Pregnant and passionate: Sex OK for expecting moms, docs say
Despite the many misconceptions, there's usually no reason for pregnant women not to have sex — if they're so inclined — says a new "primer" for doctors and patients.
Photograph by: Ian Waldie, Getty Images
Dr. Dan Farine was in Paris, chairing a session about pregnancy, when a French physician stood up and explained to the assembled doctors what causes premature labour.
Sex, he said. Specifically, prostaglandin — the hormone that normally starts labour and that's abundant in semen.
"That's why I always tell my patients that I don't care if they use condoms when they're not pregnant," Farine remembers the doctor saying. "But when they're pregnant, they have to use condoms."
The next panellist begged to differ. It's neither the prostaglandin nor the semen, the Italian professor insisted. Rather, it's the rhythmic contractions of the uterus during orgasm. "That's why I tell my patients you can have as much sex as you want, as long as you don't enjoy it."
"And I've got hundreds of doctors from some of the most remote places writing down 'condoms when pregnant'. . ." said Farine, head of maternal and fetal medicine at the University of Toronto. "I had to tell them to stop writing it down.
"If semen were that horrible in pregnancy, the species would have been extinct thousands of years ago."
The experience was one of the things that drove Farine, together with co-authors doctors Claire Jones and Crystal Chan, to publish a sex-in-pregnancy "primer" for Canadian doctors and their patients. Appearing in this week's issue of the Canadian Medical Association Journal and based on a review of the best available evidence, the primer concludes that sex in pregnancy is normal and that women should be reassured that "There are very few proven contraindications and risks to intercourse in low-risk pregnancies."
The issue is relevant to the lives of hundreds of thousands of Canadian couples every year, Farine notes.
According to Statistics Canada, there were 367,864 live births in Canada in 2007, the year for which the most recent figures are available.
Yet women tend not to broach the subject of sex during pregnancy with their doctors.
"That's a problem, because it is an important aspect of life," Farine said. Instead, they look to the Internet, where sex, Farine says, "is accused of a ton of different things," and usually without good reason. "So you read something and you turn to complete abstinence unnecessarily."
According to Farine and his co-authors, sex is generally considered safe in pregnancy and abstinence should be recommended only for women at risk for preterm labour, or for hemorrhage because of placenta previa, when the placenta covers the cervix. There is a risk the placenta could bleed during intercourse, a potentially catastrophic complication.
"In those women, we have historically, uniformly recommended that they not engage in any intercourse, and that certainly hasn't changed now after we reviewed the literature," said Jones, a resident in obstetrics and gynecology at the University of Toronto.
For women at low risk of preterm labour, a study involving nearly 11,000 low-risk, "singleton" or single-baby pregnancies found no increase in the frequency of early labour in women having sex compared with those who abstained. A smaller study that followed 140 pregnant women at more than 28 weeks gestation found that women who had sex and symptoms of lower genital tract infections did have a higher risk of preterm labour.
But, "Women with low-risk pregnancies who have no symptoms or evidence of lower genital tract infection should be reassured that sex does not increase the risk of pre-term delivery," the authors conclude.
Can sex be used to get labour going in women who are past their due dates? According to the primer, there is no evidence to support the theory that sex at term can induce spontaneous labour. Still, for those couples with low-risk pregnancies that want to try, "There are no known harmful consequences" either, the authors say.
From a physiological perspective, the theory makes sense, says Jones. Semen contains prostaglandins, which help ripen and soften the cervix. Sexual activity can also help release oxytocin, a hormone that can bring on uterine contractions.
"Generally, we say if you're feeling comfortable enough to engage in having sexual activity at term, why not give it a try?" Jones says. "It might work, though there's not a ton of evidence to say it will."
Sex drive in pregnancy varies, she says. "Some women, their interest in sexual activity really goes down a lot during pregnancy, and in other women it actually goes up."
Overall, studies have shown that, for the most part, as pregnancy progresses "people get less and less interested in having sex."
Women often ask when they can resume having sex after the baby is born. There are no specific rules or guidelines, Jones says.
"As long as people are at the point where they're comfortable enough and they're not experiencing pain, then it's totally safe."
Read more at www.canada.comFor more information, the primer can be found here: www.cmaj.ca/cgi/doi/10.1503/cmaj.091580.
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