Sex During Pregnancy

Pregnancy

Jun 26

Sex-libido postpartum.jpg — Authored by:
Anna Glezer, M.D.

For many women, their own views of themselves as sexual beings and their sexual behaviors change over the course of pregnancy and into the postpartum period.

How sexual function changes with pregnancy and postpartum

Many researchers of pregnant women note a pattern – progressive decline in sexual intercourse over the course of pregnancy, with a much more rapid decrease in the third trimester.

Others disagree. One of the original studies that looked at the changes in sexual function in pregnant women found no significant changes in the first trimester (if symptoms like nausea and vomiting were excluded, as these can of course decrease interest). They found an increase in desire in the second trimester, which they attributed to an increase in blood flow, and finally a decrease in the third trimester, which they noted was related to both physical discomfort and difficulty as well as fears of harming the baby.

The trend postpartum is often a decrease immediately after delivery, followed by an improvement in libido and sexual function after about 3 to 6 months.

Why there’s a decrease of sex during pregnancy

There are several reasons you might choose not to have sex during pregnancy. The most common include: 1) physical discomfort, 2) fear of injuring the baby, and 3) lack of interest.

Physical discomfort:

Physical discomfort might be due to several factors. In the third trimester, basic logistics might be a challenge. The most common position, missionary, becomes untenable and alternatives are necessary. It is important to have a partner who is willing and able to explore various options to make the position comfortable. Throughout pregnancy, hormones are also responsible for bodily changes, such as vaginal dryness, which can lead to dyspareunia (the medical term for painful intercourse).

Fears of harming the growing baby:

Fear of injuring the baby can be on the mind of either partner. In early pregnancy, women worry about sex causing miscarriage. There is no research confirming that sex during the first trimester increases the risk of miscarriage. Some women who are in the midst of a threatened miscarriage, however, may feel more comfortable abstaining until bleeding resolves.

In later pregnancy, common worries are that sex could lead to preterm labor or that it will somehow injure the baby. In low risk women, however, there is no association between sex and preterm labor. Reading these words, however, will not always be reassuring. I recommend speaking with your obstetrician or midwife about these fears.

Lack of desire for sex:

Interest in sex is affected by several factors. One significant issue for women both pregnant and not is body image. In pregnancy, your view of your body can change dramatically. For some, this is a positive association with the remarkable feat of growing another human being, a sense of strength and confidence. For others, this is a period of uncertainty, feeling less attractive, in part because of feeling physically uncomfortable.

Consider having an open conversation with your partner about your feelings, and you will likely find that your partner continues to find you quite attractive. If pregnancy has triggered negative self-image, consider also speaking with a counselor about how to reframe these negative thoughts.

Additionally, for many women – as many as 10% or more – pregnancy is the time when symptoms of depression and anxiety onset. The illness of depression itself comes with a loss of interest in pleasurable activities such as sex.

Treatment for depression and anxiety with medications could also lead to changes in libido. SSRI medications, the most commonly used ones in pregnancy because of relative safety, have a risk of changes in sexual function. In women, most often this is a decrease in desire or a difficulty with orgasm. If a medication side effect is the culprit, speak with your doctor about alternatives. If the illness of depression itself is the cause, consider various treatment options (see my Depression in Pregnancy article).

Why sex decreases postpartum

A number of reasons explain the decrease in sex immediately after delivery.

First, there is sleep deprivation that comes with a newborn. Fatigue and loss of sleep make the idea of sex less appealing.
There is also physical recovery after labor and delivery, and the changes in the genitalia and pelvic floor.
Postpartum depression can trigger a decrease in desire.
Breastfeeding can cause sensitivity of breasts and vaginal dryness can be associated with the hormonal changes of breastfeeding, namely lower levels of estrogen/progesterone and higher levels of prolactin.

The role of hormones

Hormones, we know, play a role in sexual function during pregnancy. We do not yet know exactly how, however. There is an indirect influence: some of the physical changes, like nausea and vomiting, are related to hormonal changes and influence sexual activity. We also believe that hormones likely influence sexual desire and activity directly, though research is still exploring the exact mechanisms.

Value of communication

Often women who have concerns about their sexual function during pregnancy feel uncomfortable bringing this up with their doctors. However, this is a standard part of a complete medical assessment, and if you have any questions, I highly encourage you to ask. You might find the information your doctor provides reassuring, you might find you have a treatable condition (like depression), and you could find that just learning about the expected changes helps bring peace of mind.

Take-Home Message

Sex, like many other things, changes during pregnancy and postpartum. There are many reasons, both physiological and psychological, that explain these changes. The reasons could include physical discomfort, hormones, mental health conditions like depression, and general fears and anxieties. While not always an easy topic, it is important to discuss these changes with your partner and with your doctor to make sure that sex continues to be a healthy and enjoyable part of your life.

Selected References:
Moscop A. Can sex during pregnancy cause miscarriage? A concise history of not knowing. British Journal of General Practice (2012) 308-310.
Master WH, Johnson VE. Human sexual response. London: Churchill; 1966.
Serati, M. et. al. Female sexual function during pregnancy and after childbirth. J Sex Med (2010) 7: 2782-2790.
Johnson, CE et. al. Sexual health during pregnancy and the postpartum. J Sex Med (2011) 8: 1267-1284.

Anna Glezer, M.D.

Dr. Glezer began her training at Harvard and then transitioned to the University of California, San Francisco, where she has been a practicing physician, teacher, mentor, and is an associate professor. She is board certified in adult and forensic psychiatry, a member of the American Psychiatric Association, and the immediate past President of the Northern California Psychiatric Society.

She has worked with hundreds of women going through the emotional challenges of conception, pregnancy, loss, and postpartum. She has been interviewed for, and her written work has appeared on multiple leading sites, including Huffington Post, Fit Pregnancy, Health Line, Help Guide, and more. She has presented at local and national conferences and published in academic journals. Several years ago, she established the annual Bay Area Maternal Mental Health Conference and launched the educational website Mind Body Pregnancy, aimed to inform women, their partners, and their providers about mental health and emotional issues common in the reproductive years.

She began her private practice to help women throughout the Bay Area access reproductive mental health services and is really passionate about helping as many women as possible.