How might sexuality and sexual activity change throughout pregnancy and postpartum?
Sexuality and sexual functioning through pregnancy and postpartum are important aspects of quality of life and general well-being, although they are often overlooked or misunderstood. While 10-22% of pregnant women report increased sexual frequency, satisfaction, and desire during this time, challenges with sexual functioning during and post-pregnancy are much more common[i]. Typically, sexual activity tends to be most frequent prior to becoming pregnant while declining over the course of pregnancy, particularly during the second and third trimesters[ii]. However, women’s experiences of sexuality and sexual functioning across pregnancy and postpartum differ depending on individual circumstances including physiological and psychological factors, relationship dynamics, and personal preferences.
Common challenges to sexual activity during and post-pregnancy:
Physical changes related to pregnancy, including dyspareunia/vaginal pain, decreased vaginal lubrication, urinary symptoms, fatigue, and concerns about hurting the baby are some common challenges to sexual activity during and post-pregnancy[iii]. Mode of delivery also can have an impact on sexual functioning postpartum[iv]. Additionally, women who breastfeed tend to experience challenges to sexual functioning, often related to breast sensitivity and/or pain, dyspareunia, and decreased sexual desire[v]. Mental health concerns, such as postpartum depression, also can have a negative impact on women’s sexual functioning and activity[vi].
Considering the significant physiological changes women experience during and post-pregnancy, body image concerns can also negatively impact women’s sexual functioning2. Although some women may feel more comfortable with their changing body during this time, many women struggle with feeling less attractive to their partner, which can impact engagement in sexual activity. Women may also have difficulty reconciling changing sexual and maternal aspects of their identity, which can fuel feelings of guilt, frustration, worry, and embarrassment, ultimately impacting sexual and relationship satisfaction1.
Ways to navigate the impact of pregnancy-related changes on sexuality:
Although some women continue engaging in sexual intercourse late into pregnancy, couples’ sexual practices often change throughout pregnancy2. Adapting sexual activity throughout pregnancy and postpartum is a way that couples can maintain physical intimacy while adjusting to the physiological, psychological, and emotional changes that a woman experiences throughout pregnancy. For some couples, the changes that come with pregnancy represent an opportunity to explore new ways to enhance emotional connection, intimacy, and share in sexual pleasure3.
Changes in sexual functioning and sexual activity during and post-pregnancy, in and of themselves, may not be problematic. In fact, about half of women experience little or no change to sexual satisfaction throughout pregnancy, although sexual desire and activity tend to decrease for a number of women3. Challenges arise when these changes cause distress for women and their partners. Women who experience distress due to sexual functioning concerns are more likely to experience reduced sexual and relationship satisfaction1. Because of this, if you or your partner are experiencing distress due to changes in sexual functioning or activity during or after pregnancy, it is important to speak with a healthcare provider about these issues.
Similarly, it is normal for changes in sexual functioning to persist for a few months following pregnancy; however, if you’re having ongoing concerns about sexual functioning for several months postpartum (i.e., more than 6 months), it’s important that you discuss your concerns with a healthcare provider. Persistent concerns about sexual functioning can not only be emotionally distressing for women, but also can have a negative impact on overall quality of life and well-being. On the other hand, research has shown that having open conversations about sexual functioning during pregnancy and postpartum can improve sexual functioning and reduce the emotional strain associated with changes in sexual intimacy2. Therefore, addressing concerns related to changes in sexual functioning and activity during and post-pregnancy can be key for enhancing both individual and couples’ relational and sexual satisfaction1. Your doctor and other medical professionals can be important sources of information about physiological and hormonal changes throughout pregnancy that are associated with changes in sexual desire and functioning, while counselling can help address psychological, emotional, and relational challenges regarding sexuality during and following pregnancy.
It’s also important to keep in mind that changes to and challenges with sexual intimacy during and following pregnancy are common. It may be uncomfortable or embarrassing to talk about these issues, but connecting with peers who have been through pregnancy can help normalize what you are experiencing. Similarly, talking with your partner about the thoughts and feelings that you are each experiencing will help build understanding and likely increase emotional connection between the two of you.
Strategies for exploring sexual intimacy during and after pregnancy:
- It’s common for women to experience decreased vaginal lubrication during pregnancy. Using a lubricant can help with this (you can ask your doctor or midwife for suggestions!). You might also use this as an opportunity for your partner and yourself to play with different forms of physical touch and massage.
- Try experimenting with different types of sexual activity and positions. You can find some suggestions here: https://www.babycenter.com.au/sex-during-pregnancy-overview
If yourself or your partner are experiencing decreased desire or arousal, or feeling discomfort with sexual activity, you might try sensate focus. Sensate focus is an exercise first developed by Masters and Johnson. It is a nondemand touch exercise; the goal is not to elicit pleasure, but to rather notice any feelings that arise. Practicing sensate focus with your partner may be a way to reduce expectations and anxiety linked to sexual activity, and help the two of you stay physically and emotionally connected. Try starting with these first phases, as described by Dr. Lori Brotto[vii]:
[i] Vannier, S. A., Rosen, N. O. (2017). Sexual distress and sexual problems during pregnancy: Associations with sexual and relationship satisfaction. Journal of Sexual Medicine, 14, 387-395. doi:10.1016/jsxm.2016.12.239
[ii] Pauls, R. N., Occhino, J. A., Dryfhout, V. L. (2008). Effects of pregnancy of female sexual function and body image: A prospective study. Journal of Sexual Medicine, 5, 1915-1922. doi:10.1111/j.1743-6109.2008.00884.x
[iii] Pauleta, J. R., Pereira, N. M., & Graca, L. M. (2010). Sexuality during pregnancy. Journal of Sexual Medicine, 7, 136-142. doi:10.111/j.1743-6109.2009.01538.x
[iv] Barabara, G., Pifarotti, P., Facchin, F., Cortinovis, I., Dridi, D., Ronchetti, C.… & Vercellini, P. (2016). Impact of mode of delivery on female postpartum sexual functioning: Spontaneous vaginal delivery and operative vaginal delivery vs cesarean section. Journal of Sexual Medicine, 13, 393-401. Doi:10.1016/j.jsxm.2016.01.004
[v] Lagaert, L., Weyers, S., Van Kerrebroeck, H., & Elaut, E. (2017). Postpartum dyspareunia and sexual functioning: A prospective cohort study. The European Journal of Contraception & Reproductive Health Care, 22, 200-206. Doi:10.1080/13625187.2017.1315938
[vi] Chivers, M. L., Pittini, R., Grigoriadis, S., Villegas, L., & Ross, L. E. (2011). The relationship between sexual functioning and depressive symptomatology in postpartum women: A pilot study. Journal of Sexual Medicine, 8, 792-799. doi:10.1111/j.1743-6109.2010.02154.x
[vii] Brotto, L. A. (2018). Better sex through mindfulness: How women can cultivate desire. Greystone Books: Vancouver, BC.
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