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.

The vagina has a self-cleaning system in the form of normal vaginal discharge. Using the wrong products or underwear may upset the delicate balance of natural vaginal organisms and irritate the vulva. Click here for more information on vaginal discharge and itch.

Clothing

• Wear loose clothing – try to avoid jeans, tight-fitting pants, leggings or pantyhose
• Try to wear white 100% cotton underwear. Materials like nylon or other manmade fibres may irritate your vulva if you have sensitive skin.
• Avoid wearing thongs
• Use a mild soap to wash your underwear and double rinse them. Avoid fabric softeners for your underwear 
• Try going without underwear at home or while sleeping if you are experiencing vaginal itch or discharge
• Change out of wet swimwear immediately after swimming 

Washing

• Use soft, white toilet paper 
• Do not wash your genital area more than 1-2 times a day. Use mild, unperfumed soap and warm water to use the outside of your vagina
• Do not douche
• Do not use feminine wash, feminine spray/deodorants, bath oils, talc or powder 
• Avoid scratching. Relieve your itch with a cold pack.

Periods

• If you prefer to use sanitary pads, try and change brands until you find a particular brand that is more suited for your skin
• Tampons or menstrual cups are another option. Avoid deodorant tampons, and change them regularly. 
• Do not use tampons when using vaginal suppositories or creams as they may absorb the medications

Vaginal pessary medications (if any)

• Take your medicines exactly as prescribed. You can continue treatment even if your period starts.
• Avoid sex until your treatment is complete

Vaginal itch affects most women at some point of their lives. Majority of the time this is temporary and goes away on its own. Causes of vaginal itch include:

Skin irritants

• Soap
• Douches
• Feminine sprays 
• Laundry detergents
• Fabric softeners
• Scented/colored toilet paper 
• Creams or ointments 

Skin conditions 

• Eczema
• Lichen sclerosis: more common in women who are menopaused, this skin condition causes patchy white and thin skin in the genital area 
• Contact dermatitis: this is when something is in contact with the vagina or vulva e.g. women who wear pads/diapers for long periods of time, or in women who suffer urinary incontinence
• Atrophic vaginitis: menopausal skin changes in the vagina due to a lack of estrogen causes vaginal skin to thin out and vaginal pH to be higher/less acidic resulting in increased risks of itch and infection 

Infections

This can be non-sexually transmitted or sexually transmitted infections (STIs), and usually occurs with vaginal discharge.

Vulvar cancer (rare)

Vulvar cancer does not always cause symptoms. Some women may experience bleeding, pain or skin changes in the area.

When should I be concerned about my vaginal itch?

If the itch is significant enough to interfere with your daily life or sleep, or if you have associated symptoms such as vulva ulcers/blisters, vaginal pain, redness, swelling, painful urination, unusual vaginal discharge, painful sex, bleeding in between periods or bleeding after sex, you should see your gynaecologist. 

What tests do I need?

Your gynaecologist will take a detailed medical history and perform a pelvic examination to check your vulva, vagina, cervix and uterus. Depending on your symptoms, you may require vaginal swabs or skin biopsy.

Is there treatment for vaginal itch?

Treatment depends on the cause for your vaginal itch. Discuss with your gynaecologist about the appropriate options for you. Treatment options may include:

Lifestyle changes

See vulva care for more information.

Vaginal creams or pessaries

These may come in the form of steroid creams (caution about using these long-term as it may thin out the skin further) or topical female estrogen (in cases of menopausal skin changes). 

Antibiotics 

For cases of infection.

Vaginal discharge is common and normal in most cases. Women of any age can get vaginal discharge. It is important to remember that the vagina (like the gut) has a self-cleaning mechanism and contains normal organisms which can be upset by stress, poor immune system or imbalanced diet.

What are the causes of vaginal discharge?

Normal causes

Ovulation

This usually happens around the middle of your cycle (if your periods are regular), where your vaginal mucus is clear and can feel wet/slippery.

Pregnancy

High levels of hormones during pregnancy can mean heavier-than-usual discharge, which is not smelly or itchy.

Certain birth control methods 

Having a IUD in your uterus can result in heavier than usual vaginal discharge that is not smelly or itchy.

Recent sex

This can occur the next day after sex if ejaculation was inside the vagina, as the semen leaves the vagina. 

Infections 

Non sexually transmitted

Bacterial vaginosis (BV): this is common and may result in a fishy smell. It is caused by an overgrowth of normal germs in the vagina. This may not need treatment if you do not experience any symptoms.

Candida (thrush): this is common and come in the form of a creamy, curd “tofu”-like discharge that can be both thick or watery. It may result in itch and/or redness. This may not need treatment if you do not experience any symptoms. If you have pain on having sex or passing urine, you will need treatment. 

Sexually transmitted infections (STIs)

STIs that can cause abnormal vaginal discharge include chlamydia, gonorrhea and trichomonas. 

Rare causes

Cervical polyps or ectropion

Cervical polyps are small growths that can occur on the cervix. Majority are non-cancerous and can be removed in the clinic. Ectropion is where cells that line the inside of the cervix grow on the outside – these are more sensitive and can bleed on contact.

Cervical cancer

This may cause a smelly discharge which may be blood stained. Associated symptoms include bleeding in between periods, or bleeding after sex. 

When should I be concerned?

See your gynaecologist if you have:

• A change in the amount, colour or smell in your discharge e.g. green, yellow, pink/blood-stained, fishy smell etc 
• Associated symptoms e.g. painful sex, pain on passing urine, bleeding in between periods, bleeding after sex

What tests do I need?

Your gynaecologist will take a detailed medical history and perform a pelvic examination to check your cervix and uterus. Depending on your symptoms, you may require vaginal swabs, Pap smear/HPV test, ultrasound scan or blood tests.

What is the treatment for vaginal discharge?

It depends on the cause. There is usually no treatment needed for normal causes. Non sexually transmitted infections may or may not require treatment (depending on symptoms). For STIs, antibiotics will be required and your gynaecologist will discuss with you the steps needed for treatment. 

What can I do to prevent vaginal discharge?

Nothing as they are part of a woman’s life. Here are some of the dos and don’ts:

Do:

Wash the outside of your vagina with plain gentle soap and warm water 

Include more probiotics in your diet. Dietary examples include natural yoghurt, vitagen, yakult. There are also oral supplements that are available.

Don’t:

Douch, use feminine washes or scented wipes: this upsets the natural balance of the vaginal organisms

Use perfumed soaps 

 

What is emergency birth control?

Emergency birth control (or emergency contraception aka “morning after”) helps prevents pregnancy after you have had unprotected sex or if the birth control method that you used failed (e.g. condom split).

What are the different types of emergency contraception?

• Morning after pill

There are 2 different morning after pills: ellaOne and Postinor-2.

ellaOne has 1 tablet that should be taken as soon as possible within 120 hours (5 days) after sex. It is up to 98% successful if taken correctly. Its effectiveness drops after 120 hours from sex.

Postinor-2 has 2 tablets – the first should be taken as soon as possible within 72 hours after sex and the second should be taken 12 hours after the first tablet. It has a 85% effectiveness in preventing pregnancy, but this is time dependent. If the first tablet is taken within 24 hours after sex, it is 95% effective. If it is taken between 48 to 72 hours after sex, it is 58% effective. 

Vomiting is a side effect of the morning after pill and you should take another tablet as replacement and see your doctor if another dose is needed. Other side effects include headache, breast tenderness, dizziness or fatigue. 

There are certain medications that can reduce its effectiveness e.g. medicines for epilepsy, tuberculosis, acid reflux.

If you have another episode of unprotected sex after taking the morning after pill, the pill will not stop you from becoming pregnant.

• Copper T (IUD)

This small T-shaped device that is put into the uterus. It should be inserted as soon as possible within 120 hours (5 days) after sex, or up to 5 days after the earliest time you may have ovulated. This can be done in the clinic. It is more effective than the morning after pill in preventing pregnancy (99% success), and can be left in to be used as your regular birth control method.

Important notes

• Emergency contraception does not work if you are already pregnant
• Morning after pills should not be used as your regular method of birth control
• Emergency contraception does not protect you against sexually transmitted infections (STIs)
• Although it is common for your next period to be a few days late, you should do a pregnancy test anytime you suspect you may be pregnant and see your gynaecologist

This article focuses on female sterilization (tubal ligation). 

Sterilization is a permanent form of birth control that is irreversible. Female sterilization involves laparoscopic (key-hole) tubal ligation as a day surgery under general anaesthesia, where the fallopian tubes are clipped or tied off to prevent the egg from meeting the sperm. It can also be performed at the time of C-section. Ligation does not affect sex or your periods. 

Male sterilization involves a vasectomy as a day surgery under either local or general anaesthesia, where the vas deferens are clipped or tied off to prevent sperm from being released into the semen. 

What are the risks of tubal ligation?

Common (affecting 1-5% of patients):

• Bleeding/ bruising at wound site
• Shoulder tip pain
• Infection
• Clip migration

Uncommon (affecting 0.1-1% of patients):

• Failure of sterilisation (1:200 chance of unplanning pregnancy – this may be higher if ligation is done immediately after childbirth or abortion)
• Ectopic pregnancy 
• Failure to gain entry into the abdomen 
• Injury to surrounding organs e.g. intestines, bladder, blood vessels 

Rare (affecting <0.1% of patients):

• Anaesthesia complications
• Uterine perforation: this may require steps to stop bleeding or additional stitches
• Death: the risk is approximately less than 3-8 in 100 000

What are my alternatives besides tubal ligation if I am not planning for more kids?

You may consider long-acting reversible contraception options e.g. IUD or contraceptive implant (implanon), which last between 3-5 years.

What happens if I regret after having a tubal ligation?

Although reversal of tubal ligation is possible, it is technically challenging and success rates are low, with an increased risk of ectopic pregnancies and the tubes becoming blocked again after reversal surgery. It is important to be sure of your decision before going for a tubal ligation – speak to your gynaecologist for further advice.

What is sexually transmitted infections (STI)?

STIs are infections spread through oral, vaginal, penile or anal sexual contact. These include:

• Chlamydia
• Gonorrhea
• Trichomonas
• Genital Herpes 
• Human Papillomavirus (HPV)
• Hepatitis B
• Syphilis
• HIV/AIDS

What are the symptoms of STI?

Most do not have symptoms. Some symptoms include:

• Vaginal itch
• Foul smelling vaginal discharge
• Fever, discomfort
• Painful sex
• Bleeding in between periods, or bleeding after sex
• Genital warts

In some cases, infections can spread upwards from the vagina and cervix to affect a woman’s uterus, fallopian tubes and ovaries (pelvic inflammatory disease).

What tests do I need?

Your gynaecologist will take a detailed medical history and perform a pelvic examination. Swabs will be taken from the genital region e.g. vagina and cervix to test for infections. Blood tests are required to check for hepatitis, syphilis and HIV/AIDS.

If your tests come back positive, you and/or your partner will be advised for additional tests. 

I have been diagnosed with STI. What treatment do I need?

Treatment depends on the STI you have. Your gynaecologist will discuss the appropriate treatment options for you, which may include antibiotics and a test-of-cure (if applicable) after antibiotic completion.

Contact your gynaecologist earlier if you experience:

• Increasing abdominal pain
• Worsening/persistent fever
• Feeling very unwell 

What about my partner?

Your partner may have no symptoms even if they have STIs. It is important for all partners to be tested and treated appropriately, to avoid reinfection and long-term health problems. 

Avoid sexual contact for a week after you and your partner have completed treatment. Use a condom to protect against STIs and to prevent reinfection. 

What is pelvic inflammatory disease (PID)?

PID is a condition where there is inflammation of a woman’s uterus, fallopian tubes and ovaries, usually caused by an infection that spreads upwards from the vagina and cervix. It is more common in young, sexually active women, or in women who have endometriosis.

In some cases, PID can be caused by sexually transmitted infections (STIs) like chlamydia or gonorrhoea; in other cases, it can be caused after procedures such as intrauterine contraceptive device (IUD) insertion, termination of pregnancy, hysterosalpingogram (HSG). 

What are the symptoms of PID?

• Fever
• Smelly vaginal discharge
• Lower abdominal pain
• Pain during sexual intercourse (dyspareunia)
• Unusual bleeding in between periods or bleeding after sex

Do see your gynaecologist as these symptoms can also be caused by other conditions. 

What tests do I need?

Your gynaecologist will take a detailed medical history and perform a pelvic examination. Swabs will be taken from the vagina and cervix to test for infections. It is still possible to have PID even if the swabs return negative as they may not be able to pick up the infections all the time. Blood tests may help to determine the level of inflammation in your body, especially if you have a fever. A urine pregnancy test may be done if you have any chance of being pregnant. An ultrasound scan will also be performed to check for any formation of abscess (pus collection) in the pelvis. 

If your swab test comes back positive, you and/or your partner will be advised for additional tests. 

I have been diagnosed with PID. What treatment do I need?

Most women can be successfully treated with 2 weeks of oral antibiotics, although severe cases may need hospitalisation for intravenous antibiotics. You will need painkillers and rest, and must continue follow-up with your doctor to ensure that your PID has resolved. 

Contact your gynaecologist earlier if you experience:

• Increasing abdominal pain
• Worsening/persistent fever
• Feeling very unwell 

What happens if I don’t treat my PID?

Prompt and complete treatment is important as there can be serious health consequences if PID goes untreated, as it can cause pelvic organ scarring and result in you being at risk of:

• Ectopic pregnancy (pregnancy outside of the womb)
• Pelvic abscesses
• Chronic lower abdominal pain 
• Recurrent PID 
• Infertility 

Do I need an operation?

Some women with severe PID and large pelvic abscesses who do not improve with intravenous antibiotics may require an operation for pus drainage. This may be done via a keyhole (laparoscopy) surgery or by the X-ray department – your doctor will discuss the appropriate options with you.  

What about my partner?

PID can be caused by STIs and your partner may have no symptoms even if they carry the infection. It is important for all partners to be tested and treated appropriately, to avoid reinfection and long-term health problems. 

Avoid sexual contact for a week after you and your partner have completed treatment. Use a condom to protect against STIs and to prevent PID reinfection. 

What is painful sex (dyspareunia)?

This refers to pain felt in the pelvis or vagina during sex, which can sometimes last up to 24 hours afterwards. It is common but under-reported by women.

What is the cause of painful sex?

• Vaginismus
  This is a condition where vaginal muscles involuntarily contract when penetration is attempted. Although this does not affect sexual arousal, it can prevent penetration from happening. This may be linked with past trauma or emotional factors.

• Insufficient lubrication
  Lack of foreplay, rough sex or sex toys can result in insufficient vaginal lubrication which causes sex to be painful.

• Pelvic inflammatory disease
  This is a condition where there is inflammation of a woman’s uterus, fallopian tubes and ovaries, usually caused by an infection that spreads upwards from the vagina and cervix.

• Endometriosis
  Tissue from the womb lining is found outside the womb, most commonly in the pelvis, where it can affect the ovaries, fallopian tubes and intestines. These tissue respond to hormonal changes and bleed during periods, causing pain and inflammation. The resultant scarring can cause a women to feel pain during deep penetration.

• Vagina scarring or abnormalities
  Scarring from an episiotomy/tear following childbirth or previous vaginal surgery may cause sex to be painful. Certain abnormalities of the vagina e.g. abnormal covering or septum may also result in painful sex.

• Chronic pelvic pain
  This refers to pain in the pelvis that lasts for 6 months or longer, and can manifest in painful sex.

• Menopausal changes (atrophic vaginitis)
  Menopause women have low estrogen which causes thin and dry vaginal skin (vaginal atrophy).

• Pelvic organ prolapse
  This refers to a drooping of the uterus, bladder or rectum beyond the vagina, and is more common in older women with previous childbirth. The sagging pelvic organs can cause a woman to feel discomfort during sex.

• Bladder pain syndrome
  Previously known as interstitial cystitis, this is a condition involving bladder discomfort or pain associated with urinary symptoms which can also manifest in painful sex.

What complications can dyspareunia cause?

It can result in an inability to have sex, which in turn may lead to relationship strain and difficulty in getting pregnant. It can also impact on one’s psychological well-being and self-esteem.

What tests do I need?

Your gynaecologist will take a detailed medical history and perform a gentle pelvic examination with your permission to check your vagina and pelvic organs. Depending on your symptoms, you may require an ultrasound scan and vaginal swabs.

How can my painful sex problem be treated?

Treatment options depend on the cause of dyspareunia. Vaginismus therapy typically involves sex counselling, with education of your anatomy, involved muscles and what happens at arousal, foreplay and intercourse. This may involve your partner, relaxation techniques and working on other forms of sexual intimacy first e.g. oral sex, sensual massage and mutual masturbation with gradual progression. Infections will need to be treated with antibiotics. Treatment of endometriosis will depend on severity of other symptoms, stage of endometriosis, and fertility plans. Vaginal scarring and abnormalities may require surgery. Menopausal changes (atrophic vaginitis) can be treated with topical vaginal estrogen creams and tablets. Painful bladder syndrome will need lifestyle and dietary modifications and sometimes medications.

This article is on intrauterine contraceptive device (IUD). 

What is an IUD?

It is a small, inert, T-shaped device that is inserted into the uterus. It sits in the cavity of the uterus, with 2 short threads attached to its end that passes out through the cervix for easy removal. An IUD lasts for 5 years, and prevents pregnancy by thickening the cervical mucus, preventing fertilisation of the egg and making it difficult for implantation of a fertilized egg. Only 1-2 out of 100 women on IUD will become pregnant over 5 years, which makes it a highly effective birth control method. 

There are 2 types of IUD – the copper IUD (known as the copper-T or copper coil), and the Mirena IUD (this contains progesterone hormone). The copper IUD works immediately after insertion, while Mirena takes 7 days to start working. Both are as effective for birth control, but the Mirena IUD has additional functions of treating heavy periods, bad menstrual cramps and endometriosis.

Both can be inserted (or removed) in the clinic if you have had sex and/or given birth before. IUD can also be inserted together with other surgeries e.g. hysteroscopy dilation and curettage, surgical abortion.

The IUD does not protect you against sexually transmitted infections (STIs) – you should use condoms in addition for that.

What are the risks of IUD insertion?

Common (affecting 1-5% of patients):

• Discomfort for a few hours and light bleeding for a few days following insertion
• 1:20 risk of IUD expulsion (most common within 1^st year)
• Menstrual disturbances especially in the first 3-6 months (e.g. light/heavy periods, long periods, bleeding in between periods, irregular periods, menstrual cramps). 30-40% of Mirena users will have light/infrequent periods or no periods by the end of the 1^st year. 

Uncommon (affecting 0.1-1% of patients)

• Difficult insertion (especially if you have not given birth vaginally before)
• Malpositioned IUD: this may require removal and insertion of a new IUD, or hysteroscopy to remove if threads are missing 
• Pelvic inflammatory disease (especially within first 20 days of insertion)
• Failure rate (getting pregnant on IUD)

Rare (affecting <0.1% of patients):

• Uterine perforation: IUD migrates out of the womb, requiring surgery to remove 
• Ectopic pregnancy: risk of this in IUD users are lower compared to women not using any contraception

How soon can I put an IUD in after giving birth?

You should wait at least 6 weeks after giving birth for your uterus to shrink back to its normal size before inserting an IUD. Breastfeeding can make your uterus soft and there can be a slightly higher risk of uterine perforation.

What should I take note of when I have an IUD inserted?

There should be no change required in your lifestyle – you should be able to go back to work and your usual activities on the day of or the next day of IUD insertion. Resume your exercise, swimming and sex as usual after the initial discomfort and spotting following insertion have stopped. You may use tampons and pads for your periods. If using menstrual cups, wait for 6 weeks after IUD insertion and check for your IUD threads after each period if you can.

See your gynaecologist earlier for a check-up if you:

• experience foul smelling vaginal discharge, fever, lower abdominal pain 
• have menstrual disturbances that persist or worsen beyond a few months after IUD insertion
• suspect that your IUD may have fallen out or if you may be pregnant  

What are the risks of IUD removal?

Common (affecting 1-5% of patients):

• Discomfort for a few hours and light bleeding for a few days following removal

Uncommon (affecting 0.1-1% of patients)

• Incomplete removal (especially if IUD is malpositioned or has been left inside for a long time)
• Pelvic inflammatory disease

Rare (affecting <0.1% of patients):

• Embedded IUCD or fragments: surgery may be required to remove this 
• Uterine perforation during removal, requiring surgery

When can I try for pregnancy after my IUD is removed?

You can try for pregnancy immediately after your IUD is removed as there is no delay to your fertility returning. Do take note of preconception care.