Sex in Pregnancy Is Generally Safe, With Few Complications

Laurie Barclay, MD

February 01, 2011

February 1, 2011 — Sex in pregnancy is generally safe, with few complications, according to a new, evidence-based primer to assist physicians in counseling patients regarding sexual activity during pregnancy. The new primer is published online January 31 in the Canadian Medical Association Journal.

"Sexual activity is common in pregnancy, but the frequency varies widely, with a tendency to decrease with advancing gestational age," write Claire Jones, MD, from the Department of Obstetrics, Mount Sinai Hospital and University of Toronto in Toronto, Ontario, Canada, and colleagues. "Decreased sexual activity may be attributable to nausea, fear of miscarriage, fear of harming the fetus, lack of interest, discomfort, physical awkwardness, fear of membrane rupture, fear of infection or fatigue. Libido and sexual satisfaction may also be negatively affected by a woman's self-perception of decreased attractiveness."

The primer notes that sex during pregnancy is normal and is generally considered safe. Abstinence from intercourse should be recommended only for women who are at high risk for preterm labor and for those with placenta previa who are therefore at increased risk for antepartum hemorrhage.

A pregnant patient seeks reassurance from her primary care provider.

However, the evidence regarding the association of sex in pregnancy with the risk for preterm labor is limited and conflicting. For women at low risk for preterm labor, frequent intercourse was associated with increased risk only in those with lower genital tract infections. Evidence is limited to guide recommendations regarding sexual activity in women at higher risk because of multiple pregnancy, cervical incompetence, or a history of early labor.

In addition to premature labor and hemorrhage from placenta previa, other potential, but uncommon, risks with sex during pregnancy include pelvic inflammatory disease and venous air embolism.

Pregnant women should theoretically have a lower risk for pelvic inflammatory disease because of natural barriers to ascending infection occurring by the 12th week of gestation, namely the mucous plug and the obliteration of the uterine cavity by fusion of the decidua capsularis and parietalis. In the first trimester, however, the upper genital tract is still at risk for ascending infection, and chronic upper genital tract infection can recur during pregnancy. Tubo-ovarian abscess has also been reported in pregnancy.

Oral insufflation during orogenital sex or the piston-like effect of a penis or finger in the vagina, particularly in the rear-entry position where the level of the uterus is above the level of the heart, may force air into the cervical canal. Air introduced into the venous circulation and pulmonary vasculature can cause serious morbidity and even cardiopulmonary arrest and death.

"Sex in pregnancy is normal," write the authors. "There are very few proven contraindications and risks to intercourse in low-risk pregnancies, and therefore these patients should be reassured. In pregnancies complicated by placenta previa or an increased risk of preterm labour, the evidence to support abstinence is lacking, but it is a reasonable benign recommendation given the theoretical catastrophic consequences."

The primer authors have disclosed no relevant financial relationships.

CMAJ. Published online January 31, 2011.

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