The World Health Organization describes healthy sexuality as “a state of physical, emotional, mental, and social well-being related to sexuality” [1]. Scholars further describe sexuality as “a fundamental part…and a cornerstone in overall couple relationship,” stating that healthy sexuality during pregnancy appears to be “a key stage in the evolution of the couple towards being parents” [2,3]. If sexuality is a “cornerstone” in a couple’s relationship, it seems counterintuitive that it would be neglected as a couple prepares to become parents.
In a 1973 study, Solberg cautioned that an “absolute prohibition of sexual activity should be considered harmful to the family unit” [4 emphasis added]. The transition from married partners to parents has been described as a “potential moment of crisis” wherein the peripartum time, or time surrounding pregnancy and birth, can be a turning point for better or for worse [5]. Many couples are unprepared to face the sexual problems that arise during pregnancy party due to lack of proper information. This article seeks to leave couples better informed and more confident when it comes to peripartum sexuality.
Fearful vs Empowered
Inadequate information about sex during pregnancy and concerns about possible adverse obstetric outcomes are the most relevant factors for avoiding sexual activity [5]. Attitudes towards peripartum sexuality have long been informed by unfortunately misinformed good intentions such as not wanting to harm the fetus during intercourse, avoiding premature labor, and avoiding bleeding and infection. Here are some facts from a study in 2005 [6]
- Of expecting couples who feared engaging in sex due to fear of abnormal bleeding (57%), only 13% actually experienced abnormal bleeding.
- Of couples who reported engaging in sex during pregnancy, none experienced premature rupture of membranes i.e., breaking water, preterm labor, infection, or damage to the fetus.
- The complication rate experienced by women who had intercourse varied between only 0% (vaginal infection or UTI) and 11.6% (vaginal pain).
In general, it’s perfectly safe to have sex during pregnancy. If you have any concerns, ask your OB/GYN. Being aware of the myths regarding peripartum sex, including extremely low risks, may help expecting couples continue to nurture their sexual relationship throughout the pregnancy.
Sex During the Third Trimester
Sex can present some challenges in the first two trimesters, and these challenges usually become significant for most women in the third trimester. We discuss here the symptoms seen in the third trimester.
Hormonal changes during pregnancy include increased estrogen, progesterone, and prolactin. These hormonal changes can create unwanted symptoms like nausea, vomiting, breast tenderness, weight gain, anxiety, and fatigue, all of which can reduce sexual desire and arousal. While this generally subsides in the second trimester, it can last into the third trimester.
Women can also experience a lack of vaginal lubrication and bleeding or irritation after sex. Researchers also reported reduced or increased clitoral sensitivity, libido, and orgasm in participants in their third trimester of pregnancy [7]. For some women the growing size of their uterus feels like an obstacle. With some care and creativity, couples can use pillows to support the woman’s baby bump, try different positions such as woman on top or rear entry, or arouse each other without intercourse (touching, oral sex, or cuddling).
Sex After Delivery
Participants identified possible causes for the delay in resuming intercourse, including breast-feeding, dyspareunia (painful sex), postpartum pelvic floor dysfunction, vaginal dryness, vaginal tightness or looseness, perineal (area between the vaginal opening and the anus) pain, depression, and tiredness [8, 9]. Researchers also found that perineal tears, which may occur during delivery, increase the risk of dyspareunia, or pain during sex. Pelvic floor trauma or weakness is positively correlated with sexual difficulty, including fecal and urinary incontinence. [10] Women also reported lower libido due to diminished body image and self-perception.
So, What Can We Do?
This article has sought to describe the sexual difficulties of the peripartum experience in order to bridge the knowledge gap faced by expecting couples. As stated previously, lack of information can result in decreased sexuality between couples who are preparing to be parents, which may harm the family unit. Below are suggestions for pregnant couples desiring to engage in sex:
During pregnancy
- Don’t let myths drive the relationship. You don’t have to factor fear into your decision to engage sexually during pregnancy, and you can continue to enjoy sex to build your closeness as a couple.
- Knowing the physical and psychological changes you may see during pregnancy will help you to be better prepared and take precautions to avoid issues that may arise from vaginal dryness, nausea etc.
After pregnancy
- Practice performing pelvic floor muscle exercises to regain muscle strength. This will help to increase sexual function. [10].
- Be aware that orgasms can gradually resume within 3 months after delivery with the resumption of sexual activity. Be patient with yourself.
- Your body will likely be different after delivery. Give yourself grace as you adapt to those differences.
- Communicate with your partner. Your partner may be unaware of the difficulties you’re facing in your post-pregnancy body, including pain that may come from intercourse. As a couple. you may consider alternatives to intercourse that still cultivate closeness.
Rebekah Smith is a senior at BYU studying nursing. She loves all things women’s health and is in the process of applying to Women’s Health Nurse Practitioner and midwife programs. She has a particular interest in supporting women understand and embrace their sexual nature as an opportunity for deep personal development and true intimacy. She has travelled to Paraguay and Spain with a small research group of nursing students to provide research-based interventions to residents of rural communities and has been a facilitator for Dr. Leavitt’s course on sexual mindfulness for couples. She hopes to continue supporting women and families through such local and international interventions.
- World Health Organization. Sexual health: Working definitions. 2002. Available at: http://www.who.International/reproductive-health/gender/sexual_health.html(accessed December 15, 2009).
- Basson R. Women sexual dysfunctions: Revised and expanded definitions. CMAJ2005; 172: 1327–33
- Pastore L, Owens A, Raymond C. Postpartum sexuality concerns among first-time parents from one U.S. academic hospital. J Sex Med2007; 4: 115–23.
- Solberg DA, Butler J, Wagnes NN. Sexual behavior in pregnancy. N Eng J Med1973; 288: 1098–103.
- Serati M;Salvatore S;Siesto G;Cattoni E;Zanirato M;Khullar V;Cromi A;Ghezzi F;Bolis P; (2010, August 2). Female sexual function during pregnancy and after childbirth
- Bartellas E, Crane JMG, Daley M, Bennett KA, Hutchens D. Sexuality and sexual activity in pregnancy. BJOG2000; 107: 964–8.
- Erol B, Sanli O, Korkmaz D, Seyhan A, Akman T, Kadioglu A. A cross-sectional study of female sexual function and dysfunction during pregnancy. J Sex Med2007; 4: 1381–7.
- Barrett G, Pendry E, Peacick J, Victor C, Thakar R, Manyonda I. Women’s sexual health after childbirth. BJOG2000; 107: 186–95.
- Glazener CM. Sexual function after childbirth: Women’s experience, persistent morbidity and lack of professional recognition. BJOG1997; 194: 330–5.
- Dean N, Wilson D, Herbison P, Glazener C, Aung T, Macarthur C. Sexual function, delivery mode history, pelvic floor muscle exercises and incontinence. A cross-sectional study six-years post-partum. Aust N Z J Obstet Gyneacol2008; 48: 302–11.