The ® Female Patient What You Should Know About ANDOUT H Sexuality In Pregnancy omen experience a Because of the increased blood supply through the pelvis many women have more intense sexual variety of physical and TIENT pleasure and orgasms. However, a number of fac- A mental changes during tors contribute to an ongoing decline in sexual pregnancy, and it functioning in this trimester as well. There is sig- P Wcan be frustrating as you and your nificant weight gain and you also begin to feel the baby’s movements. These first signs of life some- partner try to make adjustments. times make you feel like there’s a “third person” These changes continue from the present during lovemaking, and you may have moment you become pregnant fears of injuring the unborn baby as well. Numerous myths and religious until after the baby is delivered and and social taboos may further they affect every aspect of your life decrease sexual desire and satisfac- The transition to including your sexuality. tion, such as: parenthood is a • “Contractions during orgasm time of physical will cause a miscarriage or pre- and emotional The First Trimester term labor” Early pregnancy often reveals the major strengths • “Any kind of sex during crisis, and any and flaws of your partnership that were pres- pregnancy}especially oral problems in a ent prior to the pregnancy}sexual, emotional, or anal sex}are against relationship are marital, financial, and cultural. The transition to my beliefs” often made worse parenthood is a time of physical and emotional • “Oral sex can cause air to get crisis, and any problems in a relationship are often into my uterus.” by stress. made worse by stress. This leads to anxiety and frustration, and sometimes to marital problems and sexual dissatisfaction. Your doctor can explain the physical reasons for these stresses and help you to find a level of intimacy you can both enjoy. Sexual desire and satisfaction decline through- out pregnancy for women but are still near nor- mal levels during the first trimester. This is the best time to establish a strong sense of intimacy. Men and women experience different changes during pregnancy. While most women have less sexual satisfaction, only a few men feel this way during the first trimester}probably because women may have symptoms like morning sick- ness. To promote sexual intimacy, your partner can fulfill your needs through caressing, massage, and accompanying you to OB/GYN visits and to classes in childbirth and parenting. The Second Trimester The second trimester may be a time of increased sexual activity, desire, and satisfaction for women. 8/07 The Female Patient grants permission to reproduce this handout for the purposes of patient education. A downloadable version of this patient handout is also available at: www.femalepatient.com. Sexuality In Pregnancy Family and friends may give you all kinds of Common responses include nipple erection and advice about harmful sexual practices during uterine contractions while nursing, and milk leak- pregnancy and you may also have a condition age during sexual arousal}all normal reactions that puts you at high risk for miscarriage. at this time. Your OB/GYN is your best source of accurate Other factors that may decrease your sexual information, and can answer all of your ques- desire in the postpartum period include: tions regarding which sexual activities are safe for • Exhaustion from nighttime feeding and you. If you cannot have vaginal intercourse, other infant care options include fantasizing, masturbation, experi- • Spells of depression or “baby blues” menting with different sexual positions, and anal • Pain during sex from injuries during delivery or oral intercourse (with appropriate safety and • Poor body image hygiene precautions). • Adjusting to your role as a mother • Fear of awakening the baby or inability to Third Trimester hear the baby crying. Rememberthat There is a dramatic decline in sex- The important thing is for you and your part- these changes have ual activity, interest, and satisfac- ner to recognize these new stresses and make physical causes, and tion among women and men alike allowances for them. If any problems persist for a during the third trimester. You long timesuch as pain during intercourse or pro- understanding these may feel awkward and uncomfort- longed feelings of depression you should report causes can prevent able, and you’re immersed in pre- them to your OB/GYN. feelings of rejection paring for the baby’s arrival. You and resentment…. may also fear that sex will trigger Understanding Is the Key labor, bleeding, pain, and injury Pregnancy generally has an increasingly negative to the unborn baby. Again, your effect on sexual activity and satisfaction as you OB/GYN is your source for information and reas- get closer to delivery. You can prevent this from surance about these concerns. happening by talking things over with your part- ner and your OB/GYN week by week throughout After Delivery pregnancy. Rememberthatthese changes have Changes in sexuality continue after delivery. physical causes, and understanding these causes Levels of sex hormones plunge temporarily lead- can prevent feelings of rejection and resentment ing to a state that is almost like menopause. from festering. Keep the lines of communication You may have vaginal dryness and irritability, open, and don't let misunderstanding ruin this with thinning of the vaginal walls. This results in time of joy. decreased vaginal lubrication and flexibility, mak- ing sex uncomfortable and less desirable. These Points to Discuss With Your OB/GYN symptoms may be aggravated by breastfeeding. • Ask about other means of sexual stimulation However, new mothers often experience sensual during pregnancy. pleasure during breastfeeding, which is thought • Ask about alternative sexual positions, such as to be an essential part of the bonding process. side-lying (“spooning”), female superior, rear entry, and use of pillows to assist. • Ask whether sexual activity and orgasm pose Resources any risk to the baby. • The American College of Obstetricians and Gynecologists • Ask about prenatal classes and education} http://www.acog.org you can benefit from sharing your concerns • The American Academy of Family Physicians and experiences with other couples. http://www.aafp.org • The US National Library of Medicine and the National Institutes of Health This handout was prepared by Michael L. McDaniel, MD, http://www.nlm.nih.gov private practitioner, Obstetrics and Gynecology, Peachtree • The Mayo Clinic—Women’s Health Women’s Clinic, Northside Hospital, Atlanta, GA, using http://www.mayoclinic.com materials from McDaniel, ML. Sexuality in pregnancy. The Female Patient. 2007;32(8):35-40. The Female Patient grants permission to reproduce this handout for the purposes of patient education. 8/07 A downloadable version of this patient handout is also available at: www.femalepatient.com. .