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Sexuality in Pregnancy

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.

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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.

The third trimester is when coital activity is at its least level. It declines throughout the third trimester so that only 17 percent of women have sex just prior to deliver. Interestingly, 10 percent of women will not have sex at all once they learn they are pregnant.

The incidence of the man on top missionary position decreases with pregnancy advancement, with more couples using the woman on top or side-by-side positions. Some will use a rear-entry position. Most women still prefer genital-to-genital contact, while lesser numbers engage in oral sex, masturbation, or anal sex. Mutual masturbation is increasingly practiced in pregnancy. The actual sexual practices are culturally influenced. The rate of domestic violence increases in pregnancy, particularly in lesbian relationships.

Some of the factors that influence a woman’s sexual activity in the first trimester include physical problems, such as fatigue and nausea. More than half fear injury to the fetus and about 28 percent report a decrease in sexual satisfaction. There is also a decrease in clitoral sensitivity and orgasmic dysfunction in the first trimester. Libido also decreases.

Many women in the second trimester will have improvement in their libido and increased eroticism. There is increased vaginal lubrication and vulvar engorgement, both of which favor an orgasm. The actual coital frequency will, however, vary from person to person. The presence of fetal movements can change the quality of sexual intercourse and intercourse positioning.

All of the features that increase sexuality in the second trimester will decrease in the third trimester. The patient will be more uncomfortable and will have decreased clitoral sensitivity, decreased libido, and decreased ability to have an orgasm. Some will have increased pain with genital contact. Engagement of the head can cause the cervix to contact the penis, which can lead to vaginal spotting.

After delivery, up to 17 percent will reinitiate vaginal intercourse before six weeks postpartum, while most resume it at six weeks following the delivery. Even after a year, however, some women will not have resumed sexual activity. The presence of lacerations, decrease lubrication, and postpartum mood changes may affect sexual

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