5 things to know about sex during pregnancy

Depending on your stage of pregnancy, having sex might either sound like a wonderful idea or the very last thing you’d like to do. Sexual activity during pregnancy can be as pleasurable and intimate as other times, but couples may have to make a few modifications to how and when they get intimate.

Dr. Lisa Johnston, an OBGYN and chief medical officer of Sharp Mary Birch Hospital for Women & Newborns answers some of your most pressing questions about sex during pregnancy.

Can sex hurt the fetus?
No. The fetus is protected by the uterus, the amniotic fluid and the cervix. When you look at the data on miscarriage, there doesn’t seem to be any connection between sex and early pregnancy loss or preterm birth.

Talk to your doctor if you’re concerned. But know that unless you have pregnancy complications now or if you’ve had them in the past, sex during pregnancy should be perfectly safe. However, if you have heavy bleeding, painful cramps or leaking amniotic fluid after sex, call your provider or go to the hospital.

Why do some women have increased sex drives and others have disappearing sex drives during pregnancy?
It is normal for first-trimester fatigue, nausea, breast tenderness and bloating to have you feeling less interested in sex. In the second trimester, many, if not all, of these early pregnancy symptoms will have improved and you may have more energy. The increased blood flow to the vagina, clitoris and vulva may also make you more responsive to sexual stimuli and you might find it easier to achieve orgasm. In the third trimester, you may be feeling uncomfortable and tired as your baby gets bigger, and it is not unusual to have less interest in sex at this time.

What are the best positions for sex during pregnancy?
Anything goes during the first trimester. As the baby grows and your belly begins to get in the way, positions other than missionary — woman on top, spooning, woman on hands and knees — may be more comfortable. Don’t limit yourself to just penetration — cuddling, kissing, massage, mutual masturbation and oral sex may be pleasurable alternatives when your belly is in the way.

Once you’re 20 weeks along, avoid positions that have you lying flat on your back, such as the missionary position. When you lie on your back, the enlarged uterus puts pressure on your aorta, which compromises blood flow to the placenta. If you have sex missionary style after 20 weeks, try wedging a pillow under your right hip to displace the uterus off the aorta.

Are there positions or practices couples should skip during pregnancy?
Although no positions are technically unsafe (other than those that have you flat on your back after 20 weeks), some women don’t like the feeling of very deep penetration. It’s fine to give and receive oral sex during any trimester. And discuss the possible risks of having anal sex with your obstetrician — these include blood loss from hemorrhoids and risk of bacterial vaginitis caused by immediately having vaginal sex after anal sex.

Because a woman cannot get pregnant while pregnant, what would be a reason for using protection?
It is crucial to use protection during sex for the prevention of sexually transmitted diseases (STDs) if you are in a non-monogamous relationship or if your partner is known to have an STD. Herpes simplex virus can also be transmitted through vaginal, anal or oral sex, and is associated with birth defects.

Whether your sex drive is in high gear or has stalled during pregnancy, Dr. Johnston recommends that you talk to your obstetrician about any concerns you might have. Some medical conditions, such as vaginal bleeding, placenta previa, incompetent cervix or risk for preterm birth, may cause your doctor to ask you to abstain from sex while pregnant.