Now that I’m pregnant, can I still have sex?
This is a common question from our obstetric patients.  For most women, the answer is “yes!”  However, there are exceptions.  Many patients feel uncomfortable discussing sex or sexuality with their physicians.  The purpose of this installment is to dispel any myths and reiterate any truths concerning sex during pregnancy. 

During intercourse and orgasm, pregnant women may experience mild cramping.  This is normal and is not associated with miscarriage.  Some women experience vaginal spotting after intercourse.  Spotting is usually due to the softening and increased blood flow to the cervix and does not lead to miscarriage.  Any heavy bleeding or leakage of fluid more than semen should be reported to your physician.  It is natural to begin having breast discharge later in pregnancy.  Some women may have milky breast secretions during orgasm later in pregnancy.

Talk about it
Women’s emotional and physical bodies undergo incredible change during pregnancy.  In regards to sex, women may notice increased vaginal lubrication, engorgement or swelling of the genitals, and a change in the character of orgasm.  Some women experience more intense and more frequent orgasms during pregnancy. Despite these positive effects, women may be less interested in sex at times.

During the first trimester, women have increased fatigue and may be battling morning sickness, both of which can decrease desire.  By the second trimester, women are feeling better, but their bodies have begun to change with a noticeably growing belly.  Towards the end of pregnancy, women experience increased pelvic pressure and general discomfort.  Given all the physical and emotional factors that affect a woman’s desire to have sex, it is important for partners to communicate their changing expectations for sex during pregnancy.

Mama Sutra
For the times when it feels right, couples will certainly encounter the need to change positions to accommodate for the baby on board.  The missionary position or woman lying on her back is difficult by the second trimester due to blood flow requirements of the growing uterus.  The following positions are recognized as more conducive to comfortable intercourse while pregnant: woman on hands and knees, couple spooning, partner lying or sitting with woman on top, and partner behind with woman side lying with knees drawn to chest.  If the woman experiences vaginal dryness during pregnancy, water-based lubricants are best.  In regards to alternative forms of intimacy, manual or oral stimulation of the clitoris and vagina are safe in most pregnancies.  Sexual accessories such as vibrators and dildos can be safely used during pregnancy.  Patient’s advised to avoid vaginal or anal sex should also avoid insertion of these devices.   

Slow down Mama
Although sex is safe in the majority of pregnancies, there are conditions in which your physician may advise abstinence.  In the first trimester, these may include women experiencing bleeding or threatened miscarriage, a history of cervical incompetence, or immediately following a surgical procedure such as a colposcopy or cerclage.  Some physicians may instruct patients with a history of preterm labor, threatened preterm labor, or a dilated cervix to avoid vaginal intercourse.  All women with ruptured amniotic membranes or a placenta previa (placenta covering or near the cervix) should abstain from any penetrative intercourse. 

Sex induced contractions
At the end of pregnancy, many women are anxious to deliver and inquire into “natural” methods for inducing contractions.  Many cultures believe that sex and orgasm can induce labor.  I have reviewed the research available for term pregnancy and induction.  At this time, there is little to no evidence to suggest that vaginal sex with a male partner can lead to labor or decrease length of pregnancy.  Orgasm and nipple stimulation have been shown to cause contractions, but do not necessarily lead to labor.  For those healthy women who wish to try anyway, we say “go for it.”  
  
by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.

Sex is an important part of an intimate relationship.  Unfortunately, problems related to sex are very common. Approximately 43% of women have experienced a sexual problem.  These problems can be complicated and are arranged into categories of sexual dysfunction.  The purpose of this entry is to review the sexual cycle, the types of sexual dysfunction, and discuss approaches to treatment.

The traditional sexual response cycle (above) described by Masters, Johnson, and Kaplan includes: desire (libido), arousal (excitement), plateau (the highest point of sexual excitement and pleasure), orgasm (release of sexual tension), and resolution (latency or return to pre-arousal state). When it comes to sex, men and women respond differently. 

In general, men become aroused, develop an erection, and experience one orgasm associated with ejaculation.  This is followed by a latency period before they can become aroused again.  Women may take longer to become aroused, which is often demonstrated by vaginal lubrication, but they can experience multiple orgasms during sex with a shorter latency phase. 

In 2001, Dr. Rosemary Basson described an intimacy-based sexual response cycle (below) in order to account for the multiple factors that affect women’s desire to have sex.  In this model, a woman’s sexual arousal and desire are affected by emotional and physical satisfaction from interactions with her partner.  Once a woman feels secure, she can develop emotional intimacy and be open to sexual stimulation. 

Sexual dysfunction is a disruption of the normal sexual cycle.  There are four categories: desire, arousal, orgasmic, and pain disorders.  Each category represents a component of the sexual cycle that can be affected.  The causes of these disorders are multi-factorial, meaning that they arise from any combination physical and emotional interactions.  Women can experience more than one type of disorder from one or more categories.

Sexual desire disorders
There are two types of desire disorders.  Hypoactive sexual desire disorder is characterized by no or low interest or desire in sex.  This is often referred to as “low libido,” and it is the most common form of sexual dysfunction. Women with sexual aversion disorder avoid sex or genital contact with their partner.   

Sexual arousal disorder
Women with arousal dysfunction may have adequate interest in sex, but they are unable to maintain adequate vaginal lubrication or genital swelling in response to sexual stimulation.

Sexual orgasmic disorder
Orgasmic disorder results in a delay of or inability to have an orgasm after a normal excitement phase.  

Sexual pain disorders
There are three types of sexual pain disorders: dyspareunia, vaginismus, and noncoital.  Dyspareunia describes pain during intercourse.  This can occur during initial insertion or with deep penetration.  Vaginismus describes involuntary contractions of the vaginal muscles making penetration uncomfortable.  Noncoital sexual pain disorder or vestibulitis is characterized by pain with any touching of the outer vagina.  Sexual pain disorders can isolate a woman from her partner, because she is unable to experience sex without pain.  
 
Despite the difficulty in determining the causes of these disorders, there are identified risk factors.  Medical conditions that can contribute to sexual dysfunction are depression, heart disease, hypothyroidism, diabetes, and estrogen deficiency.  In addition, medications for the treatment of depression, high blood pressure, high cholesterol, epilepsy, and chronic pain can affect sexual function.

During a women’s lifetime, she can have periods of increased problems with sex, such as: pregnancy loss, difficulty becoming pregnant, or menopause.  Regardless of age and good health, stress can affect sexual relationships.  A woman’s desire for sexual intimacy is strongly affected by: conflict with a partner; her partner’s health; prior physical, sexual, or emotional abuse; substance abuse; and cultural or religious expectations.

Sexual disorders affect many couples.  Although this discussion is focused on the female patient, both men and women can experience sexual dysfunction.  It is important to speak to your physician concerning any symptoms you may have, especially if they are affecting your relationship or wellbeing.  In order to determine the type and appropriate treatment for sexual dysfunction, your physician will need to take a thorough history and perform an examination.  Outside of a medical exam, women with a sexual disorder should consider speaking to a counselor or therapist with training in sexual dysfunction.

by:  Gweneth Lazenby, M.D.

Request an appointment with a MUSC provider.