Sex during pregnancy

PART 1: SEX DURING PREGNANCY 

You'd better lock the door and draw the curtains before you read this! Sex during pregnancy is one of the last taboos. Should you, or shouldn't you?  In this first article of a two-part series, Dr Rachel Jones explains the facts. 

The subject of sex in pregnancy has yet to make it into the top 10 of polite dinner party conversation, and can make some of us a little hot under the collar. Unfortunately, society has imposed many rules and regulations on how women should behave and feel regarding sex during pregnancy.

During the Victorian era, sex and pregnancy were considered mutually exclusive. After immaculate conceptions or sex for the purpose of procreation, women were hidden behind closed doors for the duration of their "confinement" away from prying male eyes.

The "swinging 60s" liberated sex to a recreational activity, while celebrating the sexy "Earth Mother" and her pregnant beauty. Later decades saw the evolution of the career woman with her unenviable task of juggling several roles, and sex (pregnant or not) was way down a long list of priorities.

Slowly the taboos that surround sex for fun in pregnancy are breaking down and becoming mainstream, largely due to the internet and its corridors of information.

So what are the dos and don'ts, and the psychology behind it all? For most women, sex and orgasm are safe throughout pregnancy, but some exceptions do apply:

🍂 A history of early miscarriage (best not to have intercourse in the first trimester)

🍂 Unexplained vaginal bleeding

🍂 Placenta Previa (where placenta lies very near, or over, the cervix and sex can trigger serious bleeding)

🍂 Incompetent cervix

🍂 High risk for preterm labour; for example, some twin pregnancies (where it can be advisable to abstain in the last 8-12 weeks)

🍂 Ruptured membranes (intercourse may cause infection)

If your pregnancy falls into any of the above categories, do pluck up the courage to discuss the situation with your LMC.

Pregnancy is a rollercoaster ride. Each trimester brings new physical, hormonal, and psychological changes. Some women say that their sex lives improve while pregnant, and even experience orgasm for the first time. Others who enjoyed sex before getting pregnant find that they are no longer interested. During the first three months, many women suffer from morning sickness and exhaustion, which sometimes lasts all day, and even if you do feel better by the evening, it's fairly difficult to feel erotic after your head has been stuck down a toilet for several hours.

Breast soreness due to hormonal changes is another physical issue at this stage, and when sexually aroused, your breasts can swell to up to 25%, making them even more tender. Much later on in pregnancy, direct stimulation may trigger your breasts to leak colostrum (a milky discharge), and this can be a little disconcerting until you both get used to it.

Other women don't seem that physically affected by pregnancy in the first few weeks, and report a much improved and relaxed love life, as they are now free from the binds of contraception and the worry of falling pregnant. It's also a common time for couples to feel anxious about miscarriage, and this can have a negative effect on sexual performance. Fortunately, there is no evidence to suggest that sex can cause a miscarriage in normal low-risk pregnancies.

In fact, throughout pregnancy, many so-called psychosexual worries surface in the minds of both Mum and Dad. There may be confusion with the duality of the parent/lover role, anxiety about harming the baby, hang-ups regarding your changing size and shape, and your partner may subconsciously feel jealous of your preoccupation with baby.

The second trimester is when most couples seem to enjoy sex the most. An increase in pelvic blood flow, vaginal lubrication, and breast size can increase pleasure for both of you. However, some sexual positions can become a little tricky as the months pass, so adaptation and inventiveness is vital. The "missionary" position (partner on top) is suitable until around your fourth month, but becomes logistically difficult after this time. Direct weight on your baby is not a great idea and lying flat on your back is not advised as pressure from the uterus can restrict blood flow back to the heart, causing you to faint. "Spooning" (side-lying position with your back to your partner or on your side facing your partner) can be a useful alternative to relieve stress on your pregnant body. Remember to lie on your left side as this helps blood circulate back to your heart better. "Doggy style" (man enters from behind with women kneeling on all fours) is a great position when deeper penetration is needed and again prevents unwanted weight on the uterus.

Sitting positions are helpful in the third trimester if indigestion and heartburn occur when you lay down. At this stage, the baby's head can be deep in your pelvis making things quite uncomfortable and this technique allows you to control the depth of penetration. Oral sex is fine at any stage, but never let your partner blow air into your vagina as this can cause an embolism (air bubble) inside the blood vessels of that area which can be life threatening to mother and baby.

Remember that when pregnant you are still able to contract sexually transmitted diseases such as HIV, genital herpes, chlamydia, and gonorrhoea. These diseases can cause infection, early labour or even fatality to the baby. If you think you may be at risk, use a condom.

There are many myths about masturbation, but there's no reason why you can't during pregnancy. But it is not uncommon for one or both partners to go off sex completely. Remember, there are many ways of being intimate, so see this as a chance to rekindle some good old-fashioned romance.

You may have heard a few old wives' tales about intercourse inducing labour. There is some science behind it: Semen contains prostaglandins, which soften the cervix, and sex can trigger the release of oxytocin, which causes the uterus to contract. However, nothing will happen until conditions are ripe and other hormonal and physical factors are at play.

When the third trimester passes and labour starts, some women undergo the most intense sexual experience of their life. The sexuality of birth is still a taboo subject, made more so by the modern-day depersonalisation of labour and expectations on how a pregnant woman should behave in the labour room. The sensations arising during this time are not about sexual titillation, but birth can be a uniquely sensual experience. For the first time ever, a woman may be completely in tune with her body and its rhythms. Awareness develops of the body's limitations and of its great potential. As women, we have the power and privilege of nurturing the miracle of a new life.

Sex, birth, and motherhood are not mutually exclusive experiences, but are a continuation of who we are as women. What we learn from each of these aspects of our lives deepens an understanding of our own unique sexual identity and our role in the world. 

Find Part 2 here! 

Dr Rachel Jones is a family doctor, and currently a full-time at-home mum to her three dynamic daughters. She is passionate about health issues involving women and their children. Rachel is now exploring the more creative side of medicine with freelance medical writing.