Clinical Practice Guidelines Antenatal Care — Module II



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5.7Sexual 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.

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.


Discussing sexual activity

Summary of the evidence


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); and

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 hemorrhage because of placenta praevia, it may be advisable for them to abstain from sexual activity (Jones et al 2011).

Recommendation 7 Grade B

Advise pregnant women without complications that safe sexual activity in pregnancy is not known to be associated with any adverse outcomes.


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.

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.

5.8Resources


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.


5.9References


Alder EM (1989) Sexual behaviour in pregnancy, after childbirth and during breast-feeding. Baillieres Clin Obstet Gynaecol 3(4): 805–21.

Aslan G, Aslan D, Kizilyar A et al (2005) A prospective analysis of sexual functions during pregnancy. Int J Impot Res 17(2): 154-57.

Barclay LM, McDonald P, O'Loughlin JA (1994) Sexuality and pregnancy. An interview study. Aust N Z J Obstet Gynaecol 34(1): 1–7.

Brtnicka H, Weiss P, Zverina J (2009) Human sexuality during pregnancy and the postpartum period. Bratisl Lek Listy 110(7): 427–31.

Gökyildiz S & Beji NK (2005) The effects of pregnancy on sexual life. J Sex Marital Ther 31(3): 201–15.

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.

Kontoyannis M, Katsetos C, Panagopoulos P (2011) Sexual intercourse during pregnancy. Health Sci J 6 (1): 82–87.

Sayle AE, Savitz DA, Thorp JM Jr et al (2001) Sexual activity during late pregnancy and risk of preterm delivery. Obstet Gynecol 97(2): 283–89.

Schaffir J (2006) Sexual intercourse at term and onset of labor. Obstet Gynecol 107(6):1310-1314.

Tan PC, Andi A, Azmi N et al (2006) Effect of coitus at term on length of gestation, induction of labor, and mode of delivery. Obstet Gynecol 108(1): 134–40.

Tan PC, Yow CM, Omar SZ (2007) Effect of coital activity on onset of labour in women scheduled for labour induction: a randomized controlled trial. Obstet Gynecol 110(4): 820–26.

Tan PC, Yow CM, Omar SZ (2009) Coitus and orgasm at term: effect on spontaneous labour and pregnancy outcome. Singapore Med J 50(11): 1062–67.

Yost NP, Owen J, Berghella V et al (2006) Effect of coitus on recurrent preterm birth. Obstet Gynecol 107(4): 793–97.




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