfully and/or regularly, have bleeding more than spotting or are concerned for any other reason during or after sex, it is best to contact your obstetrical care provider.

If you have any questions about sex during pregnancy, ask! I can say with certainty that as women’s healthcare providers, we have heard it all and nothing you can say or ask should make you feel embarrassed or awkward. Having your partner with you while having this discussion is recommended as well.

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