Intimacy during pregnancy

Numerous concerns often lead to a downturn in sexual activity when a woman is pregnant.

IT IS common for women who are pregnant for the first time, to wonder whether sexual intercourse will affect the developing foetus.

The common questions include whether sexual intercourse will harm the foetus or cause infection and whether it can lead to miscarriage or premature labour.

Another common question in the last trimester of pregnancy is what position to use and if any position is safer than others.

There are many bodily changes in pregnancy that affects a woman’s sex life.

Some women feel sexier. Others are not in the mood, especially when they have nausea and vomiting in the first trimester.

Some women report an increase in libido in the second trimester. When the third trimester comes along, many women report a decrease in libido.

The variation in feelings and experiences are normal. It is important to remember that there is no norm. The feelings and experiences may also vary in the same woman in different pregnancies.

There is an increase in the blood flow to the reproductive organs during pregnancy, causing them to engorge. This increases sensation in some women but is uncomfortable in other women, to the extent that sexual intercourse may be painful.

An orgasm can cause an increase in uterine activity with contractions felt especially in the third trimester. The contractions last a few minutes and then go away, just like the Braxton Hicks contractions.

There may also be changes in the spouse or partner. His interest may wane in the third trimester because of a variety of reasons. It may be because of concern about the health of the pregnant woman and/or fear of harming the pregnant woman and/or the foetus. There may also be anxiety about impending parenthood.

Normal pregnancy

The developing foetus lies in a fluid-filled sac within the uterus. The sac and the uterine muscles protect the foetus from harm. There is a plug of mucus in the cervix that prevents infection from ascending from the vagina into the uterus.

Orgasm may cause some uterine activity which, however, does not harm the foetus. This increased uterine activity is not the same as the contractions that one gets in early labour. So it is safe for women with a normal pregnancy to have sexual intercourse during pregnancy even right up to the time when labour starts.

There is no relationship between sexual intercourse and miscarriage and premature labour in women with a normal pregnancy. In fact, there are reports that women who had regular sex during pregnancy were less likely to go into premature labour.

Sex during pregnancy may also enhance the relationship with the spouse or partner during the pregnancy and after childbirth.

It is important to confirm with the doctor on a regular basis that there are no pregnancy problems and that the pregnancy is normal.

There are certain conditions which, if present, would result in the doctor advising to refrain from sexual intercourse.

The doctor should be consulted without delay if there is bleeding and/or pain during pregnancy, whether associated with sexual intercourse or not.

An obstetric examination and an ultrasound will usually be done to elucidate the cause of the bleeding and/or pain and reassure that the foetus is all right.

The placenta may sometimes lie on the cervix (placenta praevia). In such a situation, the doctor will advise refraining from vaginal intercourse altogether.

If there is recurrent bleeding and there is no placenta praevia, the doctor may advise a reduction in the frequency of sex. This does not mean that one cannot partake of other forms of sexual activity.

The risk of infection to the foetus is not increased if the man does not have a sexually transmitted infection. If he does, it should be treated and once cured, sexual intercourse can be resumed. However, if the man has herpes, it would be advisable to refrain from sexual intercourse. If a pregnant woman gets genital herpes for the first time, there is a small likelihood that the foetus would be infected.

The doctor would also advise the pregnant woman to refrain from sexual intercourse if there is leakage of the fluid in the sac (liquor) surrounding the foetus because of the risk of infection of the liquor and through it, the foetus, as well. If there is a history of weakness of the cervix, it would also be advisable to refrain from sexual intercourse.

As the abdomen increases in size with advancing pregnancy, the woman may be uncomfortable with the traditional man on top position. It is advisable to find alternative positions. By trying out various other positions, the couple will find one that they are both comfortable with.

It is safe to have sexual intercourse in a normal pregnancy. It is important to check with the doctor on a regular basis that there are no pregnancy problems.

The doctor may advise refraining from sexual intercourse when certain conditions are present. One would need to adapt as pregnancy advances.

■ Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.