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LET'S TALK ABOUT SEX, BABY
A DOCTOR ANSWERS YOUR QUESTIONS ABOUT SEX DURING PREGNANCY
Confused as to which between-the-sheets activities are safe when you’ve got a bun in the oven? To answer your
questions, we asked Randy A. Fink, MD, an OB-GYN in Miami, Florida, for his advice on the dos and don’ts of bedroom
behavior during pregnancy.
THE FAMILY GROOVE: Let's talk about sex. What do women need to know about sex in the first, second and third
trimesters?
Dr. Randy A. Fink: Firstly, I must tell you that there is little true scientific
data regarding sexuality in pregnancy. So,
much of what I can offer is based on experience from a clinical practice and what seems common sense from my
perspective as an OB/GYN. Sexuality is hard to study in randomized clinical trials (the gold standard for establishing scientific norms) and pregnancy is so different for everyone that it is difficult to have true rules about sex. In general, sex during pregnancy is safe, with a few caveats.
In the first trimester, any sexual position is okay. Many couples elect to avoid sex in the first trimester for fear of causing a miscarriage. In truth, sexual intercourse does not cause miscarriages. It can, however, cause vaginal bleeding, which can understandably cause a fright. A bleeding scare in the first trimester always worries us for possibility of miscarriage. If bleeding onset was because of sexual intercourse, we usually recommend the couple refrain from sex until about the 12th or 13th week of pregnancy, which is the time after which the risk of spontaneous miscarriage drops dramatically. We also recommend that couples with a history of multiple miscarriages refrain from sex in the first trimester. There may also be reasons related to pregnancy that we ask moms to be on pelvic rest. Sometimes by ultrasound we see a bruise or hematoma surrounding an early pregnancy. It makes sense to avoid jarring this area or stirring it up with sexual intercourse.
The second trimester can result in some logistical challenges as mom’s belly starts to grow. Position-wise, anything that is comfortable for mom is okay. Toward the end of the second trimester, the man-on-top missionary position becomes less practical. Some women will have contractions after sexual intercourse. The biochemical called prostaglandin in semen can cause a thinning or ripening of the cervix, which can also lead to contractions. Some doctors recommend using a condom in the 2nd trimester so that couples can avoid unnecessary trips to the hospital for contractions after sex. There may also be medical reasons when sex should be avoided in the second trimester: pre-term labor, rupture of the membranes, vaginal bleeding or shortening of the cervix should result in a prescription for no more sex. Oral sex starts to become less pleasant for some couples, because vaginal discharge increases during this trimester.
Position starts to matter more in the third trimester. Most women prefer either woman-on-top or lying flat on the side of the bed with hips flexed and man standing. These put less pressure on the abdomen and pelvis and may be more comfortable for the woman. A from-the-rear approach also takes the pressure off the pelvis, but may result in some bladder discomfort if the baby’s head is low. If this is the position of choice, mom may want to put a couple of pillows under her belly to be more comfortable, which works in non-pregnant times, too.
It is important to empty the bladder after sexual intercourse. Pregnant women are at higher risk for getting urinary tract infections and all women risk UTIs from bacteria being pushed in the bladder during sex. Simply emptying the bladder after sexual relations cuts this risk.
Orgasms are fine in pregnancy. Some women have more difficulty reaching orgasm, others find it easier. Most who do have orgasms report the sensation to be bigger in that they are more intense and deeper. Orgasms do not disturb the baby.
Breast stimulation may be more pleasurable to some and less pleasurable to others and can completely change from what was normal before pregnancy. Breasts become larger and more sensitive and the nipples and areolae become larger and change consistency. Some women even leak milk before the baby comes. Breast stimulation is okay if pleasurable to the woman, but too much nipple stimulation will cause contractions, so be careful.
TFG: Do women need to avoid certain positions altogether?
RF: There is no particular position that poses danger to the pregnancy. Comfort is the most important consideration. Remember also that women in the third trimester should not spend extended periods lying flat on their backs.
TFG: Once and for all, please let us know: can sex hurt the baby?
RF: No! Unless there are special medical circumstances for which the doctor or midwife has recommended pelvic rest, sex is generally fine. The baby is well insulated inside many layer. There is a sac of amniotic fluid, a placenta and a thick wall of muscle (the uterus) surrounding the baby. So, during sex, the baby is so cushioned that he or she doesn’t know anything is going on.
TFG: Are there any lubricants or love potions to avoid?
RF: I recommend using water-based lubricants. Oil-based or sugar based (i.e. flavored) products are to be avoided.
TFG: Does sex really help bring on labor?
RF: I think it does, but a recent study failed to show meaningful results. Semen contains a chemical known as prostaglandin, which causes a process in the cervix known as ripening. So, while semen is not a labor-inducing agent, it can be a natural cervical-ripening agent and cervical ripening must occur before labor can begin.
TFG: Many women worry about the stretching out of the vagina during labor can cause a permanent widening. Does this really a happen? If so, what can women do to avoid it?
RF: The vagina is a very distensible organ. It has a substantial blood supply, so it heals quickly and very well after a vaginal delivery. However, the reality is that the vagina will not be the same after a vaginal delivery. It can have more stretch to the walls and the opening may not be as tight as it once was. Trauma from tears or episiotomies may cause the vagina not heal to be exactly as it was before childbirth. This is normal. There is little a woman can do the change this, other than requesting a c-section. However, elective c-sections are controversial and some obstetricians will not perform one. Fortunately, reproductive-aged women usually have healthy tissue, so they and their partners may not even notice a difference in the physical sensations of sexuality.
TFG: What about episiotomies? Can they affect postpartum intercourse?
RF: The suture used to repair episiotomies and spontaneous vaginal lacerations dissolves on its own. During the time it is dissolving, there can be some increased inflammation. By the time that first postpartum visit rolls around, the suture material is gone, but some of the inflammation may persist. Again, because of the excellent blood flow to the vaginal tissue, even a large episiotomy can heal such that it is hard to look and know it ever existed. Some women can have pain at the episiotomy site, but most heal just fine.
TFG: What can women expect when it comes to postpartum sex?
RF: The vagina may be drier than normal, especially if mom is breast feeding. I recommend going slowly at first, and using a topical lubricant such as KY Jelly or AstroGlide. And, by all means, wait until you have clearance from your clinician. Make sure everything has healed well and that you are set for birth control. I can’t tell you the number of women I’ve seen who come to their postpartum visits and are already pregnant because they didn’t think it could happen!
TFG: Are the postpartum sex rules different for women who have had vaginal births verses c-sections?
RF: I still recommend women not have intercourse until they have been seen for their first postpartum visit, regardless of the type of delivery. Women who have had a c-section do not usually have the same kind of vaginal effects as a woman who has had a vaginal delivery. The vagina may not be as stretched and there will not likely be a tear or episiotomy to heal. Even still, intercourse should be avoided until cleared by the clinician because of risks of infection in the uterus as it is healing and returning to normal size. C-section patients may have some soreness around the incision siteand sexual positions should be adjusted accordingly.
—Chelsea Kaplan
Click here to read all about Deputy Editor/Beauty Editor Chelsea Kaplan's life with child in her blog, “I'm Somebody's Mother?”
For more information or to contact Dr. Fink go to www.drrandyfink.yourmd.com.
*Photo by Suzanne Fogarty. To see more of her stunning work, go to www.suzannefogarty.com
