Female Sexual Function During Pregnancy and Postpartum
February 1, 2012 – The Journal of Sexual Medicine
The article by L Millheiser (Feb 1, 2012) addresses the key issues encompassing normal sexual functioning in the ante- and post-partum. Pregnancy is an important life-stage associated with many perceived changes and concerns of sexual intimacy in expectant mothers. Often times, their sexual difficulties are not openly addressed during a routine prenatal care and any such attempt may also receive little attention from the busy obstetricians. As a result, a modest number of pregnant women have the misconceived notion that having sex during pregnancy would hurt the growing fetus. It may be appeasing to know that the baby is within the safe confines of surrounding membranes and uterine wall. While the physiological symptoms of nausea, breast tenderness in first trimester or the physical constraint of increasing abdominal girth in the third trimester may interfere with interest, desire and inclination for sexual activity, the second trimester is probably an ideal time for renewed sexual function. Furthermore, adapting appropriate positions may allay or ameliorate the physical discomfort during the third trimester. Any other cause for concern such as vaginal bleeding, past history of premature labor or miscarriage should be discussed with the attending obstetrician. Notwithstanding the perceived constraints, for a majority of couples, sexual activity will continue to remain enjoyable during most part of pregnancy. Following delivery, postnatal sexual dysfunction may be in the contexts of low desire (due to prolactin rise) or pain (any cause for dyspareunia). In addition to specific management approaches for the disorder(s) per se, timely offer of psychosexual counseling and therapy by health care providers would not only improve the knowledge and understanding but also strengthen the overall relationship harmony and life quality in these couples.
Dr B Srilatha MD, PhD::Department of Obstetrics & Gynaecology::Yong Loo Lin School of Medicine::National University Hospital::National University of Singapore::
Sexuality and Pregnancy
For many women, sex is a healthy part of pregnancy. However, women should still be prepared for changes that may occur and discuss any concerns with their doctor.
How Pregnancy Affects Sex
Every woman’s experience is different. Typical changes during each trimester are as follows:
• First trimester. Many women are less sexually active because of fatigue, nausea, breast tenderness, and the fear of causing miscarriage.
• Second trimester. Sexual activity often increases. Women are usually more comfortable with their pregnancy. Nausea wanes. Lubrication and vaginal blood flow increase.
• Third trimester. Sexual activity often becomes uncomfortable.
Some women are afraid to have sex during pregnancy, fearing that they’ll hurt the fetus, start premature labor, or break the amniotic sac. Bleeding and infection are also big concerns.
For women going through a healthy pregnancy, there is usually no harm in having sex. With the protection of amniotic fluid and the cervical mucus plug, the fetus should be safe from any pressure. Women can usually use sex toys, such as vibrators and dildos, with no problem.
However, if there is a threat of miscarriage in the first or second trimester, penetrative vaginal sex and orgasms should be avoided.
Women who have the following conditions should probably avoid vaginal sex:
• Risk for miscarriage
• Risk for preterm labor
• Unexplained vaginal bleeding
• Early cervical dilation (also called cervical incompetence)
• Leaking of amniotic fluid
• Placenta previa
Women should discuss their specific situation with their doctor.
Physical Changes of Pregnancy that Affect Sexuality
One challenge of sex during pregnancy is finding a comfortable position. A woman’s larger belly and pressure on the vagina can make some positions unworkable.
During the third trimester, women should not lie flat on their backs for a long time, as the weight of the belly can press on veins that return blood flow to the heart.
Some couples find the following positions comfortable:
• Woman on top. The woman may face her partner’s head or feet. This position gives the woman control over the depth and pace of penetration.
• Side by side. Partners may lie face to face or in a “spooning” position; either way puts less pressure on the fetus. The woman may also be able to control the depth of penetration.
• Kneeling on all fours. This position is sometimes called “doggie style” and can keep pressure off the uterus.
Partners are encouraged to discuss what is comfortable for them.
When Couples Have Worries About Vaginal Sex
Couples who cannot have vaginal sex – or choose not to – can still be physically intimate. Hugging, kissing, and massage are all possibilities, along with mutual masturbation, breast fondling, and using sex toys.
Oral sex is generally safe during pregnancy, but a woman’s partner should be careful not to blow air into the vagina, as this can cause air embolus.
Oral sex should be avoided if the partner has a cold sore on the lips because a herpes infection can spread from the mouth to the genitals.
Anal sex is not recommended for pregnant women. Bacteria can spread from the anus to the vagina and cause infection. Also, anal sex may be uncomfortable for a woman with hemorrhoids.
Safer Sex During Pregnancy
Practicing safe sex is important during pregnancy. Sexually-transmitted infections (STIs) can be spread from mother to fetus.
Women who are not in a monogamous relationship should use male or female condoms. They should also use condoms if a partner has an STI.
Barrier protection should be used with sex toys as well, since they can also transmit STIs.
Pregnancy and Partners
Pregnancy can be a stressful time for partners. It’s important for couples to keep lines of communication open, especially as they anticipate their new responsibilities as parents. Some couples find counseling helpful.
Some partners become violent or emotionally abusive when a woman is pregnant. Women who are abused – or who fear being abused – should get help immediately.
After the Baby is Born
Most women are told to wait at least six weeks after delivery before starting vaginal sex again. Women may not have the same level of function as they did before they were pregnant because of fatigue, breastfeeding, pain, or postpartum depression.
Vaginal Dryness and Painful Intercourse After Childbirth
Pain with vaginal penetration is common after childbirth. When a new mother is breastfeeding, estrogen and testosterone are suppressed, leading to vaginal dryness, insufficient lubrication, and a thinning of the vaginal lining. This dryness and pain is treatable, however.
Non-hormonal treatments include vaginal moisturizers and vaginal lubricants.
Vaginal moisturizers can be purchased over the counter. They improve vaginal elasticity by rehydrating tissue, although it can be two months before a woman notices a difference.
Vaginal lubricants are used during sexual activity and add moisture to avoid friction. There are three types of lubricants:
• Water-based lubricants. These are easy to find and usually not expensive. They are safe to use with latex condoms. Because water-based lubricants often dry quickly, some women need to apply more lubricant or spray the area with water to keep the area moist.
• Silicone-based lubricants. Generally longer-lasting and more effective than water-based lubricants, silicone-based lubricants are also safe to use with latex condoms.
Some water- and silicone-based lubricants contain glycerin, which can cause inflammation and yeast infections. If this is a problem, women can choose glycerin-free lubricants.
• Oil-based lubricants. These lubricants also tend to last longer than water-based lubricants, but they are not safe to use with latex condoms. Petroleum-based lubricants (made from petroleum jelly, mineral oil, or baby oil) sometimes cause inflammation or irritation. Lubricants made from natural oils (such as olive, coconut, avocado, or peanut) are generally not irritating.
Some women find vaginal estrogen therapy helpful for treating pain from insufficient lubrication. Estrogen comes in cream, pill, and ring form and can be used along with lubricants and moisturizers.
Pain from insufficient lubrication usually gets better once the mother stops breastfeeding and goes back to having normal menstrual periods.
Other common causes of pain during intercourse include:
• Vaginal lacerations or episiotomies that are still healing
• Stitches in the vagina
Low Sex Drive After Delivery
Some women find their sex drive decreases after their baby is born. There are several possible causes, such as fatigue, focus on the baby, suppressed testosterone, body image changes, and postpartum blues or depression.
About 70% to 80% of women experience “blues” after delivery. About 10% to 20% experience depression. Women with depression should seek treatment.
For some women, sex drive can be improved by making some lifestyle changes, like exercising, eating a healthy diet, and socializing more.
Partners After the Baby is Born
Many new parents face relationship problems after a baby is born and some benefit from counseling. It’s important for couples to set aside time for their own interaction and intimacy, without the pressures of the new baby.