Sexual activity

Women and their partners may ask about the safety of sexual activity during pregnancy. They can be reassured that there is little evidence of harm to low-risk pregnancies.

17.1 Background

The frequency of sexual activity in pregnancy varies widely, with a tendency to decrease with advancing pregnancy, particularly during the third trimester Alder 1989, Barclay et al 1994, Aslan et al 2005, Gökyildiz & Beji 2005, Johnson 2011, Jones et al 2011. Factors contributing to decreased sexual activity include nausea, fear of miscarriage, fear of harming the baby, lack of interest, discomfort, physical awkwardness, fear of membrane rupture, fear of infection, and fatigue Gökyildiz & Beji 2005, Brtnicka et al 2009, Jones et al 2011.

As well as concerns about the safety of sex during pregnancy, women may ask about sexual activity as a natural way to induce labour at term.

17.2 Discussing sexual activity

Most available evidence comes from observational studies and relies on self-reported results. In addition, studies tend to examine any sexual activity in pregnancy, so the effects of different frequencies of intercourse cannot be known. The evidence is inconsistent on the effects of sexual activity on the length of gestation.

The limited available evidence suggests that in low risk pregnancies:

• there is a low risk of adverse outcomes from sexual activity during pregnancy Tan et al 2009, Kontoyannis et al 2011
• sexual activity is unlikely to be associated with preterm birth Sayle et al 2001, Yost et al 2006.

Nipple and genital stimulation have been advocated as a way of naturally promoting the release of endogenous oxytocin, and prostaglandins released in semen as a method of cervical ripening (Jones et al 2011). Overall, there is little evidence to support the theory that sexual activity has an effect in inducing labour at term. One prospective cohort study (n=200) found sexual activity at term was associated with earlier onset of labour and reduced requirement for labour induction at 41 weeks (Tan et al 2006); however, other similar studies have reported either no difference or a reduced rate of spontaneous labour prior to the date of scheduled labour induction Schaffir 2006, Tan et al 2007.

While there is no evidence to suggest a clear benefit from restricted sexual activity in women who are at risk of preterm labour (eg previous spontaneous preterm birth) or antepartum haemorrhage because of placenta praevia, it may be advisable for them to abstain from sexual activity (Jones et al 2011).

17.3 Practice summary: sexual activity

When

A woman asks about sexual activity during pregnancy.

Who

• Midwife
• GP
• obstetrician
• Aboriginal and Torres Strait Islander Health Practitioner
• Aboriginal and Torres Strait Islander Health Worker
• multicultural health worker
• sexual health worker.

What

• Discuss any concerns
  Explain that the desire for sex commonly decreases as the pregnancy progresses and after the birth, and in most women gradually returns over time.
• Provide reassurance
  Reassure women that sex is not likely to harm the pregnancy or increase the risk of preterm birth.
• Take a holistic approach
  Explain that it is a woman’s choice whether she is sexually active and she has the right not to consent. Also explain that childbirth and parenting may have an effect on a couple’s sex life.

17.4 Resources

• Johnson CE (2011) Sexual health during pregnancy and the postpartum. J Sex Med 8(5): 1267–84.
• Jones C, Chan C, Farine D (2011) Sex in pregnancy. CMAJ 183(7): 815–18.