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Pregnancy can be the ideal moment to envisage the couple sexuality under a new light. Free from any procreation outcome, sexuality can become a tremendous experience for the future parents, either by intensification of their sexual complicity, or through mutual discovery. For centuries, sexuality during the pregnancy period has been considered as a taboo subject, mainly because desire and pleasure are its only purpose. Cultural, social or family standards raised many obstacles prohibiting future parents to enjoy their sexual life during pregnancy. It is all the more regrettable to notice that except in the event of complications – in which case sexual relations turn out contraindicated – the fears related to sexuality during pregnancy are sometimes maintained by healthcare professionals themselves. We understand this period as a phase of fulfillment, discovery, it also can be an opportunity to resolve past difficulties. It is necessary to accompany the women in this acceptance of an “other” sexuality during pregnancy, while helping man to understand that getting prepared to be father does not prevent him at all from remaining a lover.

Sexuality evolves during four sequential phases of the pregnancy:

1/From conception to 12 weeks:

The important physical and psychic modifications occurring during this initial period of 12 weeks can bring up difficulties on the sexual side. Besides the physical changes as well as the possible inconveniences connected to the pregnancy (nauseas even vomitings, hypersomnia and modifications of the taste and the sense of smell), the decline of the desire of the woman is characteristic of this first period. All those elements combined lead to a decline of roughly 20% of sexual intercourses.

Especially during her first pregnancy, the woman experiments a new situation, she is often searching for protection; therefore, seduction is not the first of her priorities. The affection-seeking woman has for corollary a sort of backwards journey to her own childhood, which is sometimes not matching with frequent and harmonious sexual relations.

Hence, many psychological factors can disturb the future parents who are afraid of their future responsibility and fear a possible miscarriage, which they wrongly impute to sexual relations.

2/ From two and a half months to the beginning of the eighth month:

It is the period of sexual bright spell in the couple. The small inconveniences connected to the state of pregnancy disappeared, the curvatures appear but do not embarrass the woman’s movements; on the contrary, they constitute one of the elements that activate desire, the return of which is characteristic of this second stage. The woman recovered her energy and adapted herself to her new state, this acceptance of the pregnancy leads her to like her new silhouette, that she now exposes without complexes; and thus accepts and likes her new body, object of continuous transformations. Furthermore, the pelvic vaso-congestion facilitates excitement and pleasure, and the hormonal impregnation gives a euphoristic tone. The future mother is thus more available and feels better, regains her self-confidence and is radiant under the glances of her spouse, these feelings and behaviours leading to build a good sexual relation. It is really at this stage that a real satisfying sexual complicity for the future reassured parents can be set up if pregnancy goes on well. Communication and sharing are at their best, between organization and planning of the baby’s arrival, the couple cuts itself a little of the outside world in a small cocoon, and refocus on its intimacy.

This link, together with the common enjoyment to get ready to be parents, facilitates a playful and relaxed climate and strengthens the “affective safety” of the couple, which is an essential element for the desire of the woman. This enriches and improves the quality of the sexual relations and crystallizes the atmosphere of relaxation and enjoyment …

3/ The eighth month:

The desire, which reappeared during the previous period, remains intact in the majority of the cases. A considerable difference can however intervene, showing itself by “peaks” during which the frequency of sexual intercourses can considerably increase through a research for orgasmic relaxation to counterbalance the stress related to the approach of the baby birth. On the other hand, it can also decrease in a significant way, and even disappear for a while to allow the couple to finalize together the last preparations.

Obviously, possible complications at this stage can bring modifications to this theoretical plan. But altogether, complicity and affection, still strengthened, allow a harmonious and fulfilling sexuality. From this point on, the physical modifications of the woman’s body can be an important obstacle. The future parents have to adapt themselves to these important changes, but a playful approach of sex often allows to by-pass these small inconveniences. It is on the male’s side that a decline of desire usually intervenes. Sometimes, the new physical appearance of his partner blocks him, some men dread to strike the foetus or the mother, others feel excluded or in competition with the young human being to come. Once again, it belongs to the healthcare professionals to reassure the couples by providing them useful advices and appropriate practices.

4/ The ninth month.

The future family plan is set up, in an enthusiastic and impatient, but sometimes also tense atmosphere! During this “final straight”, numerous questionings rise within the couple, and sexuality can then be there affected. The belly is now very impressive, but does not necessarily affect the regularity of sexual intercourses, which frequency however drops. Indeed, the woman’s weight causes fatigability, insomnia and respiratory difficulties decreasing her availability and desire.

It is necessary to adapt to the physical constraints through love positions some women might consider more unusual; obviously, the man has to be behind or on the side, what can ill-at-ease some more conformist persons. The dialogue with the partner can then turn out quite helpful! Furthermore, psychologically, the couple can have experienced very negatively the physical modifications. Stretch marks, and silhouette degradation can block the man, and the woman can feel the same disgust facing her own body. The fear of remaining damaged physically in a durable way can also frighten her. This very point, added to the fear of the delivery, the pain, the epidural, and the fear of a premature delivery or complications are definitely not helping! And we know that anxiety and stress inhibit the sexual desire and destroy the necessary relaxation required for a satisfying sexual relation. The partner is more and more afraid of hurting the child during the sexual relations and can even perceive the foetus as an intruder or have difficulty in seeing the future mother as a lover …

This last month is thus a long and hard test for the couple, but communication, understanding and especially tenderness, often allow to limit the damages and to preserve a good atmosphere. So, when the sexual harmony persists, the sweetness and the affection are much more labelled during sexual relations.

And what about the risks?

It is particularly in these domains that circulate a large number of ready-made ideas which turn out to be mostly false. As an example, it is completely wrong to impute to the persistance of sexual relations the miscarriages of the first quarter of pregnancy. In the same way, the orgasm can only exceptionally provoke harmful uterine contractions during the first and the second quarter of the pregnancy.

However, any penetration remains highly dissuaded in numerous cases of complications, or in the presence of a sexually transmitted disease on the man’s side. High precautions are obviously mandatory in this case, and it might then be a wise move to follow the obstetrician’s advises.

We can conclude by asserting that an active and harmonious sexuality during pregnancy contributes to strengthen the links between the couple of future parents. Sexuality can be a natural, safe and balanced source of pleasure. Among numerous psychological modifications, the future mom focuses on loving and caring, whereas the man is slowly evolving from his lover’s ” status ” to the father’s. Also, sexuality during pregnancy can be considered as a phase of preparation and harmony in the couple, a fusion between two beings resulting in the arrival of the third one, the child.

And after birth?

If a gentle and tender sexual life is maintained till the end of the pregnancy, the couple has more chances to recover it after the birth. However, young moms have to cope with time and should not precipitate. A first bad experience can hinder the good progress of the resumption of a fulfilling sexuality. In the days and weeks which follow the birth, the young mother is focused on her baby. Her partner obviously plays an important role but often more as father than as lover. To reintroduce him in an intimacy it is necessary to keep for him a different, privileged place apart from the child.

The erotic life in a couple must not be a duty. Escapades, « you and me » culture, massages, sweet caresses, playful atmosphere, sharing feelings and pleasures, are advised if the couple want to rebuild its erotic culture. In other words, it is necessary to « steal » some moments to the baby, to be together and find a new intimacy in a private space for the couple. This contributes to prepare slowly but certainly the return of sexuality, when the woman will feel ready physically and psychically in a climate of agreement and mutual respect.

The sexuality can start again as soon as the couple wishes it and as soon as all the regions will have recovered a normal aspect: the well closed cervix, the disappearance of lochia (serosanguineous drainages after the childbirth); disappearance of pains and a good cicatrisation of the episiotomy (5 to15 days or so). This period is variable from a woman to the other; the average is approximately of one month.

One should not forget the use of contraceptives, since a new pregnancy is indeed possible before the return of menses even if the woman is breast-feeding.

At this stage, the lubrication is sometimes less intense and longer to occur; the use of lubricants is then recommended and is not abnormal. If the feeding disturbs the sexuality, the spouse should not settle a rivalry between the child and the father, but could substitute for a moment this erotic zone by another one, and get back to it later… The vagina, even if it has been distended during the childbirth, quickly gets back to its normal shape and elasticity. The perineal reeducation will strengthen the muscle structure around the vagina. Statistically, the sexuality starts again for the majority of the couples seven weeks after the childbirth.

Delay in starting again?

Fatigue and need for sleep inhibit sexual desire and make the partners less available. The residual weight sometimes disgusts the woman of herself, she refuses this new physical aspect of herself, and does not anymore see herself as desirable, so she often rejects any erotic contact. An adapted diet is advised, but meanwhile, love and desire should improve self confidence, then why go without it? Sometimes perineal pains connected to episiotomy cicatrisation are not helping, and the sexual area is then experienced as painful. If the women fears the pain, or in case of a bad cicatrisation, pain can even more increase. In these cases it is necessary to consult a doctor. Some positions, less stimulating for those specific zones could then be advised: the woman being on top of her partner, or the man and the woman lying side by side. Let us not forget the fear of waking up or disturb the child, or even his presence (his actual presence in the room or at an unconscious level) which hinders the intimacy. Furthermore, the change of “status” within the couple can perturb one (or both) partner who does not find his (her) lover’s place in the new parental couple, and do not manage to stack couple life with family life.

When difficulties persist, it generally means they were already latent before the birth. In that case the couple, if it feels the need, can consult a sex therapist. If the couple does not dare, we deeply advise the women to take the time for a good reconciliation with her body and feel free to experiment some desire without letting the unspoken dig an abyss in the couple. Communication is one of the best therapies when the couple is having troubles.

Sandrine Atallah, MD

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