Pregnancy is a time of change: changing weight, changing hormone levels, and changing family dynamics. Following this logic, it makes sense that sexual activity should also change. Public perception about sex and sexuality during pregnancy tend to view sex as something that does not or should not, happen very often once the woman is pregnant. Risk is often associated with sex and pregnancy. For example, it is perceived to be unsafe or dangerous for the unborn child. These assumptions in most cases are untrue and may be damaging for the expectant mother’s mental health. Thus may also have long-term effects on the relationship of the parents-to-be. During pregnancy, there are changes in sexual activity, function, and sexual satisfaction of both mother and father. In considering best practices in regards to sexuality during pregnancy all three variables of sexuality must be looked at in order to determine what is healthiest for all involved in the pregnancy – mother, father, and the fetus. Sexuality during pregnancy changes as the during the trimesters and as the woman develops and aspects of her body change. While couples may be engaging or participating in sexual activities less during pregnancy, for most couple there is no medical reason to limit engaging in sexual activities. In fact, there are reasons that support maintaining sexual activity.
Sexual Activity Rates Through Trimesters
Traditionally pregnancy is viewed as a time where couples have less sex, or even none. According to Liu, Hsu, and Chen (2013), it was found that a majority of women choose to abstain from coitus all together during their pregnancy. Women may choose to abstain from sex during pregnancy, as there is a perception that it can lead to early term pregnancy or other general damage to the unborn child. Indeed, most research shows that there is more sexual avoidance during pregnancy (Esmer et al., 2013, and Chang et all., 2011) .Some couples are indead told to avoid sexual activity by doctors if they are having a high-risk pregnancy; often in these high-risk pregnancies other physical activities like running or even working are not advised. However, the majority of pregnancies there is little to no restrictions on physical activities, and in some cases, it is encouraged.
Research show that couples express high amounts of concern about the danger that sexual activity could cause the child. Up to 82.9% of women and 84.9% of men in one study expressed t concerns for the safety of the child (Esmer, Akca, Akboyir, Goksedef and Bakir, 2013). In mothers there are fears about preterm labor, bleeding, and even a fear of infection (Liu et al., 2013). Physical discomforts, fear of hurting the fetus, awkwardness from weight gain, and pain can also be a problem for problems and may be reasons a pregnant woman may fear intercourse. Sexual avoidance and sexual anxiety are a common result of this fear. Further extreme cases of maternal and paternal fear are linked to sexual dysfunction. Studies show there are reductions in sexual activity for most mothers during the first two trimesters, but the third trimester shows even more marked decrements in sexual activity (Esmer et al., 2013). However, the couples with higher rates of sexual activity before maintained the higher rates during pregnancy, but nevertheless they also decreased in their overall sexual activity (Esmer et al., 2013). While sexual activity does decrease over the trimesters and is significantly lower in the third trimester, it is interesting to note that sexual desire does not, but remains stable through out the pregnancy (Chang, Chen, Lin, and Yu, 2011).
Although, there are some risks associated with sexual activity during pregnancy, risk is rare in healthy pregnancies. Couples however, are not provided with the most up to date information on what is harmful and what things work the best or offer the most satisfaction the least risk involved. Most risks can be negated with proper education, and many positive benefits exist, including romantic relationship improvements, maternal mental health, and other general health markers (Sagiv-Reiss, Birnbaum and Safir, 2012). The problem is that with so many stigmas around sex and sexuality, some couples may feel uncomfortable having to ask their general practitioner about their ability to have sex during their pregnancy. Instead, they turn to articles online or in magazines, often making important choices from anecdotal evidence, including family members or friend’s advice (Liu et al., 2013). Doctors are also guilty of conforming to societal stereotypes and assumptions. According to a study by Liu et al. (2013) couples reported that their doctors did not offer any information on sexual activity during pregnancy. Thus, there is a need for doctors to first assume that people will continue to be sexually active during pregnancy, second to actually advise people on how best to stay sexually active. It would be beneficial for doctors to be educated on the the safest and most satisfying sexual positions during pregnancy. It is critical that doctors work to remove the stigma surrounding sexual activity during pregnancy. With early intervention and consistent advice from doctors, there could be a decrease in the stigma associated with sex and sexuality during pregnancy helping couples have higher levels of sexual satisfaction in what is one of the most complicated times of their relationship together (Liu et al., 2013)
Sexual Functioning During Pregnancy
Much like sexual activity, sexual function slightly decreases from pre-term levels for mothers, but then has a significant non-linear drop in the final 4 weeks before the due date. Sexual function decrements include, for example, decreased vaginal lubrication, incontinence and an imbalance caused by weight gain. The third trimester is marked by large decrements in each marker for reduced sexual function. Sexual function has very few determinants that are associated with an increase in function, mainly because more often than not it is physiological changes that lead to the problems of function reported. The use of lubricant and supports like pillows may help with the physiological problems. Studies have looked to see if demographic variables have an impact on sexual function. Esmer et al, (2013) showed that only employment status shows any correlation with sexual function improvements; women who are employed full time have fewer declines of sexual function in their third trimester. Low sexual function is also tied to low body image, (Chang et al., 2011) which is also a determinant of sexual satisfaction. Body image effects on the sexual function are reliant on a woman’s background history
Rates of sexual satisfaction during Pregnancy
Research suggests that sexual satisfaction is different than sexual function and sexual activity in that it shows a linear decline over the trimesters (Sagiv-Reiss et al,. 2011) If both parents are sexually satisfied throughout the pregnancy, there is a better chance that they will have a more stable relationship immediately following, and the months after birth, (Esmer et al., 2013). Research offers several suggestions on how to improve sexual satisfaction during pregnancy, given its demonstrated benefits. During pregnancy, couples engage most often in sex in the “man on top position”; up to 67.6% of couples use it exclusively in sex during pregnancy (Lee et all., 2010) This is seen as a preferable position because it does not require the woman to bear her own weight and allows her a more passive role during a time that she may be easily fatigued. This position may also be beneficial if a woman is having a problem with incontinence, as laying on her back allows gravity to assist with her problem. However, considering all these factors research shows evidence that this it may not be there best position for sexual satisfaction. Couples that use the “women on top face to face position,” have higher levels of sexual satisfaction (Lee et al., 2010). “Rear entry” and “side to side” positions also rank higher than man on top but are reportedly used less often because they are less intimate than positions that allow the couple to be facing each other.
Across the field of psychology, it is commonly accepted that the sexual satisfaction of a woman goes hand in hand with her perception of her body, people who are less happy with their own body tend to report lower levels of sexual satisfaction, this fact remains true in pregnancy. This body perception problem may be why sexual satisfaction remains relatively stable up until the last four weeks of pregnancy, during this time the mother is at her heaviest weight and may feel off-balance and strange causing her to be unhappy with her body image (Chang et al,.2011). Independently of pregnancy associated weight gain “Pre-Pregnancy body weight affected sexual satisfaction” (Chang et al, 2011) Employing psychological interventions that allow the mother to come to terms with her changing body would be beneficial for her sexually in this time.
Even though the very presence of a pregnancy often indicates that a couple has been sexually active many don’t consider this a sexual time. Often people think that it may be inadvisable to even engage in sexual activity at all and limit sexual experiences regardless of whether or not they desire to be sexually active. This is a complex topic because so many people and relationships are involved and safely for the child is a major concern causing people to limit their sexual interactions. So to enhance the understanding in this area there needs to be more research into the safest sexual positions that provide the highest levels of sexual satisfaction for pregnant women, providing this information to couples would allow for not only higher levels of sexual satisfaction for the expectant mother but most likely in the father too because during pregnancy his sexual satisfaction is tied closely to that of the mothers during pregnancy. Much of the research on this topic was conducted in Asia specifically in Taiwan (a society that has more conservative views on sexuality than that of Canada) there is a need for it to be conducted globally so universal trends in sexual satisfaction, sexual function, and sexual activity in expectant mothers and fathers can be evaluated and methods for improvement can be implemented. This type of research consistently leaves out lesbian couples and often does not look at the father’s sexual satisfaction, both important demographics to learn more about in regards to this topic. In conclusion in a way mass media has it right, women are not as sexually active as they were before pregnancy but unlike many popular representations, they do not go sexually dormant. It is only because of the ideas about risks that they have been socialized to believe that they limit sexual activity. Perhaps through improved knowledge on practices and implementation of that information sexual satisfaction can increase during pregnancy helping to improve the bond between every member of the family and increase overall life satisfaction for the expectant mother.