Pregnancy is a period of various physical and psychological changes. These changes can effect couples’ lives in several ways. This new phase, especially in women influence their physical wellbeing, mood, relationships and sexuality.
Sexual activity usually decreases throughout pregnancy, and reports suggest that the sexual interest and enjoyment in this period could even be reduced to over 50%. It has also been observed that sexual life of a pregnant couple usually experience gradual changes throughout all three trimesters.
Various factors responsible for this decreased sexual activity during pregnancy are nausea, fear of miscarriage, fear of harming the foetus, lack of interest, discomfort, physical awkwardness, and fear of membrane rupture, fear of infection or fatigue, etc.
Among all these reasons, woman’s self-perception of decreased attractiveness also affects her libido and sexual satisfaction. Usually as pregnancy advances, women feel a decrease in the achievement of orgasm and sexual satisfaction, and an increase in painful intercourse.
Pregnant women and their partners often ask whether or not sex is permitted in pregnancy? If yes, what are the consequences from engaging in sexual activity? Can having sex in the third trimester induce labour? When is it safe to have sex after delivery?
It is completely safe to have sex while being pregnant for a woman unless your doctor has advised you otherwise.
Sex does not harm the baby at any stage during a typical, uncomplicated pregnancy as the baby is protected by strong uterus muscles, amniotic fluid, and a mucus plug that develops around the cervix.
Reports show that sex drive of a woman may increase at certain stages of the pregnancy, and is often associated with various beneficial effects.
As your body goes through several changes during pregnancy, both physically and emotionally, it is common for your sexual desires to be different now that you are pregnant. Some women take more interest in sex during pregnancy, while others have less interest.
Fluctuations in hormones may cause different response in all women, as some may feel their vagina is less “tight” with increased lubrication, whereas some women may find their pelvic floor muscles too tight (as genitalia can also become more sensitive), making penetrative sex uncomfortable.
You may also experience easier orgasms
• It has been reported that some women might experience orgasms for the first time during pregnancy because of change in blood flow and hormones.
Your genitalia may feel extra wet to you
• It is common for a woman to feel extra wet because of increased secretions and more lubrication, which is mainly occurs as a preventive mechanism against bacterial infection.
Your genitalia may be a lot more sensitive
• Studies show that blood flow increases by 50% in pregnancy. This increased blood also goes to the vulva, vagina, clitoris, and pelvis, engorging the tissues.
• A woman can feel either pleasurable, irritating, or somewhere in between.
Other parts of your body may feel more sensitive
Your breast shape and size may change and increase by up to a cup size or two in preparation for milk production. These body parts may get more sensitive as well.
The key to have a pleasurable sex during pregnancy is communication. Tell your partner about your feelings; try different sex positions, especially later in pregnancy, to find one that's both comfortable and stimulating for you.
Sex during pregnancy can have some benefits for a pregnant woman and her partner that include:
Calming the baby
• It has been believed that sexual activity or orgasms produce hormones such as endorphins that can help both mother and baby feel happy and relaxed.
Improves blood flow
• Sex during pregnancy can increase cardiovascular blood flow benefitting the baby.
• Increased blood flow to the genitals can increase the number of more powerful orgasms for pregnant women.
• Sex keep both partners fit by burning calories.
Bonding between partners
• It has been observed that sex during pregnancy brings couple closer together.
A boost to the immune system
• A study showed that sex elevates the levels of IgA, an antibody that provides protection against colds and other infections.
Can different positions influence the sex of my baby?
Different sex positions can affect the gender of the baby is a common pregnancy myth. There is no evidence behind such tales, including conception position, sexual positions during pregnancy, conception date, or time.
Pregnancy is such a unique experience for all women some may feel wonderful while others feel horrible.
Fluctuating hormones can complicate sexual desire. Many women feel a decrease in interest, comfort, and desire in the third trimester as fatigue and morning sickness may pass until this stage.
Pregnancy may be a phase of psychological and sexual exploration for the pregnant person and their partner. If you does not feel sexy, try to change your perception, believe that you can be a mom, and remain a sexual being before, during, and after pregnancy.
Woman has the biggest fear of miscarriage, if she gets involved in sex during first trimester. However, the good news is sex is safe throughout all 9 months, including the first trimester in an uncomplicated pregnancy.
However, studies report that there is a higher chance of miscarriage in general during the first trimester in contrast to other trimesters.
Unfortunately, about 10 to 15 percent of pregnancies end in miscarriage, among which majority of them occurs in the first 13 weeks, however, it is mandatory to note that sex is not a cause.
About one-half of miscarriages happen due to chromosomal abnormalities. Other risk factors include maternal infections and diseases, hormone issues, uterine abnormalities, use of certain medications, lifestyle choices like smoking and drug use, reproductive disorders that interfere with fertility, like endometriosis and polycystic ovarian syndrome (PCOS).
Therefore, there is no reason to restrain yourself from sex in your first trimester.
An article published in Pulse during 2009, suggested that there is no evidence that ‘sexual intercourse causes miscarriage.
But it can be logical to advise women with threatened miscarriage to avoid intercourse until after the bleeding has completely resolved so, if miscarriage does occur, the couple does not feel that they may have triggered events.’
It has been observed that about 15 to 25 percent of pregnant women experience first trimester bleeding. There can be several causes of why you might have experienced light bleeding or spotting in the first trimester; majority of them are not associated with the physical act of having sex.
Spotting or mild bleeding in the first few weeks can be due to implantation of the fertilized egg, which is also considered as a good sign. Other reasons of heavier bleeding may include placenta previa or an ectopic pregnancy, which are unrelated to sex.
On the other hand, it is important to understand that several major changes take place in your cervix during the time of pregnancy. Pregnancy hormones may make your cervix drier than usual and can even cause the blood vessels to rupture more easily.
In certain cases, sex can cause irritation in the vagina that results in light bleeding or spotting, which can appear as pink, light red, or brown. It is considered normal and should resolve within a day or two. However, talk to your doctor if it persists longer or in case of doubt.
Sex can feel different to each woman. It can be painful throughout pregnancy, not just in the first trimester. The pain can be attributed to several processes happening in your body. Some of them are:
• Your breasts and/or nipples are sore
• Your vagina is dry because of hormonal changes
• You feel like you need to pee or have an added pressure on your bladder.
If sex is so painful, you need to talk to your doctor. Your healthcare professional can advise you various management approaches such as applying lube, change of positions, etc. A couple can explore and adapt techniques that can make sex comfortable to the pregnant woman.
You can experience mild cramping after sex during early pregnancy. This is mainly due to below mentioned reasons:
• Orgasms, which release oxytocin, and
• Semen, which contains prostaglandins,
Both of these cause uterine contractions that lead to mild cramping for a few hours after sex. This is completely normal as long as the cramps are mild and resolve shortly after sex. If they are continued for a longer duration, inform your doctor immediately.
A doctor may recommend you to refrain from having sex, if you have the following conditions:
History of miscarriage
The American College of Obstetricians and Gynecologists defines repeated miscarriage as having had two or more pregnancy losses. Data suggests that about 1 percent of women have repeated miscarriage, and in maximum cases, the cause is unknown.
Although, sex itself does not cause miscarriage, your doctor may ask you to take extra precautions in high-risk pregnancies against uterine contractions.
If you are expecting twins or pregnant with more than one baby, your doctor may put you on pelvic rest to help you go as close to full term as possible.
However, pelvic rest is not similar to bed rest. It may or may not include restraints on having orgasms, hence, make sure that you understand your doctor’s instructions accurately.
An “incompetent” cervix means the cervix has opened too early during pregnancy.
Your cervix will begin to thin and soften right before you go into labor, so you can deliver your baby. However, if the cervix opens too soon, it results in miscarriage and premature delivery.
Preterm labor starts between the 20th and 37th weeks of your pregnancy. If you are showing signs of early labor (before week 37) like contractions, backache, and vaginal discharge, your doctor may instruct you to avoid activities that could advance you into labor.
A study published in American Journal of Obstetrics and Gynecology, 1993 concluded that frequent sexual intercourse by itself is not related to an increased risk of preterm birth. Nevertheless, women who are colonized with specific microorganisms and who engage in frequent intercourse are at increased risk of preterm delivery.
The placenta is normally forms on the top or side of the uterus, but when it forms underneath placing it directly over the cervix forms a condition called placenta previa.
• If you are experiencing unusual discharge from the vagina
• If you have a dilated cervix
• If you are experiencing pain in abdominal area
• If you are feeling pain while urinating
• If you have leakage of amniotic fluid
• If you ever had to undergo medical treatment for vaginal or reproductory issues such as pelvic inflammatory disease
• If your waters have broken which can increase the risk of infection.
Sex during pregnancy, particularly in the third trimester, may cause some cramps or contractions right after sex and during orgasm.
Your orgasm releases a hormone called as oxytocin, which can cause your uterus to contract while male semen contains prostaglandins that also lead to uterine contractions. In addition, prostaglandins also leads to cervical ripening which can help in the induction of labor.
Contractions from sex usually resolve over 1 to 2 hours. If they continue or become stronger, talk to your doctor.
If you are unsure about your partner's sexual history, please use condoms. Pregnancy does not protect against sexually transmitted infections including HIV, herpes, genital warts, or chlamydia. These infections can negatively affect your baby.
Similar to these observations, a study published in American Journal of Obstetrics and Gynecology, 2014 revealed that sexually transmitted infections and urinary tract infections are common among who have frequent intercourse during pregnancy and, thus, pregnant women should be encouraged to use safe sex practices.
Oral sex is safe to continue throughout all trimester of pregnancy. However, your partner should avoid blowing air into your vagina as this can cause a risk of an air embolism, in which an air bubble can block a blood vessel. An air embolism is a rare but a life-threatening complication for both the woman and the baby.
On the other hand, anal sex will not harm the baby, but can be uncomfortable if a person is suffering from pregnancy-related hemorrhoids. Furthermore, you should avoid anal sex followed by vaginal sex, as it can lead to spread of bacteria from the rectum to the vagina resulting in infection.
The standard recommendation of having sex after baby is about six weeks. Women with fewer complications can start having sex again even before that, as long as tearing or infection is not present.
Always check with your healthcare provider to find out more information.
Other reasons for decreased desire for sex after the birth of the baby are:
• Healing from an episiotomy (incision during vaginal delivery)
• Healing from abdominal incisions after cesarean birth
• Normal postpartum bleeding which usually occurs for four to six weeks after birth
• Fatigue after pregnancy and birth
• Fluctuating hormone levels
• Sore breasts from breastfeeding
• Demands of your newborn, which gets increased if you had twins or triplets
• Emotional issues, such as postpartum blues, anxiety over parenting, etc.
In majority cases, having sex during pregnancy is not a threat to either you or your unborn baby. However, if you have a pregnancy-related medical condition, always consult your doctor exactly what sexual activities are allowed.
Moreover, it is essential to attain a positive outlook towards sex in pregnancy. Being pregnant and being sexy are not mutually exclusive.
Everything in your relationship and body changes during pregnancy and the only constant remains throughout pregnancy and a relationship is change. Therefore, in order to keep your sexual life fulfilling, be flexible to experiment and explore different things together with your partner at each stage of pregnancy.
Jones C, Chan C, Farine D. Sex in pregnancy. CMAJ. 2011;183(7):815-818.
Kontoyannis M, Katsetos C, Panagopoulos P. Sexual intercourse during pregnancy. Health Science Journal. Available at: http://www.hsj.gr/medicine/sexual-intercourse-during-pregnancy.pdf
Pauleta JR, Pereira NM, Graça LM. Sexuality During Pregnancy. The Journal of Sexual Medicine. 2010;7(1):P136-142.
Purisch S, Brandt J, Srinivas S, Bastek J. Is frequency of sexual intercourse during pregnancy associated with preterm birth? American Journal of Obstetrics & Gynecology. 2014. Available at: https://www.ajog.org/article/S0002-9378(13)01927-3/fulltext
Pregnancy. Journal of Midwifrey & Women’s Health. 2017;62(5):645-646.
Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.12677
Moscrop A. Can sex during pregnancy cause a miscarriage? A concise history of not knowing. British Journal of General Practice 2012; 62 (597): e308-e310.
What to know about sex during pregnancy. Available at: https://www.medicalnewstoday.com/articles/321648
Sex During and After Pregnancy. Available at: https://www.webmd.com/baby/guide/sex-and-pregnancy#2