Sex during and after pregnancy

NATURALLY, a pregnant woman and her partner want to do everything to ensure the safety of their unborn child, and for some couples this includes foregoing sexual intercourse out of fear it could somehow compromise the pregnancy.

But Dr Keisha Buchanan, obstetrician-gynaecologist at ICON Medical Centre, says that sex during pregnancy is generally safe. Nevertheless, for some pregnancies women may be asked to abstain from sex or are given a list of restrictions.

“There are several myths about having sex while pregnant, including that sex can harm the baby. This is not true, as the baby is well protected by the closed cervix, cervical mucus, the amniotic sac and membranes. Another myth is that sex makes the vaginal passage open, making it easier for the cervix to dilate in labour. This is far from the truth, because the size of the passage is determined by the bones of the pelvis, and sex will not dilate the passage,” Dr Buchanan explained.

She said that another falsehood that casts a grey shadow on sex during pregnancy is the idea that sex will damage the pregnant woman, and the same is true for the suggestion that sex can trigger labour. The doctor underscored that while sex can trigger an orgasm and uterine contractions, it will not induce labour.

What is true, however, is that there are physical changes that may cause the woman to lose interest in sex or may make it less pleasurable for her. However, there are a number of adjustments that can be made to change these experiences.

“Sexual desire during pregnancy may vary. Some women find their sexual desire, sexual stimulation and orgasms to be enhanced during pregnancy, but for some it is the opposite – they have absolutely no desire for sex. For some women, the sexual experience may vary based on the trimester,” Dr Buchanan said.

She pointed out that factors such as nausea, vomiting and fatigue in the first trimester may decrease the desire for sex, while later in the pregnancy the discomfort associated with the growing abdomen, swollen feet, leg cramps and vigorous foetal movements can dampen sexual desire.

“Additionally, some women feel self-conscious due to the rapid changes in their bodies and may not want to have sex, but this is not necessary as many men find pregnant women to be attractive, and factors such as more sensitive nipples, the fact that the vagina is more engorged which makes it more moist and sensitive, help to enhance sexual pleasure for many women,” Dr Buchanan said.

To make sex as exciting, pleasurable and as safe as possible, Dr Buchanan said that couples should explore a number of adjustments:

• Try different positions. A good one is a side-by-side position (with the woman lying on her left side) during sex or the woman being on top. Dr Buchanan explained that lying on the right side or the back too long during sex can cause Supine Hypotension Syndrome. This syndrome is marked by dizziness, cold sweats, and fainting due to compression of the large blood vessel by the womb supplying the brain.

• Note that oral sex is also safe in pregnancy, but the spouse should not blow into the vagina as this can trigger air embolisms that can be deadly.

• The use of a condom is encouraged in order to provide protection from STIs, and having sex with one partner in a mutually monogamous relationship is best to prevent STIs. Dr Buchanan says STIs such as gonorrhoea, chlamydia and trichomoniasis can increase the risk of premature rupture of the amniotic membrane, premature labour and delivery, and subsequent associated foetal and maternal morbidity and an increased risk of foetal mortality.

But sometimes no amount of adjustments can make sex safe enough in the case of some pregnancies, Dr Buchanan warned.

“There are some situations in which a couple should not have sex in pregnancy. These include in the presence of vaginal bleeding such as due to a threatened miscarriage, prematurely dilating cervix (cervical insufficiency), in the presence of a placenta that is low-lying in the womb, if the woman is at high risk of premature labour or has had premature contractions that have resolved or in the presence of prematurely ruptured membranes.”

Also, if you are expecting twins, triplets and other multiple pregnancies, Dr Buchanan said that abstaining from sex may also be best since there is an increased risk of premature labour in these cases. She recommends instead that couples should still remain intimate by kissing, rubbing and massaging each other’s bodies, and engage in regular cuddling.

And just as with sex during pregnancy, couples should be equally careful about sex post-delivery. She encouraged couples to wait at least six weeks after birth before having sex.

“After vaginal delivery, especially if the woman sustained tears or had an episiotomy, allow time for these to heal. Sex prior to healing can cause pain and may irritate these cuts, leading to wound infection. After a Caesarian section, a similar healing period of six weeks (or longer) is encouraged for healing, as sex can trigger pelvic discomfort,” Dr Buchanan advised.