Pregnancy Sex: Everything You Ever Wanted to Know (but were afraid to ask)

We ask our expert about everything you wanted to know (but were too afraid to ask) about sex both during and after pregnancy

Please welcome physiotherapist Tamara Gerdis, a women’s health specialist from Physio DownUnder, Singapore’s first dedicated women’s health physiotherapy practice. 

So now that you’re pregnant you’re probably wondering what it means for your sex life. In my experience I find this varies significantly from woman to woman. Some women can’t even look at their partner because they are so nauseous, others feel great, and many women feel very sexy in their 2nd trimesters and really enjoy having sex at this time. I’ve put together a few of the most common questions I get asked by my pregnant patients, followed by those I get from new mamas: 

I’ve just found out that I’m pregnant and even though my doctor has said it’s perfectly fine for me to have sex, I really don’t feel like it. Is that normal? How long will it last?
For some women the first trimester is a time of fatigue, nausea and concern regarding their pregnancy, which means that intimacy is the last thing on your mind. This usually improves in the second trimester, where women feel more energetic and are enjoying the changes that pregnancy brings to their bodies, some of which include enlarged, more sensitive breasts and increased blood supply to their genitals. All the pregnancy hormones circulating through your body can often increase your libido, and as long as you haven’t been cautioned by your doctor, you are free to enjoy yourself.

Whichever way you feel, don’t forget to communicate with your partner so he understands why you do or don’t want to make love. Also remember that intimacy is just as important as penetrative sexual intercourse. Hand-holding, kissing and cuddling go a long way to satisfying the need for intimacy without penetrative sex.

Will sex during pregnancy be painful?
If you had no pain with sex before pregnancy, than sex during pregnancy should not be painful. With increased estrogen levels, you should find that your vagina is well lubricated which prevents pain that may be caused by any friction.

If you are feeling anxious about having sex when you are pregnant, your pelvic floor muscles may over tighten and be unable to relax, which can create pain during sex. When doing your pelvic floor muscle exercises, the relaxation phase is just as important as the squeezing phase. If you are feeling tense prior to sex, try to consciously relax and let go of your pelvic floor muscles prior to penetration.

Remember sex should never be painful and if it is please follow up with your women’s health physiotherapist, obstetrician or midwife.

As my belly grows, certain sexual positions are becoming uncomfortable. Are there any positions that you recommend during pregnancy?
As your pregnancy progresses you may prefer to be on top so there is no pressure on your belly. This is also a good position for you to control the depth and speed of penetration. Any position with your partner behind you also leaves your belly free.

If you are after shallower penetration, then lying side by side with your partner behind you allows for this. Another popular pregnancy position is your partner sitting on a chair and you straddling him (either facing him or with your back to him).

If you are having symptoms of pubic symphysis dysfunction or pelvic girdle pain, then positions where your legs are symmetrical and not too far apart are ideal.

Are there any circumstances where sex becomes unsafe during pregnancy?
Yes. The following is a list of when sex should be avoided in pregnancy. The list is not exhaustive so if you are at all concerned please, consult your obstetrician or midwife.

• Any unexplained vaginal bleeding
• Placenta previa (low lying placenta)
• Premature labour or risk of premature labour
• Cervical incompetence (cervical weakness)
• Rupture of your amniotic sac (your waters have broken)

I am approaching my due date and have read that sex is one of the many methods that can help bring on labour. Is this just an old wives’ tale or should my partner and I get busy?
Having sex and an orgasm can trigger the release of oxytocin, a hormone that causes uterine contractions. Nipple stimulation also causes your body to produce oxytocin, but the research shows you may have to stimulate your nipples for between 1-3 hours a day to have any effect. Semen is a natural source of prostaglandins and synthetic prostaglandins are used to encourage cervical ripening during an induction of labour.

Unfortunately there is very little scientific evidence to the above theories, but if you are feeling up to it and you have no risk factors, there is no reason why you can’t try sex as a way to help bring on spontaneous labour. Also remember that unless you are at risk of premature labour, techniques used to bring on spontaneous labour should only work when you very close to your due date and your baby is ready to be born. Once again if you are at all concerned, please speak to your obstetrician or midwife.

Meanwhile, Returning to sexual intercourse after giving birth can create anxiety for many women. Your baby is probably awake often during the night, meaning you are exhausted. Your body hasn’t returned to its pre-pregnancy state and you may have had some perineal stitches from a vaginal birth, or abdominal stitches from a Caesarean (C-section). It is completely normal to feel apprehensive about returning to sexual intercourse so here are a few pointers to help combat those nerves:

When is it ok for my partner and I to have sex?
You shouldn’t have sex until your bleeding stops. This is due to the risk of infection. I usually recommend my patients wait until their 6-week check-up, especially if they had a vaginal birth and have had some stitches. As long as there are no complications post-birth, I encourage my patients to try intercourse at least once after 3 months. This gives me a good indication if there are any concerns that need to be addressed.

I am nervous that sex will be painful, is there anything I can do to help minimise any discomfort?
One of the most important things to remember is lubrication. Women who are breastfeeding have low estrogen levels, which can lead to vaginal dryness. Vaginal dryness can result in painful intercourse. Please use a good quality lubricant (it shouldn’t sting).

Even if you aren’t breastfeeding and you have some vaginal dryness, don’t worry, just use some lubricant. Feeling stressed about having sex again can stop you from relaxing and feeling “in the mood”. If you are very nervous, start with other forms of foreplay rather than penetrative sex. Even just experimenting with different positions can help minimise discomfort.

My partner and I attempted sex the other night but it was really painful. Is this normal?
There is a difference between feeling nervous about having sex and actually experiencing pain with intercourse. It helps to try to distinguish between the two. Sometimes what started out as nervousness develops into a fear. The fear in itself can cause your pelvic floor muscles to tighten up so much prior to penetration, that pain is created. Sex should not be painful and if it is, you should follow up with an appropriate professional like a women’s health physiotherapist, gynecologist or your GP.

I had a vaginal delivery and now my vagina feels different. Is there anything I can do to help it go back to normal?
Your vagina has just had a big stretch from your baby’s birth and your pelvic floor muscles are often weak post-natally. Doing your pelvic floor exercises (see below) will help strengthen your pelvic floor muscles, thereby increasing vaginal sensation during sex. If you feel something coming down, or a bulge in your vagina you may have a pelvic organ prolapse, for which you should be assessed by a women’s health physiotherapist or gynaecologist.

How do I strengthen my pelvic floor?
Your pelvic floor is a group of muscles that lie at the bottom of your pelvis. They play an important role in supporting your organs, helping to control your bladder and bowel, and improving sensation during sexual intercourse. It is essential that a pelvic floor muscle contraction is done correctly as many women bear down (push down) when contracting their pelvic floor rather than lifting their pelvic floor up. Bearing down will actually do more harm than good. You can learn how to correctly contract your pelvic floor muscles here.

Now that I’ve had my baby, I’m having difficulty getting to the toilet on time. Every time I cough or sneeze, I leak some urine. What can I do to help this?
One third of women who have a baby will experience urinary leaking at some point in their lives. If you are noticing that you are leaking some urine with coughing, sneezing, laughing, running or any other physical activity, you are most likely experiencing stress incontinence. Stress incontinence can usually be helped by strengthening your pelvic floor muscles, learning how to protect your pelvic floor from further damage and implementing good bladder and bowls habits.

If you are struggling to get to the toilet on time, or if certain triggers like putting the key in the door or hearing running water make you feel like you have to wee or cause you to leak, you may be experiencing urgency or urge incontinence. Urgency and urge incontinence can usually be conservatively managed similarly to stress incontinence but we incorporate bladder training as well.

I haven’t really felt like having sex. What can I do to increase my libido?
As a women’s health physiotherapist I always encourage my patients to be kind to themselves, as they are usually exhausted and are experiencing big changes to their bodies. It is also important to allow your partner to know how you are feeling. Getting back in control of your body with regards to your pelvic floor and appropriate exercise will help with your libido. Click here for some other great tips.

Above all else, remember to look after yourself, rest when you can and explain to your partner how you are feeling.