The orientation on Sexuality in Pregnancy is usually done inadequately: poor, inaccurate, euphemistic (with dissimulation), confusing and without opportunity for clarification or discussion of alternatives. Furthermore, there are no studies that support the suggestions that are offered. Although it seems incredible, there is very little that is known about sexuality during pregnancy and there are very few conclusive studies that offer valid answers to clarify our concerns and to approve or discard personal, family or community pre-established conceptions (popular beliefs).

Despite all this the Good News is that “any prohibition of sexuality during pregnancy is inappropriate” as long as there are no formal contraindications. In short: sex is appropriate throughout the normal pregnancy .

Sex education is not only about avoiding inconveniences, unwanted pregnancies and transmission of diseases, but about making sex pleasant and safe for the mother, the fetus and the couple.

Considerations

Perhaps the only study that clarifies a point in this entanglement was published in 2001 (Obstetrics & Gynecology, February 2001) that strongly suggests that sexual relations during pregnancy are not associated with Preterm Birth in uncomplicated pregnancies, 90 %: “Sex that does not generate discomfort seems to be as safe as any other reasonable physical activity.”

Keep in mind that most of the information available is based on “Normal or Reasonable Sex” and include in it all types of manipulations and previous games, masturbation and oral sex, vaginal penetration and body positions that do not cause pain or involve exhausting efforts, physical violence or situations that compromise the life of any of the couple’s components. I consider it prudent to eliminate anal intercourse during pregnancy due to the high possibility of vaginal contamination with fecal bacteria.

To end this prologue I want to remind readers that sexual promiscuity, whether female or male, has no place in pregnancy. Apart from having seen several cases of venereal diseases transmitted to patients during their pregnancy, I have had the misfortune to manage two cases of HIV-AIDS infection due to imprudence of the male component of the couple. Except in cases of prostitutes, invariably the cases of promiscuity that I have studied during pregnancy have been caused by the man and not the woman; This phenomenon is possibly due to the lack of integration of the man to the pregnancy of his partner and disorders originated by the inadequate handling of sexuality during pregnancy.

Evolution of sexuality during pregnancy

In general, sexual desire varies a lot between people: many couples decrease their desire while others feel much more sexually stimulated. To confuse the situation further it is very possible to have differences of desire between the man and the woman (one part wants and the other does not) and on top of that each phase of the pregnancy presents different degrees of “desire” and its own characteristics. I will describe this a bit:

• First Trimester : during the first 13 weeks of pregnancy many women limit their sexual activity due to the appearance of the discomforts of early pregnancy (nausea, vomiting, discomfort in the breasts, vaginal dryness) and fears related to the loss of the baby (bleeding , abortion, injuries). Gradually hormone levels will stabilize and attenuate symptoms while the libido will improve substantially and vaginal lubrication and moisture will recover. “Normal” sex does not affect your baby because the uterus represents a very safe confinement system. Do not have any more fears in this regard in the future.
• Second Trimester : from weeks 14 to 26 a pleasant and silent period of pregnancy is presented, most of the adverse symptoms have subsided, the abdomen has grown but it does not become bothersome, the breasts are no longer so sensitive, the Vaginal lubrication has recovered and the libido is normal or even exacerbated. The movements of the baby, which have already become noticeable, give peace of mind knowing that the baby is “alive and kicking” but can be cause for guilt during sexual intercourse by the feeling of hurting him. Remember, nothing is wrong with the baby, it is very well protected. During this stage and the next it is possible that your orgasms become more intense and pleasurable, they could even generate uterine contractions, but it is already known that they do not cause premature births in normal conditions.
• Third Trimester : from week 27 to 40 the situation begins to change: the abdomen has grown a lot, there is more fatigue and suffocation sensation, the breasts are bigger and more sensitive, there is joint pain in the pelvis and back, the fetal movements are more and more intense and sometimes painful, you notice more often the presence of uterine contractions, the changes have made you feel less attractive, your libido has been decreasing, sexual positions have been reduced to one or two that do not cause discomfort or discomfort, you are looking for other things: the latest purchases, prenatal rest, finalizing the details of the clinic or hospital, fear of childbirth, pain at birth, healthy baby? In short, little by little you have less desire to have sex. And in many cases your partner too. For all these reasons, the frequency of relationships decreases spontaneously as we approach delivery.

Is there a need to suspend sexuality at the end of pregnancy?

No. Until a couple of years ago I personally banned relationships starting at week 35 or 36 because of some reports that talked about the risk of premature delivery or infections of the baby and her baby around the time of delivery. Most of this information has been discarded so that now I allow them to continue and leave the couple free to decide when they wish to suspend them.

Is it safe for the baby?

Yes. I reiterate that the baby is very well protected.

Is it safe for the mother?

YES. As long as common sense and safety prevail, and in the absence of contraindications, sexual activity poses no risk to the mother.

How should sexual relations be carried out?

The progression of the sexual relationship is exactly the same as that of the non-pregnant woman. It only adapts to your physical changes, especially abdominal growth and joint discomfort, hypotension and fatigue from posture.

In what situations are sexual relations prohibited?

When the pregnancy stops being normal and there are risk conditions, sexual intercourse is suspended by medical order. If the event is momentary, your doctor will tell you when you can restart them, but if it is a longer-lasting problem they will probably be stopped altogether. The time they should be suspended will also be your obstetrician’s criteria based on your condition and risk factors. Let’s see the most frequent:

Momentary Suspension: at the end of the event, finish the treatment, etc.

• Threatened abortion
• Bronchial Asthma Crisis
• Moderate to severe vaginal irritation
• Symptomatic urinary tract infections

Total Suspension: until after the birth of the baby

• Recurrent vaginal bleeding without accurate diagnosis
• Previous placenta
• Cervical incompetence
• Antecedents of premature birth
• Membrane Rupture (Breakage of Sources)
• Multiple pregnancy
• Promiscuity

Promiscuity and pregnancy

Multiple couples around the pregnant woman, whether direct (pregnant woman with more than one sexual partner) or indirect (male partner with other sexual partners) impose a high risk for the acquisition of Sexually Transmitted Diseases such as Gonorrhea, Herpes, Trichomoniasis, Syphilis , HIV AIDS. These infections have been associated with Abortion, Preterm Birth, Intrauterine Infections, Neonatal Sepsis, Congenital Abnormalities, Prematurity, Fetal Death, Neonatal Death, and Maternal Death. Just imagine what it means to be infected with the AIDS virus during pregnancy: 2 or more affected by a fatal disease due to the error and recklessness of a person.

Situation of your partner during pregnancy. Some tips …

Although men do not go through the dramatic physical changes of pregnancy, we will have our own challenges and uncertainties. We experience sensations of happiness and rejoicing (for the miracle of creation) as well as fears and anxiety: we worry about not knowing the type of help that should be given during pregnancy and childbirth, the economic conditions to meet the needs of the new member of the family, our role as a couple once the baby is born, our sexual needs (and yours), we are terrified of the structural changes that your genitals will suffer after childbirth (this is a classic), we fear doing harm to the baby if we maintain relationships sexual, we fear jealousy for your attention to the baby, we doubt our capacity as parents, etc. You see, for both of them, the cause of happiness is the same as the causes of anguish.

The anguish of the couple is solved with communication and involvement. You have to involve your partner in your pregnancy to be both and so both live the profound changes that are gestating. If one morning my wife woke up with a “belly” of nine months (it grew during the night) I would panic and I would run away but if I live the changes progressively and I get involved in them the fears will disappear, I will understand you better and I will know how to satisfy your needs.

Sexuality is adapting to your changes if your partner is involved in them, it will be fully satisfactory for both and they can maintain a close and harmonious union.

Discuss in an open and honest way the sexual needs and limitations of each one. Discard unfounded fears and cultivate love and respect.

Postpartum sexuality (puerperal)

After the birth of the baby, by birth or cesarean, sexuality is interrupted (ideally) for 6 weeks, this is to prevent placental bed infections and above all, avoid an unwanted pregnancy immediately postpartum, which could represent a catastrophe for some couples. Cellular immunity is decreased in pregnancy and the risk of acquiring or developing severe forms of certain sexually transmitted diseases is increased (especially HPV ) and returns to normal during this period.

We are very careful during this period because usually the couple of the puerpera has had a few weeks of sexual abstinence and increases the risk of having extramarital relationships in compensation for sexual deficiencies with their partner and the aesthetic effects of pregnancy on her; In addition, the puerperal period presents with discomfort in the genital or abdominal area (due to the scar of caesarean section), genital bleeding, lactation and breast discomfort, fatigue and little sexual interest on the part of women due to the effects of motherhood and the approach to the constant care of the newborn.

Immunity at this point is normal and resistance to sexually transmitted diseases returns to normal, except for the fact that the vagina has thinned mucous membranes and limited defenses due to the effect of progesterone and the lactam hormones that inhibit Estrogens, the hormone that stimulates vaginal growth and moisture. That is why during the beginning of puerperal relationships, and after counseling on the most appropriate contraceptive method for each case, we guide the couple to have relations with delicacy and using water-soluble lubricants if necessary due to coital intolerance.

We always advise women not to forget about the couple’s needs for attention and sexuality so they do not feel displaced by the new member of the family, this maintains and reinforces family and couple ties.

At the end of the puerperium, and within a few months, the conditions of the woman have returned to normal and the family and couple dynamics have acquired a new balance and the routine care of women’s health begins.

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