sex and sexuality in pregnancy dr reji 2022 .pptx

SEX AND SEXUALITY IN
PREGNANCY
DR REJI MOHAN,MD DNB FELLOW RM(Belgium)
ASSISTANT PROFESSOR
DEPT. OF REPRODUCTIVE MEDICINE AND SURGERY
SREE AVITTOM THIRUNAAL HOSPITAL
GOVT MEDICAL COLLEGE
THIRUVANANTHAPURAM
12/25/2023 drrrejimohan@gmail.com 9447044485 1

Woman’s sexual function
• Complex interplay
Physical
Emotional
Psychological
factors
• 'To be a mother' is a natural instinct
• Both pregnancy and sexuality are natural and normal
phenomena of a woman's life

Knowledge gaps
Pregnancy or childbirth is not a disease.
The couple should not be denied of sexual pleasure
and happiness when pregnancy is devoid of any
complications
Sexual relationship is part of Quality of Life.
The woman and the couple will have plenty of
questions regarding sexual activity during pregnancy.
They feel shy and are hesitant to discuss the issue
with their doctor.
Doctors also think that it is not an issue to discuss.

Knowledge gaps
Changes in sexuality can be significant during
pregnancy and in the postpartum period.
Unless you are familiar with scientific data, the
potential for providing patients with misleading or
incorrect information is high
Patients may rely on anecdotes, old wive’s tales
or other incorrect sources or the google aunty
and whatsapp university

Knowledge gaps
• When the woman conceives and welcomes her
new bundle of joy the whole family will be
preparing to welcome the new member.
• The woman starts getting many advises
regarding
• Diet
• Sleep
• Dress
• Travel etc
• Not about the sexual relationship

Self imposed abstinence
By avoiding sex during
• Pregnancy
• Postpartum
• ALMOST Two years
• It can lead to Disturbed interpersonal relationship
or extramarital relationship of the husband.
49% of women surveyed were
concerned that intercourse
could harm their pregnancy.
91% of pregnant women met the
cut-off for sexual dysfunction in
the Female Sexual Function
Index (FSFI), compared to 68%
of their non-gravid female
counterparts.

Sexual behaviour depends on
Age
Culture
Relationship
Physical changes
Discomfort
Fear of fetal damage
Partner’s sexual function

Hormonal effects
• In pregnancy various hormones affect physical and
mental aspects can have an impact on sexual functioning
• Progesterone – responsible for physical and mental
changes
• Estrogen – can affect sexual desire and function
• Oxytocin – release during orgasm can cause uterine
contractions
• Prolactin – increased level can affect sexual desire.

Psychological changes
Decreased self esteem
Anxiety
Fear
Body image
Perceived loss of attractiveness
Cultural differences
Myths about sexual practice
Interpersonal relationship

Physical aspects of sexuality in pregnancy
Nausea
 Vomiting
Urinary frequency
Urgency, back pain
 Fetal movements
Breast changes
Genital changes
Vaginal secretion
Abdominal girth can cause discomfort and can have a
bearing on sexual activity

Because of the taboo attached to sex,
many couples do not consult the doctor
Is Sex During Pregnancy Safe ?
When it is not Safe ?
Can Sex harm the baby ?
Can Intercourse orgasm cause abortion or uterine
contractions?
Is sex drive increased or decreased during
pregnancy?
Man’s View?

Why decrease in sexual activity

Lets get aware
• Be aware of the sexuality concerns during pregnancy to
answer the queries of the couple
• Most pregnant women can engage in sexual activity
throughout pregnancy, in the absence of any
complications
• The sexual desire, libido, arousal, orgasm may vary
during the three trimesters.
• Couples should keep some level of intimacy going on
throughout the period of pregnancy. This helps them to
keep the relationship healthy

• Most researches suggest sexual desire during 1st
trimester of pregnancy decreases.
• Some studies indicate that it increases during 2nd
trimester.
• Some women report greater sexual satisfaction during
pregnancy
Sex during pregnancy is a low risk behaviour
except when it is a high risk pregnancy or there is
a bad obstetric history

Advantage sex
Psychological usefulness
• Some research studies in 1980s and 1990s indicate that
overall sexual satisfaction was correlated with feeling
happy about being pregnant, feeling more attractive in
late pregnancy and experiencing orgasm
Induction of labour
• Natural prostaglandin content of seminal fluid can favour
the maturation process of cervix, make it more flexible,
allowing easier dilatation and effacement of cervix.
Preeclampsia prevention
• There is some evidence that exposure to partner's semen
prevents PET due to the absorption of several immune
modulating factors present in seminal fluid

Will sex be different during pregnancy?
• Sex feels different during pregnancy
• More pleasurable OR less pleasurable
• Increased blood flow to the pelvic area can cause engorgement
of the genitals-may give uncomfortable feeling of fullness.
• The heightened sensation that results may add to the pleasure
during sex.
• More vaginal discharge or moistness will also help.
• Mild abdominal cramps due to uterine contractions after
orgasm.
• The breast may feel, tender and unusually sensitive to touch,
particularly in 1st trimester.
• Breast remains more sensitive throughout. Some women may
prefer that their breasts are not touched at all.

TAKE CARE
The partner should know if anything feels uncomfortable.
If the woman is not enjoying intercourse, the couple can
indulge in mutual pleasuring, hugging, kissing, oral sex or self
stimulation.
Couple has to experiment and make adjustments
The woman may feel too tired, moody, or nauseated to make
love specially in the 1st trimester.
She may feel overwhelmed by physical and emotional
changes.

Libido can return in the 2nd trimester after morning
sickness and fatigue have eased up.
The desire can wane in the 3rd trimester particularly in
the last month of pregnancy
She may be too big, or exhausted to make love. She may
feel self conscious about her body.
She may be preoccupied with the approach of labour and
birth of the child.
She has to reassure her husband that she continues to
love him

Orgasmic function – Reduction of orgasm noted in some
studies.
Clitoral sensation may reduce during pregnancy
Non coital behaviour prefered by women – ex
masturbation, hugging, kissing .
Woman likes close physical contact.

• According to Master’s and Johnson sexual behaviour of
pregnant woman remains unchanged or decreased during
first trimester with improved sexual function during second
trimester and again a decrease during third trimester.
• According to Bancroft – Sexual problems are linked to
emotional and marital satisfaction.
• The couple should keep the lines of communication open
and support each other as best as they can

REASSURE -Will sex harm the baby?
The baby does not get hurt by making love.
During pregnancy the fetus is protected from penetrative
thrusting by the amniotic fluid and by the cervix.
The thick mucus plug that seals the cervix helps guard
against infection.
While orgasm may cause mild uterine contractions (and
also nipple stimulation and PG in semen), they are
temporary and harmless
With orgasm, baby may move around more. This is
because of increased heart beat of the mother and the
uterine contractions

AVOID SEX
At any high risk pregnancy
Toxemia, diabetes, anemia, multiple pregnancy
Bleeding per vagina
Abdominal pains
Premature uterine contractions
Leaking membranes
Low lying placenta
Previous BOH, recurrent abortions
Previous cervix incompetence
Partner having genital herpes, etc.

Is it normal if there is no sex during
pregnancy?
• Yes, it is normal. Pregnancy hormones can reduce libido
• If one feels positive about the pregnancy and the
associated changes, one can feel more sexual
• If the woman is unhappy or feels insecure or have
relationship problems, it can have negative effect
• What is normal for one person won't necessarily be the
same for the other

Partner's or dad -to -be's behaviour:
• Man can feel as attracted as usual during the 1st
and 2nd trimesters
• He may feel less interested in the 3rd trimester
Reasons for lack of desire for the dad to be:
• Fears that sex can hurt the baby
• Worries about the wife's and unborn baby's
health
• Apprehension about burden of parenthood
• Self-consciousness about making love in the
presence of the unborn child.

Doctor should discuss
• The fears and concerns with the dad to-be
• Reassure
• Advise

Is oral sex safe during pregnancy
• Yes, normal oral sex won't harm the baby.
• Avoid blowing of air into the vagina. This can cause air
embolism and can be fatal.
• It is safer if he sticks to kissing and licking the clitoris and
labia rather than inside the vagina

POSITIONS
• Sexual positions which are most comfortable during
pregnancy
• As the pregnancy progresses the missionary position is
not comfortable any more.
•
Over the course of pregnancy, the use of man-on-top
position declines, and woman-on-top, side-by-side, or rear
entry positions are practiced more often

• Woman on top-gives more satisfaction
• Lying sideways
• Make love sitting on the partner's lap

• Coming to the edge of the bed with the partner standing
or kneeling in front.
• Doggy position
In any position, the pressure on the abdomen and deep
penetration inside the vagina should be avoided

• One large meta-analysis showed that up to 98.3% of
pregnant women preferred genital-to-genital contact, with
other types of sexual activity also being desired: 38.1%
oral sex, 20.4% masturbation, and 6.6% anal sex,
consistent with a non-pregnant cohort.
• Another study cited that up to 75% of European and
American couples will practice mutual manual genital
stimulation and up to 50% will practice oral genital
stimulation during pregnancy.
• With a little experimenting, each couple should work
towards finding techniques that are suitable for them.
• Communication and openness are the keys to maintaining
or improving sexual satisfaction during pregnancy

Various Sexual dysfunctions during
Pregnancy
• Female
- ↓ Libido
- Anorgasmia
- Dyspareunia
• Male
- ↓ Libido
- PE
- ED

COITUS
AND
COMPLICATIONS OF PREGNANCY

Preterm labour
• Theoretical mechanisms of induction of labour by
sexual activity
• Nipple and genital stimulation may induce oxytocin
release from the posterior pituitary, causing uterine
contractions.
• Prostaglandins released from mechanical stimulation of
the cervix may cause cervical ripening.
• Prostaglandins in semen may cause cervical ripening.
In populations at increased risk for preterm labour,like h/o
PTL,Twins or incompetent cervix, there is no evidence to
suggest a clear benefit from restricted sexual activity; however,
this is a simple intervention that causes no harm and may be a
reasonable recommendation until better evidence emerges

Prematurity
• Two small, early studies found higher rates of prematurity
in orgasmic women during the third trimester.
• All other studies failed to find a relationship between
orgasmic frequency and prematurity, PROM,premature
labor or LBW

Fetal Distress
• Several studies have researched potentially negative
effects of maternal sexuality on the well-being of the
newborn infant.
• Although coital frequency during pregnancy has been
associated with fetal distress and perinatal deaths, these
studies suffer from either small samples or incomplete
control for confounders.
• Larger and more representative investigations have
observed no overall association between sexual activity
and either fetal distress47 or perinatal mortality.

Antepartum hemorrhage in placenta previa
• Penile contact with the cervix during intercourse can
hemorrhage in placenta praevia, and are advised to
abstain from sexual activity during pregnancy.
• Despite limited evidence, it is probably safest to advise
patients with placenta previa to abstain from sexual
activity to reduce the theoretical risk of catastrophic
antepartum hemorrhage.

Vaginal Bleeding
• Many women will experience some vaginal bleeding or
spotting after coitus, especially during the first trimester of
pregnancy, and will continue to have a successful
pregnancy
• Medical attention is warranted when bleeding or spotting
continues for several days or is accompanied by clots and
abdominal cramping

Pelvic inflammatory disease
or Infection
• Theoretically, pregnant women should be at decreased
risk for developing pelvic inflammatory disease because
of natural barriers to ascending infection created by the
mucous plug and the obliteration of the uterine cavity by
fusion of the decidua capsularis and parietalis by the 12th
week of gestation
• Study Group found that women who had frequent
intercourse and were colonized with Trichomonas
vaginalis, Mycoplasma hominis, or bacterial vaginosis
were at increased risk of preterm delivery.
• Frequent intercourse in women without such colonization
was not associated with preterm delivery.

Venous air embolism
• Venous air embolism, a rare but potentially life-threatening
event, has been reported in pregnant and peripartum patients
having orogenital and penile–vaginal sex.
• 18 in 20 million pregnancies
• Two conditions must be present for venous air embolism to
take place: direct communication between the source of air and
vasculature, and a pressure gradient favouring passage of air
into circulation
• So advised to
• 1.Avoid orogenital sex with air
• 2. Penile–vaginal sex, especially in the rear-entry position
where the level of the uterus is above the level of the heart

When is it safe to have sex after the birth of the
child
Wait until the-bleeding stops
completely and wounds have healed.
Normal involution of genital tract has
occurred.
One is physically and emotionally
ready for sex.
Use of contraceptives.

• Small number of couples have sex within the first month
after delivery.
• Many wait until 6 weeks.
• Most couples try sex by 3 months.
• Most studies advise to start sex 6 to 8 weeks after
delivery either normal, caesarean or instrumental.
• If one is not yet ready to have sex the other has to
continue with foreplay, by being physically close to each
other

Lack of sex desire after delivery
• Feeling exhausted
• Lack of sleep
• Demands of motherhood
• High Prolactin hormone
• Low oestrogen
• Feeling low, postnatal depression, fear or pain, and
stress.
• Post caesaerean is like recovering from a major
operation.

Advice to patient
• Try just cuddling and being intimate at first.
• Gradually get used to being sexually aroused.
• Enjoy each other's company with plenty of foreplay
without expecting it to lead to penetrative sex.
• Try lubricating gel
• Try making love during baby's nap time.
• Keep doing pelvic floor exercises (Kegels) to bring back
muscle tone to vagina.
• If there is persistent dyspareunia call the doctor and get
help
• Eat well, drink plenty of fluids and rest whenever you can

To conclude
• In their role as providers of health education and
preventive care, physicians have many opportunities
during prenatal care to give accurate information and
dispel myths.
• Many patients may be reluctant but would welcome a
discussion of sexual matters if approached sensitively by
their physician.
• Counseling can relieve a couple's anxiety and enhance
adjustment to their changing relationship, which may help
prevent the development of longer-term conflict.

• For any query or problem regarding
• Sex during pregnancy

THANK YOU
AND
GOD BLESS YOU
drrejimohan@gmail.com
9447044485

sex and sexuality in pregnancy dr reji 2022 .pptx

Recommended

Recommended

More Related Content

Similar to sex and sexuality in pregnancy dr reji 2022 .pptx

Similar to sex and sexuality in pregnancy dr reji 2022 .pptx (20)

More from Reji Mohan

More from Reji Mohan (11)

Recently uploaded

Recently uploaded (20)

sex and sexuality in pregnancy dr reji 2022 .pptx