A Guide to Sexual Health and Intimacy During Pregnancy 

Pregnancy is a unique time characterised by various physiological changes within your body. It can be exciting and challenging. One big question that often arises for expectant parents is how pregnancy affects their sexual health and intimacy.

This helpful guide will discuss how to maintain good sexual health and keep intimacy alive during pregnancy. We'll provide clear advice and answers to your questions so you can feel more confident about these changes during this special time. 

Why should we prioritise sexual health and intimacy during pregnancy?

Prioritising intimacy and sexual health during pregnancy is crucial for several reasons:

• Physical well-being: maintaining sexual health also leads to good physical stamina and mobility, which aids in ensuring a smooth delivery. 
• Emotional connection: pregnancy can feel like a physical and emotional rollercoaster. Focusing on intimacy can strengthen the emotional bond between partners as they embark on the journey to parenthood. 
• Communication: discussing desires, insecurities, concerns, and boundaries can lead to a deeper understanding and a more fulfilling sexual relationship – this is particularly important as an expectant mother goes through massive physical, mental, and emotional changes. 
• Reducing stress: engaging in sexual activities can release endorphins, which is excellent for dealing with a stressful pregnancy. 
• Preparation for labour and delivery: some sexual activities can help prepare your body for labour and delivery. Semen contains prostaglandin, which can help soften and ripen the cervix and initiate contractions. Sexual arousal and orgasm can also lead to the release of oxytocin, which plays a role in uterine contractions as well. 
• Postpartum benefits: prioritising sexual health during pregnancy can make it easier to resume a fulfilling sexual relationship after childbirth. 

What are common concerns about intimacy during pregnancy?

Here's an overview of common concerns about intimacy during pregnancy: 

• Hormonal shifts: hormonal fluctuations during pregnancy may lead to decreased libido in some women and increased libido in others, as well as emotional and psychological shifts such as anxiety or stress. Furthermore, each pregnancy is different. Recognising your physical and mental needs and being open with your partner about these are important. 
• Physical changes and body image: pregnancy is a time of significant bodily change – weight gain, breast enlargement, growing belly, lower limb swelling, spider veins, skin pigmentation, etc. Whilst these are natural and necessary, the expectant mother may not feel at her most flattering. It is important to be kind and gentle to yourself, understand what your body is going through to appreciate how amazing it is, surround yourself with body positivity, and communicate openly with your partner. 
• Discomforts and aches: the third trimester can be particularly marked by discomforts/aches, especially due to ligamentous stretch as your body prepares for childbirth. Certain sexual positions may also become more challenging; take your time to figure out what feels comfortable and what works best for you and your partner during this time. 
• Safety and medical considerations: some pregnancy conditions may preclude sexual intercourse due to the risk of bleeding or preterm delivery, e.g. placenta previa – do seek your obstetrician’s advice on this. However, this should not stop you from having non-penetrative/non-sexual intimacy with your partner. 
• STIs and infections: some people may worry that having sexual intercourse during pregnancy can lead to ascending infection into the uterus, resulting in foetal infections; this is not the case unless the water bag has leaked/burst. If you are concerned about STI transmission, condoms are the only known way to protect against that. 

It is important to note that while these concerns are common, each pregnancy is unique. Expectant parents should openly communicate with their obstetrician and gynaecologist to address specific questions and ensure a safe and healthy sexual experience during pregnancy.

What are some physical intimacy tips during pregnancy?

Maintaining physical intimacy during pregnancy can be both enjoyable and safe if you follow a few helpful tips:

• Explore safe and comfortable positions: these can include side-lying, spooning positions that do not put pressure on your abdomen or lower back. Using pillows to prop/support your body is also a good idea. 
• Understanding libido changes: increased libido can be influenced by hormonal changes, increased blood flow to the pelvis, and changes in breast sensitivity; on the other hand, decreased libido can result from morning sickness, fatigue, nausea, and anxiety/stress regarding the pregnancy. Hence, it is not unusual for your libido to fluctuate during pregnancy. Although it is important to recognise this in yourself, it is also good to remember that your partner may also have reactions/responses to your changing libido, and hence, being honest with each other is vital. 
• Consider non-penetrative activities: intimacy does not always need to end up in penetrative intercourse. There are myriad ways to achieve physical intimacy with your partner during pregnancy, including kissing, cuddling, hugging, massage, foreplay with oral/manual stimulation, shared showers, etc.  

When should I seek a doctor’s guidance regarding sexual activity during pregnancy? 

It is crucial to know when to seek a doctor's guidance regarding sexual activity during pregnancy. While sexual activity is generally safe for many pregnant individuals, there are specific situations where caution and medical advice are necessary. Here are some guidelines to consider:

• Placenta previa: this refers to a low-lying placenta that covers part of/all of the cervix (neck of the womb). This can put you at an increased risk of bleeding during your pregnancy; this bleeding is usually painless and can range from light to heavy bleeding. The good news is that in most cases, the placenta will move up and away from the cervix as the pregnancy progresses and the uterus grows; avoid sexual intercourse until your doctor advises you that it is safe to do so. 
• Preterm labour risk: preterm labour refers to going into labour before 37 weeks of pregnancy; risk factors include having a history of preterm labour in your previous pregnancy, anything that increases uterine distension (having a big baby, twins, excessive amniotic fluid in the water bag), abnormal uterine shape, short cervical length leading to cervical insufficiency. Sexual activity can sometimes promote the release of prostaglandins, which in turn can induce contractions, so if your doctor has told you that you are at a higher risk of preterm labour, it would be prudent to avoid sex. 
• Vaginal bleeding: if you experience vaginal bleeding before, during, or after sexual intercourse, do not continue sexual activity and seek your obstetrician’s advice at the soonest. 
• Ruptured membranes: if your water bag has leaked/burst, it is generally not a good idea to have sexual intercourse due to the risk of ascending infection. 

Schedule an appointment with an obstetrician and gynaecologist to discuss your concerns about intimacy and sexual activity during pregnancy.

What should I know about postpartum intimacy?

Understanding postpartum intimacy is crucial for both partners following childbirth. The timing varies between couples and depends on individual comfort and physical recovery. Afterbirth bleeding (lochia) typically lasts 6-8 weeks following birth, and it is advisable to wait until this has stopped or significantly decreased to reduce the potential risk of infection. 

If you had a vaginal birth with tears/episiotomy, wait until you have fully healed before resuming sex, which is usually around 6 weeks. If you had a caesarean section, the abdominal wound can take a little longer to heal. The first sexual intercourse after childbirth can feel scary; it is crucial to listen to your body and go slowly. Postpartum hormonal changes and breastfeeding can result in vaginal dryness, so using a water-based lubricant can go a long way in making sexual intercourse more comfortable. 

If you experience pain, discomfort, or bleeding during or after sex, it may be a sign that your body is not yet fully healed or ready for sex; do not persist and seek individualised advice from your gynaecologist. It is usually advisable to space pregnancies, so if you are not ready for your next one, do discuss contraceptive methods with both your gynaecologist and partner so that you can make an informed decision regarding this. 

Conclusion

The importance of maintaining intimacy during pregnancy cannot be over-emphasised. Remember to listen to your body and communicate openly with your partner about what feels comfortable and pleasurable. If you experience any discomfort, pain, or spotting during or after sex, contact your obstetrician to ensure there are no underlying issues. Every pregnancy is unique, so what works best for one couple may not be the same for another. Prioritise safety, comfort, support, and communication to have a satisfying and enjoyable sexual experience during pregnancy.