Gynecological Issues and Special Concerns

Can I be sexually active during my pregnancy?

Sexual activity during pregnancy can change throughout the course of the pregnancy, and many women describe increased arousal and desire in the second trimester, especially when the morning sickness and fatigue that they have experienced early on in pregnancy have subsided.

The first phase of pregnancy is sometimes a period of adjustment accompanied by morning sickness, fatigue, and hormonal changes; many women describe feeling decreased sexual interest. Morning sickness and increased sensitivity to smells may also be issues. Sexual thoughts may return in the second trimester. And after the second trimester, as delivery approaches, many couples find sexual positioning challenging; sex may be uncomfortable for the pregnant woman and finding a sexual position that is comfortable may be difficult. Don't give up—side to side and other positions can be used safely. Also, use pillows to help get comfortable.

If you have an uncomplicated pregnancy, there is no reason not to engage in sexual intimacy with your partner.

Some couples fear that sexual intercourse can hurt the unborn baby or even cause preterm delivery, but if you have an uncomplicated pregnancy, there is no reason not to engage in sexual intimacy with your partner. Always consult your physician or obstetrician who is managing your pregnancy, and ask him or her if there are special concerns given your specific pregnancy. Some healthcare professionals advocate abstaining from receptive oral sex for the woman, especially in the last few weeks of pregnancy because cases of air embolus have been reported. But this doesn't mean you cannot be intimate with your partner.

There are many emotional and psychological changes that happen when a couple discovers that they are expecting a child: the fear of the unknown, the desire to have a healthy child, the concerns for providing for family, and the dynamics of a family rather than a couple. Sexual tension can occur throughout the pregnancy, so it is always important to talk about what you are feeling and how it affects your relationship with your partner. Even if sexual intercourse is not possible for some medical or obstetrical reason, there is no reason to stop being intimate and close.

How Mode of Delivery Affects Sexuality

A 2006 issue of the European Journal of Obstetrics and Gynecology and Reproductive Biology published the important study of Buhling, Schmidts, and colleagues on the rate of painful intercourse after delivery according to mode of delivery. More than 1,613 women who all gave birth in a tertiary referral center were mailed 16-question questionnaires concerning sexual behavior and painful intercourse. The patients were divided into four groups: (1) uncomplicated spontaneous vaginal delivery, (2) cesarean delivery, (3) episiotomy (a cut in the genital area that helps provide room for delivery) and perineal lacerations, and (4) operative vaginal delivery including vacuum and forceps. Although the response rate was only 41%, almost half of the patients (47%) reported resumption of intercourse at 8 weeks postpartum.

Forty-nine percent of women experienced significant pain on intercourse and significant persistence of pain in the operative delivery group. Although the low response rate may lead to bias, this interesting but small study does suggest some provocative conclusions, including that continued painful intercourse was minimal in those with spontaneous vaginal delivery over those with significant lacerations and vacuum and forceps deliveries. Fortunately, by 90 days post-delivery, most women reported resumption of sexual enjoyment.

Discussing sexual health concerns with your healthcare provider after delivery and in the postpartum period is essential. You should not assume that lack of interest and painful intercourse are caused solely by behavior adaptive to new parenthood. Certainly, you are fatigued, up all night feeding the newborn, and attending to his or her needs. However, there may be some physical and hormonal issues contributing to your lowered interest or lack of sexual pleasure. Breastfeeding, lactation, and mode of delivery do affect sexual functioning.

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