Expert / 18 April, 2020 / Etienne Horner
Pregnancy poses particular challenges related to the different construction of masculinity, femininity and sexuality. Differences between men and women are at no other point so sharply delineated. The feeling about sex whilst pregnant depends very much on individual feelings about sex, the partner’s feelings about sex, and the physical and emotional changes during the pregnancy. Many couples find these differences exciting and so women become aroused more easily and climax quicker. Many men find their pregnant wifes sexier than ever and sex can even be more pleasurable and more frequent. However, when some couples find pregnancy as their peak erotic time other couples find it difficult and a downturn in desire and sexual satisfaction. For most couples, it is a combination of both. But most importantly all the above feelings are normal.
Having a child represents deeply felt hopes, fantasies and fears for those involved. The pregnancy can be seen as a demonstration of love, as evidence of feminity, potency and virility, as a solution to problems of identity or esteem or even as a route to adult status and social approval. Women may feel fascinated, excited, discontented and exhausted in confusing mixtures. Men can feel envious and excluded or relieved and guilt-ridden. These feelings are usually semi-conscious experienced and can be difficult to talk about but will influence sex during pregnancy. However, most of the couples manage these feelings just as normal and experience increased tenderness and closeness and intimacy and sexual passion can be heightened. Sexuality will be profoundly affected by pregnancy and in particular by a first pregnancy.
The couple may feel that the baby in the womb represents a third presence in bed and the penis could be seen as damaging; the baby in the womb could be imagined as an audience to the sex of the couple; the activity of the baby could be inhibiting and even leading to impotence.
There are emotional and physical changes during each trimester in pregnancy. During the first trimester desire for sex can be increased as for once the thought about birth control is not important anymore. Breasts become more sensitive which could cause increased pleasure or pain. Nausea is very common in the first trimester and therefore may limit the amount of intercourse or orgasms.
In the second trimester many women feel sexy with their new figures; partners may be more fearful of hurting the baby once he can feel the movements. Some partners could be jealous of the closeness from the baby to the mother.
The vagina is more lubricated and clitoris and vagina more engorged and women can become multi-orgasmic because of this added engorgement.
In the third trimester women could feel that her body is repulsive to her partner but in contrary, most men are actually aroused by their wife’s blossoming figure. Position for sex can be difficult and needs a little more phantasy then just the classical missionary position. In the third trimester women should not lie on their back.
Contractions can occur in the third trimester after sex and orgasms. The uterus can also have spasms during sex which are not contractions and not dangerous in pregnancy.
There are changes in the sexual organs during the pregnancy: the same hormones preparing to birth also change the way the body experiences sex. The breast become increasingly full and nipples become larger and more sensitive; there is more blood flow to the breasts during sex. There is also increased blood flow to the muscles and lining of the vagina and this can change sexual joy for the women and for the men. More blood flow to the cervix can also lead to bleeding after intercourse; deep penetration should therefore be avoided.
Communication is key! Women will need to show their partners what produces pleasure and what produces pain or irritation during sex. Even the language of lovemaking changes in pregnancy!
Yes, you can have sex throughout unless there is a medical condition which we generally advise not to have penetrative sex; this could be bleeding, shortening of cervix, preterm labour, low line placenta. It’s also generally advisable to be careful and maybe avoid penetrative sex in the first trimester if women had difficulties to get pregnant (fertility treatment) or have lost many pregnancies in the past. However, I always mention that penetrative sex does NOT lead to a pregnancy loss or even to vaginal infections or to pre-term contractions.
Not at all as the baby is well packed within the uterus; no sexual position is at risk to harm the baby however women prefer to have sex later in pregnancy being on top then in classical missionary position. To lie sideways is also quite a good position as the partner’s weight is completely of the uterus.
Absolutely; no reason in pregnancy to not have oral sex if this is preferred by the couple. This might even be a good alternative to penetrative sex if women feel less comfortable or men are worried to harm the baby.
Orgasms are experienced very differently during pregnancy; they might be less powerful and even might be more difficult to reach. Whilst experiencing an orgasm the muscles of the uterus could lead to spasms which will only last for a short period of time like Braxton hicks. They are in the same category and not harmful for the baby and will not lead to preterm labour.
Penetrative sex generally won’t bring on labour during pregnancy. It might help to bring labour on at term with increasing oxytocin release when women experience an orgasm or with the prostaglandins in the semen. However, there is lack of evidence and therefore it might just be coincidence.
Generally, I advise to wait until the postnatal check-up at around 5-6 weeks after the birth. Women will have a vaginal examination and hopefully be reassured that the cut or tear has healed well and it should not be a problem to start having penetrative sex again. I find it very important to reassure women and often discuss as well that the first time after having had a baby can be difficult as women and partners are usually very nervous as they feel it could not work as before.
Etienne Horner Obstetrician & Gynaecologist