Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / @xirurgi_2025 / @xirurgi_2025 - 276 - файл
.pdf
Sexuality During andAfter
https://t.me/medicina_free
Pregnancy
6
HaticeYıldız
Take-Home Points
• Pregnancy and postpartum processes, which
play a temporary but also very specic role in
the life of women and couples, cause signicant changes in the sexual life of women and
couples.
• Women’s sexual functions are being highly
affected, particularly during the third trimester
of pregnancy.
• Multiple sexual dysfunctions may occur during pregnancy and postpartum period.
• Sexuality during pregnancy can be benecial
in maintaining healthy sexual functions and a
good relationship between couples after birth.
• Prepregnancy sexuality should not be overlooked while approaching the sexual functions during pregnancy and postpartum,
because the couples’ background on this issue
is important.
• Sexuality during pregnancy is safe in general,
and in fact, more evidence is needed to claim
that sexual function should be avoided in order
not to jeopardize high-risk pregnancies.
• Especially perineal traumas related to assisted
vaginal deliveries and episiotomy are cause to
play a critical role in postpartum sexual
dysfunction.
H. Yıldız (*)
Faculty of Health Sciences Division of Nursing,
Department of Obstetrics and Gynecology Nursing,
Marmara University, İstanbul, Turkey
e-mail: heryilmaz@marmara.edu.tr
• Women and couples have many concerns and
questions about their sexuality and changes
regarding pregnancy and postpartum periods,
but couples generally do not share their problems on this issue. On the other hand, pregnancy and postpartum sexuality is generally
neglected in healthcare services.
• Sexual functions and sexual health counseling
are outstandingly important in preconceptional, pregnancy, and postpartum processes
in relation to these issues discussed above.
6.1 Introduction
Sexuality is an important component of health
and well-being, and it is fundamental for the protection and maintenance of them [1–3]. According
to the World Health Organization, “Sexual health
is a state of physical, emotional, mental and social
well-being related to sexuality; it is not merely the
absence of disease, dysfunction or inrmity” [4].
Sexuality is a natural part of human life and is
a multidimensional phenomenon [5–9]. Human
sexuality is a complex subject, because it encompasses a broad range of issues such as behaviors
and processes, including sexual identity and sexual behavior, and the physiological, psychological, social, cultural, political, and spiritual or
religious aspects of sex [10–13].
Women’s sexual function is also a complex
and dynamic interplay of many variables [14].
© Springer Nature Switzerland AG 2023
M. Gomes-Ferreira, J. Olivas-Menayo (eds.), Post-maternity Body Changes,
https://doi.org/10.1007/978-3-030-43840-1_6
99
100
https://t.me/medicina_free
H. Yıldız
Throughout history, the subject of female sexuality has been expressed in several writings and
depicted in numerous Venus gurines and fertility goddesses [10]. The earliest surveys about
sexuality behavior started in the 1890s [15].
However, research on sexuality began in the
1950s when Masters and Johnson described the
anatomy and physiology of the human sexual
response [10, 16]. Sexual health in pregnancy
and after childbirth is also a relatively new
research interest [10, 17–19].
Sexual function has a complex etiology for
any couple, and sexuality may be adversely
affected by biological, psychological, social, cultural, ethical, interpersonal, organic, and neuroendocrinological factors. However, the sexuality
of each person or couple is intensely private and
individual [2, 5–7, 9, 20].
Sexual function that is being affected by many
factors may change at various stages of human
life; pregnancy, childbirth, and postpartum periods are temporary, but they are very special and
important processes in women’s and couples’ life
[5–9]. These periods are genuinely emotional,
unique, and difcult experiences with a great
impact on the woman’s life and health, including
sexual health and relationship with her partner
[10, 11, 21].
Pregnancy, labor, and postpartum periods constitute an extremely signicant, indeed exclusive,
time in every woman’s life; on the other hand
these events affect their health, along with other
aspects of their lives, including sexual activity,
which is undeniably a signicant aspect of human
life [10, 11, 19, 21–29]. These changes associated with these periods affect not only the sexuality of the woman but also the health of a couple’s
sexual relationship [5, 9, 10, 19, 22, 25, 30–34].
Although it is stated that female sexual problems
during pregnancy and postpartum are generally
related to changing conditions in those periods, it
is stated that the prepregnancy sexuality of
women or couples should not be overlooked in
order to make an assessment on sexuality during
pregnancy and postpartum [8, 35].
Although pregnancy and postpartum are just
temporary periods in the life of women, healthy
sexual activity during pregnancy and after deliv-
ery is one of the main features in maintaining a
good relationship for couples [5–7, 9], because
sexual function is an important part of each
human being’s personality and a keystone in the
general couple relationship, with an obvious
impact on the quality of life [36]. It is stated that
sexual problems that cannot be solved during
pregnancy and after birth can trigger ongoing dispute patterns with harmful consequences for
men, women, couples, children, and society [37].
On the other hand, pregnancy and postpartum
sexuality shows a signicant linear correlation
with prepregnancy sexuality [8]. So, in addition
to the importance of solving sexual problems
during pregnancy and postpartum periods, which
are temporary processes in the life of a woman
and/or couple, the resolution of the existing prepregnancy sexual problems especially during the
prepregnancy period is extremely important for
the couples to sustain their healthy sexual function and relationships.
It is recommended that appropriate care strategies should be developed to increase knowledge
and reduce worries related to the sexuality of
women who are pregnant or gave birth, and
hence their partners [38]. Pregnancy and postpartum sexuality, which has not received sufcient attention from healthcare providers in the
past, has recently started to attract attention. And
sexual health during these periods is increasingly being recognized as an important component of women’s and couples’ life and a notable
area of maternity service provision and postpartum care [30, 39].
In this chapter, pregnancy and postpartum
sexuality is investigated in a wide frame with literature data.
6.2 Sexual Function During
Pregnancy
Pregnancy is one of the very specic, complex,
exciting, and temporary periods in a woman’s life
where many physical, hormonal, and psychological changes occur [1, 2, 30, 37, 40, 41]. Sometimes
depending on changes or serious problems, pregnancy may not be a desired experience for all
6 Sexuality During andAfter Pregnancy
https://t.me/medicina_free
101
women [2, 37], because changes during pregnancy often affect women’s physical well-being,
mood, relationships, and sexuality [20, 30, 40,
42–44]. There are numerous factors that may jus-
tify the change in sexual functions during pregnancy [2, 45, 46].
6.2.1 Factors Aecting Sexuality
During Pregnancy
Many factors may affect sexual functions during
pregnancy. Factors related to sexual problems in
pregnancy according to von Sydow are shown in
Table6.1 [29].
6.2.1.1 Hormones
Women’s hormonal changes in pregnancy may
provoke and promote a decline in sexual activities [30]. Hormonal changes (increased estrogen,
progesterone, and prolactin) cause nausea and
breast tenderness, which together with fatigue,
weakness, and anxiety can reduce sexual desire
and arousal or in other ways determine the difculty of sexual life [2, 30, 47]. It is indicated that
serum androgen levels have the highest levels at
the beginning of pregnancy and then they fall in
the third trimester, which theoretically may lead
to a decrease in sexual desire [48]. Thorne and
Table 6.1 Factors related to sexual problems during
pregnancy
Biomedical factors
Tiredness
Worry that the fetus could be hurt during intercourse
Dyspareunia
Backache
Woman’s low physical attractiveness (self and partner
evaluation)
Psychosocial factors
Mental symptoms (depressed mood, emotional
lability)
Prepregnancy sexual history and sexual symptoms
(e.g., dyspareunia)
Negative or ambivalent feelings about the pregnancy
Couple/relationship factors
Low relationship satisfaction
Von Sydow K.Sexuality in pregnancy and the postpartum
period. In: Reece EA, Hobbins JC, eds. Clinical obstetrics:
the fetus and mother. John Wiley & Sons; 2007:
1016–1021
Stuckey suggested that in the relationship
between decreased sexual desire and hormones
in late pregnancy, increased progestin hormone
negatively affected sexual behavior rather than
decreased androgen levels [49]. Relaxin relaxes
the ligaments in the pelvis, softens and widens
the cervix, and causes epithelial cells in the
vagina to enlarge and vaginal circumference
lumen to increase, and this subsequently might
cause a decrease in vaginal sensitivity [50].
Hormonal changes can also cause emotional
changes, and these may affect the sexual desire
and sexual behavior [51]. There are also studies
reporting that there is no signicant relationship
between hormones and sexual behavior [52].
Studies suggest that hormones cause symptoms of diminished clitoral sensation, orgasmic
disorders that may last up to 6months postpartum, and lack of libido [30]. On the other hand,
although men may not experience the hormonal
changes that occur within their partners’ bodies,
they may often have emotional and visceral reactions to pregnancy [32].
6.2.1.2 Worry About Damaging
theFetus or Pregnancy
Both the woman and her partner may be worried
about those complications that may occur as a
result of sexual activity during pregnancy [53–
56], and the sexual interest of both partners may
be reduced due to their concerns [51, 57].
Although during pregnancy one-third or half of
the expectant parents were reported to be afraid
of harming their babies [26, 53, 58], in a prospec-
tive study, this rate was indicated as 80% [59]. It
is stated that one-quarter of women reported that
they experienced fear of sexual intercourse during pregnancy [2, 60, 61]. Also, males are afraid
of hurting a female, and females are afraid of dissatisfaction of a male partner [26, 31, 53]. One
study reported that the majority of their participants stopped engaging in sexual activity during
pregnancy, one reason for which being the fear of
harming the fetus [1]. It is stated that sexual problems and dysfunction during pregnancy often
arise from the worry that the fetus will be damaged [31], and these fears indicate the major
inuence on male sexual activity [51, 57]. Some
102
https://t.me/medicina_free
H. Yıldız
people believe that sexual activity or orgasms
might harm the baby, increase the chances of a
miscarriage, or induce early labor [30]. However,
in a healthy pregnancy, none of these are true and
it is said that as long as no health issues are
involved, sexual intercourse during pregnancy is
safe [30, 62].
6.2.1.3 Nausea, Vomiting, andFatigue
Nausea, vomiting, and fatigues are some of the
most common problems and reasons for loss of
sexual desire during pregnancy. Nausea and vomiting, which many women experience during the
rst trimester, may diminish their feelings of
eroticism, and fatigue may lead to insufcient
energy to participate or enjoy in sexual intercourse [30].
6.2.1.4 Abdominal Growth, Weight
Gain, Breast Tenderness, Body
Image, andDiscomfort
As pregnancy progresses, the abdomen of the
woman grows, body gains weight and changes
physically, breasts grow and become sensitive,
and therefore the woman’s perception of body
image also changes. Discomforts due to changes
in pregnancy may affect the sexual satisfaction of
both men and women [63]. Women might feel
less attractive due to the increased size of their
body and abdomen [32, 36], and increasingly
large abdomen of a woman causes physical limitations and gradual changes in fullling some
sexual positions during pregnancy [2, 32, 36, 47].
It is stated that some couples may be distracted
by the idea that a third person is in bed during
lovemaking [32]. Physical appearance is a prominent preoccupation during pregnancy [30, 48].
Moreover, the presence of uterus that grows day
by day during pregnancy and the gradual change
in a pregnant woman’s self-image that inuences
her self-condence affect sexual functions [2,
47]. Studies show that there is a relationship
between body image and sexual satisfaction and
between dissatisfaction with the body and sexual
distress [64]. In relation to the change in breasts
mentioned above, while a male partner may nd
larger breasts exciting, the female partner may
nd any breast or nipple stimulation to be painful
rather than erotic [30, 65]. On the other hand,
fetal movements and Braxton-Hicks contractions
may serve to diminish feelings of intimacy [32].
6.2.1.5 Traditional
Social and cultural factors and related myths can
inuence the sexual life of a pregnant couple, and
they may also be associated with a decrease in
sexual interest [30, 66]. As reported in a study
conducted in Nigeria, a total of 44.3% of the
respondents believed that sexual intercourse during pregnancy widens the vagina and facilitates
labor and 30.2% believed that it caused abortion
in early pregnancy [67]. In one study in Iran, it
was found that women fear about sexual activity
during pregnancy because of the possibility of
causing rupture of the hymen of the female fetus
or possible fetal blindness. Women also believed
that sexual intercourse might be an act of adultery while carrying a female fetus [68]. It is
emphasized that traditional Chinese medicine has
many prohibitions on sexual activities during
pregnancy and places great emphasis on dietary
and behavioral restrictions to restore physical
and emotional harmony [1]. According to the
study by Malewitz etal., sexuality in pregnancy
for Polish couples means a stimulus to search for
new ways of pleasing each other in love play. In
addition, in this study, it was stated that experience of sexual satisfaction by pregnant women
improves their self-esteem, facilitates the mutual
relationship between partners, and strengthens
the bond of marriage [69]. In case of another
study conducted in Nigeria, 34.8% of women
believed that sexual intercourse during pregnancy
improves fetal well-being. It has been reported
that demographic factors also, such as education
level, full-time employment, marriage duration,
and ethnic group, affect sexual function during
pregnancy [30, 66].
6.2.1.6 Partner Approach
The partner approach plays an important role in
pregnancy, and the mutual understanding
between partners during pregnancy is important
for them to seek new ways of sexual satisfaction
[70]. That is, this reinforces the role of pregnancy
as a stimulus for partners to search for new ways
6 Sexuality During andAfter Pregnancy
https://t.me/medicina_free
103
to enhance mutual emotional connection, intimacy, and close physical afnity, in order to
share physical sexual pleasure and satisfy each
other’s sexual needs [2, 41, 70]. One study investigated that women reported more of a decrease
in communication about sex when compared
with their partners and that signicant difference
was seen in mean avoidance of sex between
women and men, and non-sensuality [71]. In a
different study, it was reported that the level of
intimacy and passion were higher at the beginning of pregnancy between couples; the commitment score in women was, in general, higher than
men; and the commitment score in men increased
at the beginning of the third trimester [72].
The sexual relationship seems to be the most
vulnerable area in the relationship of expectant
and young parents [26], and sexual function during pregnancy is one of the keystones for couples
to go forward from partners to parents [73].
Pregnancy can also affect the sexual functions of
a pregnant woman’s partner, because there is a
strong correlation between male and female sexual function [42].
6.2.2 Sexual Dysfunction
inPregnancy
Pregnancy affects people’s sex drives in different
ways, so there is no typical response. The majority of studies on the subject reported that pregnancy has a negative effect on the quality of
sexual intercourse between couples [10, 19, 20]
and that there is a relationship between pregnancy and sexual dysfunction [74]. Contrarily,
there are also studies showing that pregnancy has
no negative effect on sexuality [60].
In studies, rate of sexual dysfunction in pregnant women is stated as high. This rate was indicated as 91.08% by Aydın et al. [75], 92% by
Erbil [76], and 72% by Mobasher etal. [77]. A
study that evaluated sexual functions of pregnant
women stated sexual desire disorder rate as
88.9%, sexual arousal disorder as 86.9%, lubrication disorder as 42.8%, orgasm disorder as
69.6%, and sexual satisfaction disorder as 48%
[78]. In another study, the most common sexual
dysfunctions in pregnant women were reported
to be diminished clitoral sensation 94.2%, lack of
libido 92.6%, and orgasmic disorder 81% [52].
Sexual desire and arousal inuence sexual satisfaction and intercourse frequency [2, 47, 79], so
sexual activity decreases during pregnancy [2, 7,
47, 53, 55, 61]. A prospective cross-sectional
study revealed that Chinese pregnant women had
less sexual activity and desire during pregnancy
[59]. In one study, it was reported that one-third
of women reported a decrease in sexual desire,
and they expressed that vaginal, oral, and anal
sex and masturbation had been performed by
them during pregnancy [2, 61]. In some literature, it is stated that desire, arousal, lubrication,
orgasm, and satisfaction decreased signicantly
with the progression of pregnancy (especially in
third trimester) [75, 79, 80], and Erbil’s study
results support these studies’ results (except sexual desire) [76].
In the studies comparing sexuality between
pregnancy and prepregnancy, it has been found
that frequency of sexual intercourse, orgasm,
libido [8, 81], desire, arousal, lubrication, and
satisfaction during pregnancy signicantly
decreased according to prepregnancy period [8].
Moreover, the duration of intercourse and the
ability to experience orgasm decrease during the
later phases of pregnancy compared with prepregnancy, and dyspareunia increases signicantly throughout pregnancy [26].
Sexual pain disorders, including vaginismus
and dyspareunia, are quite prevalent in pregnancy. Results suggest that about half of women
may develop genito-pelvic pain during pregnancy, which will persist for about a third, and
that pain will also develop after birth in this group
[82]. In a small percentage of pregnant women,
an increase in libido and orgasm has been
reported. Arousal and increased orgasm ability
due to the disappearance of contraception
requirements and increased genital blood supply
are shown as the possible reasons [37]. One study
found that overall sexual function and satisfaction were not problematic for couples during
pregnancy [71].
It is emphasized that healthy sexuality during
pregnancy is necessary and it may play a key role
104
https://t.me/medicina_free
H. Yıldız
for a couple towards becoming parents [2, 30,
41]. It is even stated that prenatal sexuality may
be a predictor of postpartum sexuality [10, 19,
37]. Yıldız reported that there was no relation
between pregnancy and postpartum sexuality. In
addition, she stated that all of the participants
who had prepregnancy sexual dysfunction continued to also experience it during pregnancy, and
the majority of them had a signicant level of
sexual dysfunction by 6months postpartum [8].
Pauls etal. reported that sexual practices changed
during pregnancy but returned to early pregnancy
levels in the postpartum period and stated that
sexual functions that worsened during pregnancy
did not recover by 6 months postpartum [83].
Trutnovsky etal. indicated signicant decrease in
perceived “importance of sexuality,” “importance
of sexual intercourse,” and “contentment with
present sex life” from over early pregnancy to
late pregnancy, which was followed by a slight
increase in the postpartum period [84]. Each individual and couple have a background of sexuality. So, it is important not to ignore the
prepregnancy sexual relations of women or couples, because the prepregnancy sexual relations
of couples also have a decisive role in pregnancy
and especially postpartum sexuality [8].
6.2.3 Sexuality inPregnancy
According toTrimesters
Most women are sexually active during the pregnancy [26, 60, 70, 85, 86], but sexual activity dur-
ing pregnancy is decreased over time compared
to prepregnancy [70, 83, 87], and also one study
reported that the majority of women stopped
engaging in coital activities during pregnancy
[1]. This is because sexual activity, which is
inuenced by biological, psychological, and
social factors, modies as pregnancy progresses
[1, 2, 58, 70, 80].
In the rst 3months of pregnancy, women’s
sexuality may be affected by drowsiness, breast
pain, nausea, vomiting, mood disorder, and fear
of damage to the embryo or fear of occurrence of
miscarriage as a result of sexual contact [70]. In
the second trimester of pregnancy, there is a signicant increase in the number of sexual inter-
course and experiences of sexual fantasies in the
majority of women due to the genital congestion
and more intensive and faster wetting of the walls
of the vagina in relation to physiological and hormonal changes. During this period, the increase
of achieving a sexual satisfaction is also noted
[70]. In terms of sexuality, the most affected process during pregnancy is third trimester, and in
this trimester of pregnancy, a woman may experience problem and pain during sexual intercourse
[69, 70].
Specic changes that occur in each trimester
of pregnancy have signicant inuences on sexual behavior [2, 54, 55, 59, 83]. A meta- analysis
study showed that 90% of women were sexually
active during pregnancy [26, 85], but this rate
decreased to 30% in the ninth month and women’s sexual interest and coital activity declined
slightly in the rst trimester, showed variable patterns in the second trimester, and decreased
sharply in the third trimester [26]. Some studies
reported mean sexual function scores to be similar in the rst and second trimesters [52, 58]; in
another study, it was reported that women were
most active sexually also in the rst trimester of
pregnancy [70]. Some studies demonstrated that
the frequency of coitus does not change or
changes only minimally during the rst and second trimesters of pregnancy [2, 3, 29]. One study
showed that 90% of pregnant women had no sexual intercourse in the past 4weeks [68].
As pregnancy progresses, the frequency and
length of sexual intercourse decrease as well as
the achievement of orgasm, sexual satisfaction,
and stimulation [7, 31, 62]. Most studies indicated that the sexual function (like frequency of
sexual intercourse, desire, arousal, orgasm, satisfaction) decreases during pregnancy and signicantly declines in the third trimester [1, 7, 8, 31,
42, 52–55, 58, 62, 87, 88], they were reluctant to
enjoy sexual satisfaction [70], and dyspareunia
increases signicantly throughout pregnancy [7,
31, 55, 62]. But Masters and Johnson stated that
many women who have never had an orgasm during their intercourse can experience their rst
orgasm during pregnancy and that women who
have been previously orgasmic may have the
experience of multiple orgasms [89]. von Sydow
stated in the third trimester that 54% of sexually
6 Sexuality During andAfter Pregnancy
https://t.me/medicina_free
105
active women report having an orgasm with the
last coitus [29]. Prevalence of reduced sexual
interest, desire, and enjoyment during pregnancy could be over 50–60% [30, 58, 80]. von
Sydow stated that women’s enjoyment of sexual
intercourse in the rst trimester decreases to
59%; in the second trimester, it increases to
75–84%; and in the last trimester, it decreases
again to 40–41% [29].
One study indicated that the prevalence of
sexual dysfunction is high during pregnancy and
reaches higher levels in the third trimester [68].
Pauls etal. reported that overall sexual function
declined throughout pregnancy and did not return
to baseline by the 6-month postpartum assessment although sexual activity and variety of practices had returned to prepregnancy levels [83].
The results of the studies that examined sexual
function during pregnancy according to the prepregnancy sexuality showed that reduction
occurred in sexual function as pregnancy progressed, and particularly during the third trimester, signicant decrease occurred in many women
compared with prepregnancy [2, 8, 54, 55, 59,
70, 83]. Some studies stated that this typically
occurs in nulliparous women, while in multiparous women, usually changes are not observed in
sexual activity compared with the prepregnancy
period [70]. Although sexual activity during
pregnancy decreases over time, there is also study
indicating that sexual satisfaction in pregnancy
does not change compared to prepregnancy
period [2]. Another study reported no differences
in the prevalence and indices of sexual function
between pregnant and nonpregnant women [77].
Possible changes in pregnancy according to
trimesters and their possible effects on sexual
functions, and the sexual dysfunction states that
can be seen, are summarized in Table6.2.
6.2.4 Conditions Aected by
Sexuality During Pregnancy
There are some conditions in pregnancy where
sexuality may be contraindicated. But there is
limited evidence about situations where it is
advisable to limit sexual activity during preg-
Table 6.2 Changes in pregnancy according to trimesters
and their possible effects on sexual functions
Changes according to
trimesters
First trimester
Drowsiness, breast pain,
nausea, vomiting, fatigue,
mood disorder, fear of
occurrence of
miscarriage, etc.
Second trimester
Hormonal and
physiological changes,
increase in genital
congestion and vaginal
sensitivity, good
physiological adaptation
to pregnancy, etc.
Third trimester
Abdominal growth, weight
gain, breast tenderness,
body image, discomfort,
worry about damaging
the fetus, genito-pelvic
pain, etc.
Sexual dysfunctions that can be seen during
pregnancy
Sexual desire disorders, lack of libido
Sexual arousal disorder, lubrication disorders
Orgasmic disorders
Sexual satisfaction disorders
Sexual pain disorders (including vaginismus and
dyspareunia)
Possible effects on
sexuality
Decrease in sexual
activities
Decrease in sexual
intercourse (coital
activity decline slightly)
Decrease in sexual desire
Decrease in eroticism
feelings
Insufcient energy for
sexual intercourse
Increase in libido
Increase in sexual
intercourse
Increase in sexual arousal
Increase in sexual
fantasies
Increase in sexual
satisfaction
Increase in achievement
of orgasm (may be
experience of multiple
orgasms)
Sexual absence
Decrease in sexual
intercourse (coital
activity decrease sharply)
Loss of sexual desire
Decrease in sexual
frequency
Sexual distress
Orgasmic and sexual
dissatisfaction
Decrease in intimacy
feelings
Decrease in clitoral
sensation
Pain during sexual
intercourse
Difculty in sexual
positions
(There are generally
decrease in frequency of
sexual intercourse,
desire, arousal, orgasm,
and satisfaction in the
third trimester)
106
https://t.me/medicina_free
H. Yıldız
nancy [30, 80]. In the 1990s and early 2000s,
large representative studies observed no overall
association between perinatal complications and
either coital activity or orgasmic frequency. In
general, most of the studies could not nd any
relationship between frequency of intercourse
and preterm labor [26, 90, 91].
One study showed that 29.4% of women
believe that sexual intercourse during pregnancy
has a negative effect [85]; another study reported
that many women believe that having sexual
intercourse at term will expedite the onset of
labor [92]. It is estimated that nipple stimulation,
clitoral stimulation, and orgasm-related uterine
activity may help trigger the onset of labor. The
physiological basis of this is the production of
oxytocin and prostaglandin. Prostaglandin (PG)
E and F play an important role in ripening the
cervix and contribute to the contractibility of the
uterus (prostaglandins in pregnancy are pro-
duced by the cervix, the fetal membrane, and the
decidua, and there is presence of prostaglandin E
in human semen) [30, 80]. It is stated that sexual
activity may have an effect on the onset of labor,
and this effect may be due to the role of prostaglandin E, that is present in human semen, in the
maturation of the cervix and the onset of uterine
contractions [80]. It was found that the concentration of prostaglandin E and F in the cervical
mucus of women was similar in the rst and second trimesters of pregnancy, but that the PGF
level was 10–20 times higher in the third trimester. In addition, 2–4h after intercourse, prostaglandin concentrations in the cervical mucus
were found to be about 10–50 times higher than
normal [93]. Therefore, there is a biological
probability regarding the effect of sexual intercourse on the onset of labor from this point of
view [30]. In three different studies conducted by
Tan etal., a variety of parameters were examined
in terms of the relationship between coitus and
onset of labor, but they generally could not nd a
relationship. It was reported that the rate of spontaneous onset of labor was similar in term pregnant women who are advised and not advised to
have sex in order to induce labor [94–96]. It was
stated that sexual intercourse did not show a signicant relationship with cervical maturation and
initiation of labor [64, 92], but Faumane et al.
indicated that the women who had active sexual
intercourse before and after 28 weeks in pregnancy signicantly had a shorter active phase and
a shorter second stage, higher rate of spontaneous
deliveries, and a lower rate of cesarean sections
and needed less oxytocin usage before expulsion
[64]. One study found that coitus in early pregnancy did not associate with increased preterm
birth risk, but there is an association between an
increasing number of sexual partners in a woman’s lifetime and recurrent preterm delivery [97].
On the other hand, some literatures state that
intercourse just before the expected date of birth
or woman’s orgasm may lead to the start of the
birth due to the prostaglandins contained in the
semen of male [70, 98]. Also, it is stated that an
orgasm or sexual penetration in the late period of
pregnancy is possible to initiate Braxton-Hicks
contractions [30]. As is seen, most of the studies
date back to several years. And there is limited
evidence to guide recommendations on sexual
activity in women who are at increased risk of
preterm labor. Therefore, restriction of sexual
intercourse is often recommended for prevention
and management of threatened preterm labor.
Although it is thought that there will be an
increase in the risk of preterm labor in twin or
multiple pregnancies as a result of sexual activity,
studies have not conrmed this [99, 100]. In
some studies investigating the effect of coitus on
premature rupture of membrane, it was stated
that there is no relationship between membrane
rupture and sexual intercourse, coital frequency,
frequency of orgasmic coitus, or sexual position
[30, 91].
In contrast to common belief, sexual intercourse is stated to be not associated with vaginal
bleeding in the rst trimester of pregnancy.
However, placenta previa, placental abruption,
and prenatal hemorrhages in the second and
third trimesters are reported to be associated
with increased frequency of sexual intercourse
[62]. Despite inadequate evidence, it is thought
that advising women with placenta previa to
avoid sexual intercourse will be the safest way in
terms of prenatal bleeding risks [62]. And it is
theoretically accepted that penile contact during
intercourse could result in a similar risk of hemorrhage [80].
6 Sexuality During andAfter Pregnancy
https://t.me/medicina_free
107
On the other hand, vaginal vascularization
increases during pregnancy. Although there are
few reported cases, it is expressed that the highpressure rough sexual intercourse during pregnancy may create a risk of venous air embolism
due to the increased vaginal vascularization
[101]. Also, it is stated that the uterine orgasminduced contractions during pregnancy may
increase the risk of uterine rupture in women
with uterine scar after sexual intercourse in the
last weeks of pregnancy, and dangerous infection
can more often occur [98]. Therefore from
6weeks before the expected date of birth, especially if there is a risk of premature rupture of the
membrane, it may be recommended that the
woman avoid sexual intercourse because of the
increased risk of infection [69].
In the late 1990s to early 2000s, von Sydow
and Leeners et al. made the following descrip-
Table 6.3 Most common risks to sexual intercourse during pregnancy
Serious risks:
• Unexplained vaginal bleeding
• Placenta previa
• Premature dilatation of cervix
• Premature rupture of membranes
Increased risks:
• History of premature delivery
• Multiple gestation
• Repetitive bacterial vaginosis
Jones C, Chan C, Farine D. Sex in pregnancy. CMAJ.
2011;183(7):815–818
tion: “for the majority of healthy pregnant women
and their partners, there is no reason to forbid
sex, even in the last weeks before birth” [26, 90].
Table 6.3 shows some situations in which
women with pregnancy complications should
avoid sexual intercourse and/or orgasm. But these
situations have not been exactly validated with
the studies [25, 29, 80]. However, there is also a
lack of substantial evidence about the safety of
having sexual intercourse during pregnancy in
high-risk pregnant women. So, a woman’s experience of having a negative pregnancy risk as a
result of sexual intercourse should be evaluated
separately for each individual [30].
Sexual activity in pregnancy is a topic insufciently addressed in clinical practice and in the
literature. Many studies evaluating sexual activity during pregnancy and in high-risk pregnancies have been conducted decades ago, and there
is even less scientic evidence and insufcient
data to provide proven recommendations in highrisk pregnancies [102].
Clinicians need to engage in conversations
regarding sexual activity for patients experiencing complications in pregnancy [30, 80, 102].
But it is important to provide validated recommendations. So, recommendations for or against
restricting sexual activity should be based on
evidence-based guidelines [102]. Sexual activity
recommendations in high-risk pregnancies are
presented in Table6.4.
Table 6.4
For history of preterm birth (PTB)
*Level II-2: Sexual activity of any type should not be discouraged in women with a history of PTB
*Level III: Sexual activity of any type should not be discouraged in women with a history of PTB until they have
an episode of preterm labor (PTL). After this, sexual activity of any type that causes an increase in frequency or
intensity of uterine contractions should be avoided
Author’s opinion: Women with a history of PTB in the absence of a short cervix or other obstetrical risks need not
be discouraged from sexual activity of any type
For both a prior PTB and a short cervix
*Level III: Women with both a prior PTB and a short cervix should avoid coitus
*Level III: Limited data suggest that women with a short cervix need not be discouraged from sexual activity of
any type
Author’s opinion: Women with a short cervix need not be discouraged from sexual activity of any type unless
experiencing bleeding, increase in baseline uterine contraction frequency/intensity, or worsening in cervical length
(CL). After this, vaginal penetration and any non-penetrative sexual activity with or without orgasm that causes
patient perceived uterine contractions or painful contractions should be avoided
Sexual activity recommendations in high-risk pregnancies
(continued)
108
https://t.me/medicina_free
H. Yıldız
Table 6.4
For cervix with a cerclage
*Level III: Vaginal penetration should be avoided
*Level III: After prophylactic cerclage placement, pelvic rest for 1week and use condoms with coitus thereafter.
After rescue cerclage, abstain from coitus until 32–34weeks of gestation
For preterm premature rupture of membrane (PPROM)
*Level III: Patients with PPROM, regardless of gestational age, should adhere to strict pelvic rest
Author’s opinion: Vaginal penetration may increase the risk of infection and thus should be avoided
For placenta previa
*Level III: Until placenta previa is conrmed in the second trimester, typically after 28weeks, the need for sexual
activity restrictions is usually not indicated
*Level III: Abstain from any sexual activity that may lead to orgasm after 20weeks of gestation (earlier if they
have experienced vaginal bleeding)
Author’s opinion: Sexual activity of any type need not be restricted until the CL is <3cm, after the sentinel
bleeding episode, or the baseline uterine contraction frequency/intensity increases. If the CL is between 3cm and
2.5cm, recommendations for sexual activity of any type need to be individualized. After the sentinel bleeding
episode, penetrative sexual acts and any sexual activity leading to patient perceived uterine contractions or painful
contractions should be avoided. Non-penetrative sexual activity that does not result in patient perceived uterine
contractions or painful contractions need not be restricted after the sentinel bleeding episode
For placental abruption
The literature did not provide any data or expert opinion on sexual activity recommendations with an existing
placental abruption
Author’s opinion: Sexual activity recommendations in women with a chronic placental abruption stable enough for
home monitoring need to be individualized. In women with a stable, chronic abruption, any sexual activity that
results in bleeding should be avoided
For twin gestation
*Level II-2: Sexual activity of any type should not be discouraged in twin gestation
The literature does not provide any data or expert opinion on sexual activity recommendations in higher order
multiple gestations
Author’s opinion: In the absence of other obstetric risk factors, sexual activity of any type need not be restricted in
twin or higher order multiple gestations
For history of classical cesarean section
The literature does not provide any data or expert opinion on sexual activity recommendations with a history of
classical cesarean section
Author’s opinion: In the absence of other obstetric risk factors, a history of a classical cesarean section alone would
not necessitate sexual activity restrictions of any type. Women who experience very painful or intense, prolonged
uterine contractions following any sexual activity should limit that specic sexual activity
For all
*The evidence to support or refute the safety of penetrative or non-penetrative sexual activity with or without
orgasm is limited
*Individualize recommendations based on consideration of obstetric history and comorbidities as well as patient
and partner fears and emotional needs
*Further research is needed to make validated recommendations
MacPhedran SE.Sexual activity recommendations in high-risk pregnancies: What is the evidence? Sexual Medicine
Reviews. 2018;6(3):343–357
(continued)
Соседние файлы в папке @xirurgi_2025