Review Discusses Safety of Sexual Activity During High-Risk Pregnancy

When expecting couples are facing a high-risk pregnancy, they often wonder whether sexual activity is safe. A recent review of medical literature suggests there is little published data to guide them.

Dr. Sally MacPhedran of Case Western Reserve University School of Medicine (Cleveland, Ohio, USA) conducted the review and published her findings and opinions in March in Sexual Medicine Reviews.

Dr. MacPhedran noted that patients do not always receive information about sex during pregnancy. And when pregnancies carry risk, couples might be advised to avoid sex altogether. However, this recommendation is not always necessary.

She began her review by describing three ways sex could cause pregnancy complications:

  • Prostaglandins – produced in women’s bodies and found in semen – may cause contractions and induce labor.
  • Foreplay, orgasm, penetration, and oral sex spark the release of oxytocin, which might also start contractions.
  • Couples may fear that direct contact or trauma to female reproductive organs during sex might harm the fetus.

Dr. MacPhedran then discussed several examples of high-risk pregnancy and sex-related research on each. For each example, she recommended that physicians consider the needs and medical histories of patients as individuals, as what might be advised for one woman might not apply to another. She added that more research is needed before “validated recommendations” can be made.

Specific cases and recommendations from the article include:

Prior pre-term birth Women do not need to avoid sexual activity as long as they do not have a short cervix or other obstetrical risk.
Short cervix Sexual activity is safe as long as there is no bleeding, increases in uterine contractions, or worsening cervical length.
Cerclage (stitching the cervix closed during pregnancy to prevent pre-term birth) Penetration may need to be avoided, depending on the situation.
Premature rupture of membranes Because of infection risk, vaginal penetration is not safe. Non-penetrative activity may be safe depending on the situation.
Placenta previa (when the placenta covers the cervix, either partially or completely) Recommendations for activity should be individualized. After sentinel bleeding, penetration and acts leading to contractions should be avoided. Non-penetrative activity may be safe.
Placental abruption (when the placenta separates from the wall of the uterus) Sexual activity is safe for women with stable, chronic abruption unless they are experiencing “frequent, intense, or painful” contractions or bleeding.
Multiple gestation (twins, multiple births) Sexual activity is safe unless there are other obstetric risk factors.
Prior classical Cesarean section Women who experience painful or intense contractions during certain sexual activities should “limit” those activities.

“Restricting sexual activity in women with high-risk pregnancies has far-reaching implications,” Dr. MacPhedran wrote. “Pregnancy is a time of bonding, sharing, and intimacy. . . To completely restrict the intimacy impacts the health of the relationship physically and emotionally and further increases stress and fear.”

Couples who do need to restrict sexual activity can still be intimate through kissing, hugging, and cuddling, she said.



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