Sex & Pregnancy

Lets talk about what to expect when you’re expecting… when it comes to sex! Even though most people become pregnant as a result of sex, not many people will ask how someone’s sex life has changed because of pregnancy. I personally believe we need to normalize checking in on the sexual wellness state of our friends, especially during significant periods of change. People are still sexual beings during pregnancy and how pregnancy affects someone’s sex life can vary considerably. It can be immensely helpful to talk about those changes with the people you trust and who care for you. 

Is it safe to have sex while pregnant?

Sex is considered safe during all stages of a low-risk pregnancy. The fetus floats in amniotic fluid that acts as a cushion and the strong muscles of the uterus also protect the fetus during sexual activity. However, there are certain health concerns that may require abstaining from sex. Here are some pregnancy-related conditions that could lead to a healthcare provider recommending avoiding sexual activity:

• Placenta Previa: This is a condition where the placenta covers part or all of the cervix. Sexual activity, especially penetrative sex, could increase the risk of bleeding and complications with this condition. 

• Preterm Labour: If there are signs that suggest the risk of going into labour prematurely, restricting sexual activity may be recommended to avoid triggering contractions. 

• Vaginal Bleeding: Any unexplained vaginal bleeding during pregnancy can be a sign of complications, which sexual activity could aggravate. 

• Ruptured Membranes: If the amniotic sac has ruptured and the “water has broken”, there is a risk of infection if sexual activity occurs. 

Every pregnancy is unique. Talk to your healthcare provider to determine what is safe based on your specific health circumstances. 

What are some factors that can affect someone’s sex life during pregnancy?

During pregnancy, individuals may experience various changes due to hormonal, physical, and emotional factors that can have an impact on their sex life. Here are some examples of those changes:

• Hormonal factors: Fluctuations in hormones can influence libido. In general, pregnant people experience a decrease in sexual desire during the first trimester due to increased progesterone. A sexual desire boost is usually experienced during the second trimester, what is often referred to as the “honeymoon phase” of pregnancy, because of increased production of estrogen. Estrogen causes increased blood flow to the pelvic region to heighten sexual sensitivity and arousal. 

• Physical factors: Pregnancy involves a range of physical changes that can lead to discomfort or pain. In the first trimester, morning sickness, breast tenderness, and overall fatigue can dampen sexual desire. As pregnancy progresses and the body grows larger, certain sex positions may become uncomfortable and other physical changes can contribute to decreased sexual interest (e.g., back pain, frequent urination, or difficulty sleeping). 

• Emotional shifts: Sexual arousal is both a physiological and psychological process. Anxiety about pregnancy, childbirth, and parenthood can interfere with sexual desire. Some pregnant people may have fears about harming the baby during penetrative intercourse,, which can dampen their interest or satisfaction. Changes in body image can also affect a person’s self-esteem, influencing their comfort during intimacy. 

These changes can vary widely among individuals and throughout the stages of pregnancy. Some pregnant people may overall experience enhanced sexual satisfaction, while others face challenges. 

Differences in sexual satisfaction during pregnancy

There are many different factors that can have an influence on whether a couple experiences change in sexual satisfaction. Why might some couples experience a reduction in sexual satisfaction during pregnancy while others experience it as equal or even improved?

A 2021 study published in the Journal of Sex Research studied 523 married, mixed-sex couples in the U.S. to understand what may be contributing to these different experiences. Overall, most couples were satisfied with their sex lives (79%), a small subset were neutral about satisfaction with sex (21%). Sexual satisfaction was measured in terms of affection, frequency of sex, orgasm frequency, creativity and initiation patterns. Those participants that reported healthy partner attachment, conflict resolution and an ability to openly express their opinion about their relationship were more likely to report satisfaction with sex during pregnancy. The most significant factor impacting sexual satisfaction was the presence of depressive symptoms in women, which correlated strongly with lower sexual satisfaction.

This research shows us that sexual satisfaction during pregnancy appears to be a relatively common experience, and that its likelihood is tied to a couple's ability to have healthy, honest communication about their sexual needs. Pregnancy is a period of change, and couples are inevitably required to adapt to those changes. Being able to talk about exploring sexual activities outside of penetration can be especially effective in promoting higher levels of sexual satisfaction during this time.

Considerations for maintaining a healthy sex life after pregnancy

Here are some helpful considerations for navigating this period of transition together:

• Allow time for physical healing. Childbirth can be a physically traumatic process for the body, and several injuries or conditions can occur as a result (e.g., perineal tears, vaginal and cervical lacerations, pelvic floor damage, uterine rupture, etc.). These can vary in severity and may require different levels of medical attention or rehabilitation. It’s important to wait for clearance from a healthy professional before resuming sexual activity.
  
  

• Allow time to emotional healing: The psychological transition to motherhood can require emotional healing. The concept of "matrescence" was popularized by Dr. Alexandra Sacks, a reproductive psychiatrist, to describe the transformative process a woman undergoes when becoming a mother. During matrescence, women often experience shifts in their identity, priorities, and roles. This phase involves redefining one's sense of self, which can be challenging and may include moments of joy, anxiety, confusion, and even grief for the loss of their previous identity. Matrescence is an ongoing process that can last months or even years. It involves gradually adapting to motherhood and learning how to maintain a balance the role of being a mother with one’s own needs, including sexual wellness. 
  
  

• Addressing physical changes and discomfort: Strengthening and rehabilitating the pelvic floor muscles can make a significant difference in sexual comfort as well as sexual satisfaction, as the pelvic floor muscles play a crucial role in orgasms. Hormonal changes can lead to vaginal dryness after birth. It’s helpful to use a quality lubricant to make sex more comfortable and juicy.
  
  

• Maintain intimacy: Since sexual activity is not advised until generally six weeks after birth, couples can maintain intimacy during that period with non-sexual physical touch, such as cuddles or massages. It's also important to explore new ways to be intimate, which may include redefining what sex looks like and finding new methods of pleasuring each other.
  
  

• Don’t stop talking about sex: Sexual communication is the most important tool for having fulfilling sex. It’s important to keep talking about your shared sex life with your partner, even in a period when you feel like it's non-existent. Being open about fears, discomfort, or lack of desire helps partners feel understood and connected. Keep the topic of sex out in the open instead of in the shadows, because that will breed shame. Remind each other of your commitment to working towards having an enhanced shared sex life, while acknowledging that it may take time and that’s okay.
  
  

By embracing healing, patience and open communication, you can maintain a healthy sex life during and after pregnancy.