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by Susanne
J. Phillips, MSN, NP
A woman's sexual response can vary greatly during and after pregnancy, due to a host of factors. Such influences include hormones, physical symptoms such as nausea and fatigue, and psychological issues such as fear, anxiety and self-image. Despite these factors, some women find their libido improves during this period.
Interestingly, the woman's feelings, emotions, and physical symptoms are not the only factors to influence this issue. Sometimes her partner has strong opinions about sex during pregnancy, which can influence the libido positively or negatively. If your spouse or partner is concerned about sexual contact during pregnancy due to fear of hurting the fetus, you should speak with your health care provider about the concerns. A little bit of education is often all that is required to clarify any concerns.
Women with a multiple pregnancy, (twins, triplets, quads,
etc.), history of frequent miscarriages, or infertility treatments
will be advised to abstain from intercourse during some or
all of their pregnancy. However, a woman with a low-risk,
normal pregnancy, (which is the majority), sexual intercourse
is not contraindicated.
The First Trimester (4-12 weeks)
During the first trimester, (4-12 weeks), many women notice
a decreased libido primarily due to fatigue and nausea caused
by normal hormonal fluctuations. Women who have had a miscarriage
may be concerned that intercourse during the first twelve
weeks of pregnancy will put them at higher risk of subsequent
miscarriage. Although this is a real fear, there is no evidence
that sexual intercourse during the first trimester will cause
a miscarriage.
The Second Trimester (13-28 weeks)
During the second trimester,, (13-28 weeks), most women notice
a return of their libido and many report an increase in libido
during this period, due in part to the increased blood supply
to the pelvic region and increased estrogen levels. The fatigue
and nausea usually taper off by the second trimester when
women usually report they feel their best. As the third trimester
approaches (29-40 weeks), women again report variability in
sexual desire. This is primarily influenced by the size of
her growing abdomen, fatigue, and general comfort. If there
are no obstetric complications, sexual intercourse may be
continued as desired. There is no evidence that intercourse
precipitates premature labor, however, if a woman has experienced
premature labor, her physician, nurse midwife, or nurse practitioner
will advise her to stop sexual activity until after delivery
of the baby.
Reasons to Discontinue Intercourse
During Pregnancy
Not all women are advised to continue normal sexual activity in pregnancy, however. Your physician, nurse midwife, or nurse practitioner will advise you to discontinue intercourse or orgasm, or both, for at least part of your pregnancy if:
- You or your partner has an untreated sexually transmitted infection
- You have a history of premature labor or have signs of premature labor
- You have been diagnosed with placenta previa
(when the placenta blocks all or part of the cervix)
- You have a recurrent history of first-trimester miscarriage
- Your placenta has prematurely separated from the uterine wall
- You are carrying more than one baby
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After the Delivery of the Baby
Following delivery of the baby, couples usually look forward to a return to their normal sexual activity. There are many factors which influence the rate at which women and their spouses resume sexual activity, including fatigue, self image, role adjustment, breastfeeding issues, and fear of pain and new pregnancy.
Healthcare providers usually recommend abstaining from sexual activity for six weeks to allow the vaginal and uterine tissues to heal and to allow for the vaginal bleeding to stop, however many women report a resumption of sexual activity prior to this appointment. Women are advised that pregnancy is possible and should be counseled to use a method of birth control suited to their needs. Many women have returned to their healthcare provider for a six-week follow up only to find out that they are pregnant again.
Fatigue and fear of pain are frequently reported as major
concerns and reasons delaying sexual intercourse. Disturbance
of sleep in the first three to five months is often enough
to prevent sexual intercourse from resuming. Vaginal discomfort
may persist for weeks or months due to factors such as episiotomy
and or breastfeeding. Following delivery, estrogen levels
fall temporarily, allowing thinning of the vaginal tissues
to occur. Most healthcare providers recommend using a water-based
lubricant to alleviate discomfort and prevent tearing
of the vaginal tissues. Breastfeeding will also influence
the return of hormones to pre-pregnancy levels, which may
alter sexual desire.
Most healthcare providers recommend resuming your sex life slowly, following a discussion between you and your partner about expectations and body image. Patience and time are required to allow your body to resume normal hormone patterns, heal tissues and for your mind to accept a positive self-image. If you continue to have symptoms or concerns that prevent you from resuming sexual activity four months after the delivery of your child, make an appointment to see your healthcare provider for an exam and consultation. Keep your expectations realistic, use humor, and continue to communicate. You can look forward to an active, healthy sex life–who knows, maybe even be better!
References
DeCherney, A. & Pernoll, M. (1994) Current Obstetric & Gynecologic Diagnosis & Treatment, 8th Ed. Appleton & Lange: Connecticut.
Other Resources
 www.webmd.com
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