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Sex during Pregnancy: When to Indulge, When to Abstain

Thursday, October 24th, 2013

Pregnant women and their partners often have questions about sex. Is it safe during pregnancy? Will it induce labor? How long do we have to wait after delivery to have sex? In spite of doctors’ reassurances, many pregnant women still have fears related to sexual intercourse while they are pregnant, such as whether it could cause miscarriage or otherwise harm the fetus. In addition, body image, physical discomfort, and fatigue often curtail the sex lives of pregnant women.

In fact, for women with low-risk pregnancies, sex is perfectly safe. Studies have shown a slightly increased risk of preterm labor in women who had sex and symptoms of lower genital tract infection, but in low-risk women with no symptoms of infection, sex does not in any way increase the risk of preterm labor. Fears of harming the fetus are also unfounded; the fetus is very well-protected and completely oblivious to the mother’s sexual activity.

Women at increased risk for complications, such as those who have a history of preterm labor, incompetent cervix, or multiple gestation, may be advised by their doctors to abstain from sex, but even in these women, an increased risk of complications may not exist. Studies have not shown elevated risks of preterm labor even in women with higher-risk pregnancies, despite the fact that these women are often cautioned that sex could be dangerous for them. Studies also show that women with twin pregnancies and women with cervical cerclage due to incompetent cervix have no greater risk than other pregnant women of preterm labor caused by sex. Although these women are commonly advised not to have sex, the evidence does not exist to support these concerns.

What studies have shown is that women with a higher number of sexual partners throughout their lifetimes do have an increased risk of preterm labor. This is probably because in these women there exists a higher probability of asymptomatic bacterial colonization in the genital tract, which does present a higher risk. Therefore, women with high-risk pregnancies should, at a minimum, be screened for bacterial vaginosis before engaging in sexual intercourse.

It should be said that regardless of actual risk, abstaining from sex causes no harm and is a simple intervention that can be implemented to remove any doubt about whether sex during pregnancy is safe. Therefore, in women with high risk pregnancies, this is still a reasonable recommendation, until further studies present even more solid evidence.

Besides preterm labor, other possible complications thought to arise from having sex during a high-risk pregnancy are venous air embolism, antepartum hemorrhage in placenta previa, and pelvic inflammatory disease.

As for whether sex can be used to induce labor in a full-term pregnancy, there is no evidence showing that it works. Nipple and genital stimulation have commonly been recommended as ways to induce labor by supposedly promoting the release of natural oxytocin, and prostaglandins in semen have been said to encourage cervical ripening. However, there is no scientific evidence to prove that these methods have any effect. But again, there is no harm in trying them in low-risk pregnancies, either.

The bottom line is that there are very few known risks involved in sexual intercourse or other sexual activity during pregnancy, so don’t worry.  I fondly remember my grandmother saying, “Why would you want to have sex?  You’re already pregnant!”  With that said, abstinence may be a reasonable action to take to remove the risk altogether in high-risk pregnancies, but still, the evidence does not show that this makes a difference in the outcome of the pregnancy. After delivery, follow your doctor’s instructions and your own physical and emotional comfort level in deciding when to resume intercourse.

– Yvonne S. Thornton, M. D., M. P. H.