SEXUALITY IN PREGNANCY There are many emotional and physiological changes that happen in pregnancy, which can affect a woman’s libido, sexual responsiveness, and sexual behaviors. Sexual interest decreases in the first trimester, is variable during the second trimester, and decreases markedly during the third trimester. There are very few guidelines as to the recommendations for sex during pregnancy, which impacts the knowledge women have regarding how sex should work in pregnancy. Nearly half of all women believe that sexual intercourse is harmful to their pregnancy. The majority of women have some type of sexual dysfunction during pregnancy, which might include pain with sex, problems with libido, arousal problems, or orgasm difficulties. In theory, coitus during pregnancy can increase exposure to infections, stimulate uterine contraction, release oxytocin, and release prostaglandins in semen. Large studies, however, have not shown differences in outcome related to the frequency of intercourse among pregnant women. Despite the apparent safety, few women discuss sexuality with their doctor while they are pregnant or after the six-week postpartum visit. Studies on sexual responsiveness in pregnancy have shown an increased circulation to the pelvic structures during pregnancy, which becomes enhanced during sexual excitement. The vulva will change in color when they become engorged. Orgasms can trigger uterine contractions, which may be felt as pelvic cramping in the first trimester and as uterine contractions in the late third trimester. Pelvic congestion is not usually relieved in the resolution phase; in fact, it can take up to 45 minutes for this to occur. Women in the postpartum period often have decreased vaginal lubrication and thinner vaginal rugae. The cervix will be closed by about 4 weeks postpartum but the uterus is in the abdomen. Ovulation returns in non-nursing women by about 3 months postpartum and normalization of lubrication and the vaginal tissues. Normal sexual responses occur by the third month postpartum. Some researchers feel that intercourse can begin two weeks after delivery but most recommend waiting six weeks.
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