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Sex during and after pregnancy

Expectant women and future fathers often worry if it is safe to have sex during pregnancy and if it won’t hurt the baby. However, pregnancy need not mean sexual abstinence: neither penetration nor orgasmic contraction can harm the child.

Illustration depicting considerations and advice for sexual activity during and after pregnancy.

Pregnancy tests a couple’s level of intimacy—a pregnant women’s libido is unstable because it is affected by hormones and how she and her partner perceive the changes in her body. Understanding the physical and psychological transformations a woman experiences during childbearing can help couples overcome difficulties they may experience.

Pregnancy is not a disease, but it does cause real hormonal, physical, and psychological upheaval, which can have a significant impact on the pregnant woman and on the people around her.

The first trimester

Libido changes during pregnancy, and this is absolutely normal. A woman’s sex drive usually decreases during the first trimester due to fatigue, nausea, vomiting, and other minor problems caused by elevated oestrogen and progesterone levels. Sometimes these symptoms are associated with constipation, haemorrhoids, heartburn, or vaginal dryness.

If sexual intercourse is less frequent at this stage of pregnancy, it is usually due to a decline in female desire.

A pregnant woman will naturally become less physically available to her partner as her body undergoes many transformations under the influence of hormones. Sensations that normally feel pleasant can sometimes become unpleasant. Penetration may be painful as the vaginal walls and the position of cervix change. Some pregnant women also notice an increase in their cervical mucus.

Breasts get bigger, which often pleases the partner, but for many women they become more sensitive and may hurt. Why? An expectant mother’s hormones are working overtime to prepare her breasts for breastfeeding by stimulating the growth of milk-producing glands. This process takes place very fast and, like other rapid growth, it is associated with pain. An expectant mother’s body may feel dull and achy; her breasts may feel heavy and swollen and can be super-sensitive to the touch, especially the nipples, making sex play very uncomfortable.

As partners sometimes have trouble decoding these changes in desire, it is important to communicate and perhaps explore other types of intimacy during this time. Even if the frequency of intercourse diminishes, there is no reason to give up on pleasure. Instead, frame this period as three months of relative calm in a tender and sensual atmosphere because ignoring the needs and feelings of your partner in gloomy silence can leave lasting emotional scars.

On the other hand, not all pregnant women react in the same way to hormonal changes—higher levels of sex hormones and an increase in blood flow to the genitals can lead to heightened sexual desire. However, the most commonly reported experience is that libido decreases in the first trimester but increases in the second.

The second trimester

As her body adjusts and many of the unpleasant symptoms decrease the expectant mother begins to feel more like her energetic self. For many women, the second trimester is more comfortable physically and, as the greatest risk of miscarriage has passed, more relaxing psychologically as well.

It is important to know that having sex during pregnancy won’t cause a miscarriage. Most miscarriages occur because a fetus isn’t developing normally.

The libido is back! From the fourth month of pregnancy, many women experience a feeling of fullness where their sexual desire awakens and sometimes even feels more vivid and exciting than before they were pregnant. The body is not yet as heavy as it will be later on and tiredness is diminishing. Hyper-vascularization of the genital area is responsible for hyper-sensitization, which increases the sexual appetite. An increase in vaginal secretions, coupled with the uterus pressing on the genitals can also result in increased sexual pleasure.

It is quite normal for the breasts to “leak” during the second half of pregnancy, (although some women never experience this). Leaking cannot be controlled; it is a reflex that happens when the breasts are stimulated, when a woman feels happy and relaxed, or when she hears a baby cry. This is the colostrum, also known as pre-milk or first milk, it is a highly beneficial concentration of nutrients a mother’s body prepared for her new baby. Wearing thin breast pads inside the bra can help prevent the colostrum from soaking through and causing embarrassment.

Fetal movements at five months and possible baby activity during intercourse

At around five months, the movements of the fetus become perceptible and the baby may also move during intercourse. Expectant parents experience a wide range of reactions when this happens, but there is no reason to fear hurting the baby. The fetus is well-protected by the abdomen and the muscular walls of the uterus and is cushioned by the fluid surrounding the baby in the amniotic sac.

Unless a healthcare professional recommends otherwise, most forms of sex, including vaginal, anal, oral, and masturbation, are perfectly safe while pregnant. The contractions that happen during orgasm aren’t the same as labor contractions and cannot cause premature birth.

Sex toys—electric and/or vibrating—designed for insertion into the vagina are not recommended during pregnancy for safety reasons, but non-vibrating sex toys can be used, if the rules of hygiene and comfort are respected.

Some fathers experience the fetus as a “presence", which can feel like a problem. However, it should be clear that the future baby cannot “witness” intercourse—the fetus feels neither pleasure nor displeasure at coitus.

Attention! Pregnancy by itself does not guarantee 100% safe sex. If an expectant mother’s partner has an active or recently diagnosed sexually transmitted infection all forms of intercourse should be avoided as this can cause serious health problems for both mother and child. Condom use is mandatory if the couple is not in a mutually monogamous relationship.

The third trimester

In the third trimester of pregnancy many women face major challenges. Swelling, rapid weight gain, exhaustion, and body pain… Expectant mothers often have back pain, they move with difficulty, the belly feels heavy, and they may have gastric upset. In short, this mixture of discomforts can make sexual activity more difficult.

Discomfort or pain during sexual activity is also a fairly common concern. Trying different positions can solve this problem. Women who want to have sex but do not like certain types of sexual activity may want to consider other forms of intimacy at this time; pregnancy is a good excuse for creativity. Many couples put aside penetration in the last trimester and opt for caresses and more sensual than sexual intimacy.

Pregnant or not, it is important to remember that making love is sharing intimacy, and is meant to be a pleasure, not a duty.

By the end of the third trimester, the delivery is fast approaching. Despite advances in medicine, giving birth is still a mysterious and miraculous experience that occupies a woman’s mind, especially when she is expecting her first child. Sometimes, anxiety around giving birth doesn’t leave much room for lovemaking.

Some women fear that sex at the end of the third trimester can cause premature labour and some doctors recommend avoiding intercourse during the final weeks of pregnancy, as prostaglandins (the hormone-like substances found in sperm) can cause cervical ripening. Medications containing prostaglandins are one method healthcare professionals use to induce labor in specific cases, often in combination with the hormone oxytocin, which stimulates contractions.

Although this issue has been studied, the role of sexual intercourse in the initiation of labour is uncertain. It has not been possible to standardize these studies because of their intimate nature, which makes it difficult to get meaningful results.

As no direct link has ever been proven, most doctors believe that under normal circumstances having sex won’t trigger premature labour and cannot make the baby turn around in a womb, but can help move the process along once a woman is ready to give birth. They advise couples who wish to make love to go ahead and do so until the very day of the birth as long as there is a mutual desire and no other medical reason to be careful.

When not to have sex

Doctors will advise a pregnant woman not to have sex (or do anything that involves orgasm or sexual arousal) if she is at risk for any of the following:

  • risk of miscarriage or history of past miscarriages
  • risk of preterm labor (contractions before 37 weeks of pregnancy)
  • vaginal bleeding, discharge, or cramping without a known cause
  • a ruptured or leaking amniotic sac
  • the cervix has opened too early
  • the placenta is too low in the uterus
  • the woman is expecting twins, triplets, or other multiples
Exploring the timing of post-pregnancy sexual activity and considerations

Sex after pregnancy: how soon?

After childbirth, sex may be the last thing a new mother thinks about. A return to sexual intimacy can be delayed by fatigue and pain. A body that has just given birth needs time to recover, so resting is an absolute necessity. Many health care professionals recommend waiting to have sex until four to six weeks after delivery, regardless of delivery method. If a woman has a vaginal tear during delivery requiring surgical repair, she may need to wait a little longer.

If the allotted time has passed and desire has returned but pain persists or is aggravated after intercourse, ice wrapped in a towel applied to the genitals and/or over-the-counter pain reliever can help mitigate discomfort. 

Some preventative steps can be taken before intercourse to reduce the possibility of pain, such as emptying the bladder, taking a warm bath, or taking a painkiller.

In any case, partners do best when they communicate about what feels good and what doesn’t. You can discuss alternatives to vaginal intercourse, such as massage, oral sex, or mutual masturbation.

Women often complain that after childbirth, sex no longer gives them the same pleasure as before. This is usually because the vagina has become dry and tender due to hormonal changes, especially if a woman is breastfeeding. This is normal and, fortunately, temporary, and can be eased by the use of a lubricant.

In other cases, women may experience low libido because they are fully involved in caring for their baby. This phenomenon is also explained by the production of prolactin, the hormone of attachment, which increases just after birth while the production of estrogen decreases.

Another reason for lack of sexual desire may be a new mother’s dissatisfaction with her body and appearance, which have experienced a great deal of change during pregnancy and after delivery. If a woman doesn’t feel desirable, she is likely to avoid being sexual. It takes time to regain both physical fitness and self-confidence.

The transition to parenthood requires major adaptations and involves a set of challenges and demands that can result in parental emotional distress. This is more than just restoring sexuality in a relationship; new parents must reorganize their lives to care for the needs of the new baby. Many parents, mothers and fathers, experience mental health problems during the postpartum period. If you or your partner are experiencing mood swings, anxiety, sadness, crying, irritability, appetite, and sleep problems talk to your general practitioner, midwife, or psychotherapist. The sooner you detect postpartum depression or the so-called baby blues, the sooner you can get treatment and start to recover and feel better again. This is good for both parents and baby.

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