Sex During Pregnancy

George Macones

If you're pregnant or even planning a pregnancy, you've probably found an abundance of information about sex before pregnancy (that is, having sex in order to conceive) and sex after childbirth (general consensus: expect a less active sex life when there's a newborn in the house).
But there's less talk about the topic of sex during pregnancy, perhaps because of our culture's tendency to dissociate expectant mothers from sexuality. Like many parents-to-be, you may have questions about the safety of sex and what's normal for most couples.
Well, what's normal tends to vary widely, but you can count on the fact that there will be changes in your sex life. Open communication will be the key to a satisfying and safe sexual relationship during pregnancy.

Is It Safe to Have Sex During Pregnancy?
If you're having a normal pregnancy, sex is considered safe during all stages of the pregnancy. So what's a "normal pregnancy"? It's one that's considered low-risk for complications such as miscarriage or pre-term labor. Talk to your doctor, nurse-midwife, or other pregnancy health care provider if you're uncertain about whether you fall into this category. (The next section of this article may help, too.)
Of course, just because sex is safe during pregnancy doesn't mean you'll necessarily want to have it! Many expectant mothers find that their desire for sex fluctuates during certain stages in the pregnancy. Also, many women find that sex becomes uncomfortable as their bodies get larger.
You and your partner need to keep the lines of communication open regarding your sexual relationship. Talk about other ways to satisfy your need for intimacy, such as kissing, caressing, and holding each other. You also may need to experiment with other positions for sex to find those that are the most comfortable.
Many women find that they lose their desire and motivation for sex late in the pregnancy - not only because of their size but also because they're preoccupied with the impending delivery and the excitement of becoming a new parent.

When It's Not Safe
There are two types of sexual behavior that aren't safe for any pregnant woman:

• If you engage in oral sex, your partner should not blow air into your vagina. Blowing air can cause an air embolism (a blockage of a blood vessel by an air bubble), which can be potentially fatal for mother and child.
• You should not have sex with a partner whose sexual history is unknown to you or who may have a sexually transmitted disease, such as herpes, genital warts, chlamydia, or HIV. If you become infected, the disease may be transmitted to your baby, with potentially dangerous consequences.
  

If your doctor, nurse-midwife, or other pregnancy health care provider anticipates or detects certain significant complications with your pregnancy, he or she is likely to advise against sexual intercourse. The most common risk factors include:

• a history or threat of miscarriage
• a history of pre-term labor (you've previously delivered a baby before 37 weeks) or signs indicating the risk of pre-term labor (such as premature uterine contractions)
• unexplained vaginal bleeding, discharge, or cramping
• leakage of amniotic fluid (the fluid that surrounds the baby)
• placenta previa, a condition in which the placenta (the blood-rich structure that nourishes the baby) is situated down so low that it covers the cervix (the opening of the uterus)
• incompetent cervix, a condition in which the cervix is weakened and dilates (opens) prematurely, raising the risk for miscarriage or premature delivery
• multiple fetuses (you're having twins, triplets, etc.)
  

Common Questions and Concerns
The following are some of the most frequently asked questions about sex during pregnancy.

Can sex harm my baby?
No, not directly. Your baby is fully protected by the amniotic sac (a thin-walled bag that holds the fetus and surrounding fluid) and the strong muscles of the uterus. There's also a thick mucus plug that seals the cervix and helps guard against infection. The penis does not come into contact with the fetus during sex.

Can intercourse or orgasm cause miscarriage or contractions?
In cases of normal, low-risk pregnancies, the answer is no. The contractions that you may feel during and just after orgasm are entirely different from the contractions associated with labor. However, you should check with your health care provider to make sure that your pregnancy falls into the low-risk category. Some doctors recommend that all women stop having sex during the final weeks of pregnancy, just as a safety precaution, because semen contains a chemical that may actually stimulate contractions. Check with your health care provider to see what he or she thinks is best.

Is it normal for my sex drive to increase or decrease during pregnancy?
Actually, both of these possibilities are normal (and so is everything in between). Many pregnant women find that symptoms such as fatigue, nausea, breast tenderness, and the increased need to urinate make sex too bothersome, especially during the first trimester. Generally, fatigue and nausea subside during the second trimester, and some women find that their desire for sex increases. Also, some women find that freedom from worries about contraception, combined with a renewed sense of closeness with their partner, makes sex more fulfilling. Desire generally subsides again during the third trimester as the uterus grows even larger and the reality of what's about to happen sets in.
Your partner's desire for sex is likely to increase or decrease as well. Some men feel even closer to their pregnant partner and enjoy the changes in their bodies. Others may experience decreased desire because of anxiety about the burdens of parenthood, or because of concerns about the health of both the mother and their unborn child.
Your partner may have trouble reconciling your identity as a sexual partner with your new (and increasingly visible) identity as an expectant mother. Again, remember that communication with your partner can be a great help in dealing with these issues.

When to Call Your Doctor
Call your health care provider if you're unsure whether sex is safe for you. Also, call if you notice any unusual symptoms after intercourse, such as pain, bleeding, or discharge, or if you experience contractions that seem to continue after sex.
Remember, "normal" is a relative term when it comes to sex during pregnancy. You and your partner need to discuss what feels right for both of you.
(AAFP)