Episode 66 - Sex in Pregnancy
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:25] Hello and welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and today we have a very juicy topic, but first I would love to thank the main sponsor of this podcast, Poppy Child, who is a doula and hypnobirth practitioner and the creator of the oxytocin bubble and the birth box. Poppy's main purpose is to help women cope with the overwhelm of labor and navigate the pain and sensation of what it means to be in labor and birth, and then also to deal with the big things that are going to happen in your parenting journey afterwards. Poppy Child is offering Great Birth Rebellion podcast listeners 25% off the birth box and the oxytocin bubble. You can either get them together or separately, and the links are in the show notes. Hello and welcome. I'm your host, Dr. Melanie Jackson, and today's episode comes with a parental warning. Most Great Birth Rebellion podcast episodes are suitable for children, but today's episode will be sensitive for little ears owing to the topic we'll be talking about today. I'll be describing anatomy, intimate behaviors in detail relating to this topic. So if you are listening around little ears, now is the time to turn off and plan your listen for a more quiet and private time. And perhaps this is the perfect episode for you to be listening with your partner.
[1:55] While we wait for some of you to make alternative listening plans and usher your children out of the room or pop your earbuds in, before I say anything that I do not want your children to hear, if you are listening to this episode pregnant, or if you care for women who are pregnant, there's something I want to tell you. This podcast is created for you completely for free. You will never have to pay for the Great Birth Rebellion podcast. And most of the information that you'll need to plan a great pregnancy, birth and postpartum can be found here in the Great Birth Rebellion podcast. We are up to over 220 episodes now, which totals to about 250 listening hours. That is a lot of content to get through, especially if your birth is coming up soon. And if that's you, if you don't have time to work through all the episodes that you really want to get to and your birth is coming up soon, Something I'd like to offer you is my Guide to Giving Birth Without Pain Medications.
[2:56] It's all facts, no fluff. We get straight to the point in the Guide to Giving Birth Without Pain Medication about how to manage the pain and sensation of contractions. And it also gives your partner tips, really clear strategies. As I said, all facts, no fluff on how to support you in labor and birth. Now, you may have been able to listen to all of the Great Birth Rebellion podcast episodes, but perhaps your partner hasn't. And they need a crash course in how to support you through labor and birth. And if that's where you're at, the guide to giving birth without pain medication is what you are going to need in order to prepare for a birth with all possibilities. You can get the guide in the show notes. There's a link there, easy access for you to get today.
[3:41] Okay, all of the little ears are gone now. So we can start talking about sex in pregnancy. It's a big topic in life and it continues to be so during pregnancy. So today I'm going to talk about the safety of sex during pregnancy, the times in which sex is not recommended, which sexual habits or fetishes are not safe during pregnancy. We'll talk about what to do if sex is painful or uncomfortable and we'll talk about what causes that and what to do about it. And there will be some pointers in here for partners who are wondering what they might need to change in order to keep sex safe and comfortable for you. One of the big concerns about sex during pregnancy is, is it safe? Is somebody going to get hurt?
[4:31] Am I bopping the baby in the head with my penis? All of these questions will be answered in today's episode.
[4:38] I'm going to talk about all of the normal things that you'll notice when having sex during pregnancy, including which things are normal. I'll talk about your vulva anatomy, the power of semen. And if you follow me on Instagram at Melanie the Midwife and The Great Birth Rebellion, you'll see I did a recent call out for questions about sex during pregnancy. And boy, was I flooded with questions. No surprises there. So I will be answering some of those through this episode as well. There were heaps of questions about sex drive, positions, if sex can replace perineal massage, does it help ripen your cervix, why do orgasms change in sensation and so much more. It's going to be a juicy episode which I hope will help you feel more confident to have sex during pregnancy and understand why your sexual experiences, desires and sensations are different during pregnancy. The truth is, is that your whole life is different during pregnancy and your life after pregnancy will be different too. It's no surprise that your sex life is also different. So let's have a look at how you can navigate that. And I'll start by addressing a few of the comments that came through when I did the shout out on social media. One midwife who I know very well, very tongue in cheek with a big laughy face emoji. She said, I know you love sex. I do love sex because my husband's very good at it. I don't know how she knows I love sex. Maybe I mentioned it one day.
[6:05] But she says, and she's right, she says that many women report not wanting to have sex or they have low libido during pregnancy and postpartum. And she'd like me to speak to that. And there were countless questions from curious women asking the same thing. How long till my sex drive comes back? I've been waiting years. Another woman was asking why was she so interested in sex before and then all of a sudden she can't be bothered.
[6:37] So the big major questions that came through firstly were, why don't I want to have sex? So there was a few common threads. So we're going to talk about that first. The second thing that came up was some anxiety about the safety of sex and if, we could keep doing it when we were pregnant.
[6:54] So we'll talk about the first one, libido or sexual desire when pregnant. Firstly, know that if this is happening to you, it's a really common experience and there's been a little bit of scientific research into it. But unfortunately, of course, anything that involves women's bodies or orgasms is not as heavily researched as male bodies or orgasms. But there's a little bit of research that we can tap into. And thankfully, there was a systematic review which was completed in 2024. So a systematic review draws together all the papers on a particular topic and covers them in one paper as a literal. They systematically review the articles. And in this one that I found from 2024, they found 19 papers that studied women's interest in sex during pregnancy. And it found the overall very general finding was that the first trimester seems to be the time where women's desire for sex is least because mostly in the early pregnancy days.
[8:01] There's some apprehension about miscarriage. You might be very, very tired. You might be suffering from nausea and vomiting and generally feeling unwell and potentially overwhelmed by the fact that you're pregnant. And so you might, when you do have time to rest, you may have no interest in using that time for sex properly.
[8:23] Now, there seems to be, according to this research, an increase in desire in the second trimester, which again could correlate with the general experience that early pregnancy symptoms start to ease. Women tend to get more energy in the second trimester. Your nausea and vomiting could settle in that time. And the fear of miscarriage in the second trimester is less than in the first. And then the researchers found that, again, in the third trimester.
[8:53] Women's desire for sex drops off. And this could be for various reasons, but what they found in their research was that the third trimester comes with more physical discomfort as your body's getting bigger. And as you get closer to having your baby, you may have more of a mental load on you knowing that life is about to change, that maybe that mental load is preoccupying your mental space. These are just a few reasons. There can be lots. And again, this is general research, which just has a little bit of a brush over some of the issues. But we also need to consider our physiology and some of the hormotional, hormotional, that's a good word. All right, the hormotional, that kind of encapsulates everything actually. But I'm trying to say hormonal and relational reasons for changes in sexual desire.
[9:47] So the first one is quite obvious, is that hormonally, women actually desire sex more when they're in their fertile period of your cycle. So when you're ovulating, you're in an estrogen-dominant state. And this seems to create a situation where you want to have sex more, a little bit of a biological drive to conceive. And they say apparently that in an estrogen dominant state when you're fertile you actually appear more luscious and welcoming of sexual partners, now the thing is is that once you're pregnant that estrogen dominant state changes and you come into a more progesterone dominant state and potentially now that you're pregnant there's a biological, sort of detraction or you don't necessarily, a sort of impulse towards having sex. This could be one thing.
[10:47] That hormonal thing is a theory of mine, but to me, it makes sense. But if we go back to the studies about libido and sexual interest in that systematic review, they did pinpoint that some of the research studies in that systematic review said that the desire to have sex was reduced as well because during pregnancy, women experienced sex to be more painful or they started to experience pain where they didn't before. And both men and women in their relationship expressed a change in their orgasmic experience but also in erectile function. And so it's not always that you don't have the desire to have sex but actually maybe it starts to hurt or maybe your partner's having erectile difficulties or maybe you are both or one of you is having trouble achieving orgasm.
[11:44] Now, the study highlighted that these issues or dysfunctions, the pain, the erectile dysfunction, the orgasm differences, they seem to be transient. But my suspicion is that these things aren't always or usually caused from a physical dysfunction. Sex is really complex. It's not just about our bodies. It's all about our relationships and our minds and where we are in life. If you're feeling generally overwhelmed, your whole life is affected, including your sex life.
[12:20] Because sex is so much about what is happening in our mind, life, and relationships, and not only what's happening in our bodies, I don't think it's fair to peg, sexual dysfunction or pain or erectile issues on pregnancy specifically. I think pregnancy would possibly accentuate existing issues.
[12:44] In the relationship, in your life, and maybe it's starting to indicate that something needs to change.
[12:51] You know, when we're relaxed and we have few worries and we're getting on with our partner and there's nothing too overwhelming happening in your life, sex is easier. It's more fun, you probably do it more frequently, and possibly both more likely to orgasm. But when your mind is burdened and your relationship is strained or you're feeling overwhelmed or unwell, or maybe, maybe your partner is frightened of what sex might do to you and your baby and has a complete mental block around sex. And one particular mental block that came up in the research that I was just talking about, the systematic research done in 2024, was for men and their arousal capacity, which changed because they had fears that preoccupied their mind about what impact sex would have on the baby so it was, not that they didn't want to have sex but their mind was they were so fearful because they weren't educated about the safety of sex in pregnancy and the worry of doing damage to either their partner or their baby was enough to turn them off sex or they struggled to achieve or maintain an erection because they were genuinely scared.
[14:05] That they might hurt somebody. So I want to speak specifically to that woman who asked me on Instagram why her partner's penis went soft partway through sex. And I need to tell you that it doesn't have anything to do with the changes in your vagina during pregnancy.
[14:26] Men are capable of maintaining erections during blowjobs, handjobs, all on their own. The tightness of your vagina is not relevant to his capacity to maintain an erection. But when his penis went soft, he may have felt embarrassed and blamed it on you. But it's not your fault. And actually, it probably wasn't even his fault. He might have fears in his mind and mental preoccupations that destroyed his ability to maintain an erection. So please know it wasn't you. He may have lashed out in embarrassment, but it wasn't you. It was definitely him.
[15:10] And if it keeps happening, this is something to talk about if there is a mental block, if he doesn't realize that actually sex is safe during pregnancy. Perhaps, though, he has a medical condition that could be looked at, a physical condition. And the other possibility, and this is something that's happening in this more, pornified society, is that men are losing the ability to maintain their erections because they're overusing pornography. I don't know your personal situation but if this is part of the story it could help you in the recovery.
[15:44] Either way the best thing that you can both do together and this is for anybody listening who's having sexual issues during pregnancy it may not be pregnancy it may just be this is the trigger that seems to change something. So the best thing you can do together is to try and talk about this without embarrassment or blame, without shaming each other. So it's true that your vagina and vulva changes during pregnancy. However, there is more to sex, arousal and erectile function than your vulva and vagina. And your partner's ability to maintain an erection doesn't have anything to do with you usually. It's something that he needs to work on and then you can support him through that. So the take-home message from the current research is that yes a reduced libido seems to be common and related to both physical, mental, emotional, relational changes and potentially a sense of overwhelm that comes with pregnancy. This is not isolated.
[16:47] Now, I want to say that it's not all sex deserts out there. There were a number of women, of course, who commented that they were not interested in having sex during pregnancy. However, there were just as many women who said that pregnancy increased their sex drive. And this could also be related to your relationship with your partner before you were pregnant. What's your relationship like now? How generous of a lover are they? So for me, I was like that. I could not get enough sex during pregnancy. My appetite was insatiable. And yes, it did feel different. My body did change, as will yours. And lots of things did change, but it was kind of exciting and new to us. It was kind of like, whoa, that hasn't happened before. And we just kind of welcomed it and explored it. So change and different doesn't mean bad. So this is an opportunity to explore your new body. You don't have to feel scared that you're going to do some damage. You can let go of that and have a little bit of fun.
[17:51] All right, I'm going to leave that for a bit and work through some of the basic facts about the safety and dangers of sex during pregnancy. And I will keep answering all those questions that came through on social media. And hopefully, as I keep talking, some of your fears about sex during pregnancy will be settled. But first, I'd like to start with telling you that sex during pregnancy is safe and fine to continue under most circumstances. There is no danger to having sex with a few caveats, and here is why because during pregnancy your baby is protected by your uterus and cervix your cervix is the opening to your uterus which closes up shut and gets long and firm, while you're pregnant and in between there's two muscular closures of your cervix which is, long and firm and in between there is a mucus plug and inside your uterus the baby's in an amniotic sac protected by amniotic fluid and then your baby's inside all of that. Surrounding your baby is a strong network of muscles fascia and fat and for this reason objects that are the size of a penis this is your.
[19:10] Benchmark objects that are the size of a penis are safe to admit into your vagina during pregnancy and your womb and the uterus is a very safe place for your baby.
[19:22] In addition to that, during sexual arousal, your vagina actually gets bigger and changes shape. It becomes longer, more engorged. It undergoes something that we call tenting, which describes how it opens up, specifically mostly on the inside, where it opens up when you feel safe, which describes how it opens up wider than usual in order to accommodate penetration. Again, your yardstick is the size of a penis, is safe. What this means is that when you feel safe, aroused, and your partner has taken the time to help you feel comfortable and you're turned on with the appropriate amount of foreplay.
[20:06] Your vagina is even more accommodating to penetration. Situation so sex is absolutely safe in fact probably even safer and more comfortable if you're aroused and prepared and foreplay is the key, so straight up if you hear nothing else please be reassured that consensual sex that includes vaginal sex with penis fingers vibrator in the vagina, clitoral stimulation oral sex anal sex are all considered safe in pregnancy under normal circumstances. Unless you have specifically been told by your care provider that sex is not safe for you because there are specific reasons, then you and your partner can continue to engage in sex as normal.
[20:55] The only other caveat I'll make here, and I do this again, we're in a pornified culture, and so new and interesting fetishes are becoming more mainstream. But if your partner and yourself are engaged in violent or rough sex acts, it's advisable that these don't continue through pregnancy due to physical safety reasons. But otherwise, you are safe to continue with sex all the way through pregnancy. And this is one of the main issues that women and men think during pregnancy is that sex could be linked to miscarriage or pregnancy loss or damage to your baby. But there's no research to support this. So overall, we say, yes, it's absolutely safe under normal circumstances unless your care provider has told you that it isn't.
[21:48] And the other thing to mention is that sex is one thing and penetration is one thing and orgasm is another thing. So some conditions, and we'll talk about these later, but some conditions will prevent you from having penetrative sex, but orgasms are okay. So clitoral orgasms, for example, whereas some conditions would mean that you would need to avoid orgasms altogether. And I'll talk about what times during pregnancy, if you've got specific conditions and illnesses or complications, that you should abstain from sex and or orgasms. So we'll chat about that as we go.
[22:26] But first, let's have a look at how sex can be had comfortably during pregnancy so that both of you actually enjoy yourselves. With the emphasis on everyone involved, you and your partner, actually enjoying yourself. So if you are in a relationship where you regularly don't have the opportunity to orgasm during sexual activity or adult fun time, it's time to explore this with your partner. It's unreasonable and unacceptable that the only person who should orgasm during sex is your partner. You should both work out how to satisfy each other. And as a general rule in a healthy relationship, if you're having sex together, both of you should orgasm. It's never okay for you to be left out of that scenario or have to finish yourself off.
[23:19] Now, the way to get there is foreplay. As a start, I am not a sex therapist or a sex expert. But what I do know is foreplay should always start, be the starter. It's not even the entree. I feel like foreplay is like the main meal and the orgasm part of sex is dessert.
[23:46] So this is a quick pit stop on this sex during pregnancy journey for the women and their partners who are finding sex either practically difficult or painful. And this was a large proportion of the questions that women asked for the social media, very informal social media questionnaire. So many of the questions were from women who wanted to have sex, but they found it difficult or uncomfortable or painful due to either their changing body and size or their vulva and vagina actually hurt. So to all of you, I would say, and to all of you sisters who aren't getting orgasms during sex, it's time to start playing around sexually with your partner. This is an activity that you can do.
[24:34] And I don't want to reveal too much about my own sex life, but, consider this activity and activity of exploration for all of you who are feeling like you want to have sex, but it's uncomfortable, painful, or you are having trouble achieving orgasm.
[24:50] Start to play around with you and your partner, with your bodies, without the intention of actually having sex. It all may lead to sex, but instead of trying to have sex, what about planning to just play around with each other's bodies without that intention but the intention is for it to feel good, to learn about each other's bodies and as your body changes during pregnancy understanding now what's changed what feels good and what doesn't feel good anymore the idea is to have fun and explore each other's, bodies and hopefully that leads to both of you orgasming whether you have sex or not, and it can be a lot of fun for your partner too if you start to discover things about their body that you didn't know about.
[25:36] Now, you may be hearing this for the first time, but actual sex with a penis and a vagina is not usually the best part of sex, for women at least. The best part is the playing and touching and the activity of getting each other in the mood with foreplay. And not like mechanical foreplay, like routine. It's not rote level foreplay. It's not about a quick kiss, a booby grope, and then a few fingers in the vagina. That's not counted as foreplay. That's a little bit of a warm-up, but foreplay is a longer, tender journey. So it's actually about exploring and touching in different ways to build up the excitement and get both your bodies ready to then enjoy penetrative sex more.
[26:28] So if you are one of those women whose partner has either not worked out how to, or has not prioritized you having an orgasm each time you have sex, now is the time to gather up your assertive energy and tell your partner what you need during your interactions, in order to achieve orgasm. Consider this a potentially uncomfortable situation where you need to practice and exercise that muscle of developing mental toughness and intention to tell the people around you how you want your body to be touched. Now, why this is important is through your pregnancy, birth and postpartum, there are going to be a lot of people interacting with your body, all of which should be completely consensual and only with your permission. But if you don't have the ability to tell people how to interact with your body and you're shy about it, you may be exposed to unwanted touching that you don't have the skill or capacity to tell people to stop. So consider this opportunity to explore your bodies with your partner in a safe space with somebody who you love and who hopefully loves you and practice this.
[27:45] Ability to tell people what you do and don't want done to your body so that your needs are met. It's a simple activity to help you develop your, ability to be an autonomous person making choices and telling people what you need during labour at birth because if you can't even tell your partner what you do and don't want done to your body you have to start questioning your capacity to stand up for yourself during pregnancy birth and postpartum. So give it a try you might be pleasantly surprised. So this is an activity for you women who said you either don't enjoy sex when you're pregnant or if you're having trouble achieving orgasm if it hurts and others commented that their vagina was too dry for sex all of a sudden.
[28:33] This activity is still a place to start where you start exploring each other's bodies. But you may also need to find a lubricant that is low toxic and good for you. It's okay for your microbiome, some microbiome friendly lubricant to begin with, to address that vaginal dryness. And if you need to, if you are really uncomfortable about your changing body, it's okay to just do it with the lights off. If you don't want to be fully exposed, it's very understandable. You can just do it with the lights off to start with as you get more comfortable with your body and learn about each other. Now, this playtime may lead to sex, but in the beginning, it's okay if you just let it lead to orgasms or just a little bit of fun and then leave it there and see how much you're going to want sex later for both of you.
[29:24] All right. Now, with regards to painful sex. There might be more to this than just hormone changes and bad technique.
[29:33] So we are going to talk about the pain, the potential increase in pain when you're having sex during pregnancy.
[29:43] Okay, so this leads me to talk about orgasms specifically. So when you orgasm during pregnancy, things in your body and uterus will feel different because during orgasm, a hormone called oxytocin is released and it gives you the happy feelings. You bond with the person you're with and this hormone's also responsible for giving you contractions during labor and so your uterus is not completely sensitive to oxytocin yet your uterus, gains oxytocin sensitivity the closer you get to birth so in early pregnancy, having orgasms and sex is not something that's going to put you into labor unless you're already at risk of preterm labor, serious risk of preterm labor. We'll talk about that later. But your uterus is somewhat more responsive to oxytocin during pregnancy. And because of this, you might experience cramps in your uterus after orgasm. They might feel like Braxton Hicks contractions. Sometimes your uterus tightens and just makes you feel like you have a really full bladder. But you will probably feel your uterus after orgasm. There is no problem with this. It's not a problem in itself. It's normal. And of course, unless you have a medical condition that precludes you from having orgasms.
[31:08] But this is what you might feel after sex is just some cramping in your uterus or just tightness. And fun fact, orgasms aren't only good to release oxytocin, but there's some anecdotal evidence that orgasms can be used to relieve the discomforts of pregnancy. Something like nausea vomiting pain even mood changes can be relieved with a big old oh bit of orgasm so give it a try you might get some reprieve from some of those annoying pregnancy symptoms, and some of you in the question box ask things like why has the sensation of my orgasm changed, and that's because your body has changed your vulva has changed things are changing So other sensations in your body will change. Your sense of smell has changed. Your circulation has changed. There's no surprise that your vulva, clitoris and orgasmic sensations will change. It could change for the better. Some women have the best orgasms of their life when they're pregnant, but you won't know until you start exploring and enjoying your brand new body with your partner in the ways I described earlier. Yeah.
[32:25] Now, the other thing to consider, particularly if you're having penetrative sex with a man and he ejaculates inside of you, is that semen contains prostaglandins. Not so much as it's going to put you into labor. So let's clear that up. But later in your pregnancy, when your uterus and your body is more sensitive to changes and keen to sort of jump over the edge of that cliff and go into labor, then the prostaglandins in semen could add to the potential of starting contractions later in pregnancy and some people say that frequent and, constant contact with semen on your cervix will ripen your cervix for labor, but there is no evidence for that so please if you are having lots and lots of sex in the hope that it'll bring labor on. There's no evidence that that's actually going to work. I do hope you're having fun but please don't have sex on account of trying to put yourself into labor. There's no evidence that it actually works but feel free to go have a bit of fun with it. Of course if you're orgasming and you're trying to go into labor or you're already in labor the additional oxytocin might give you a little boost but it's unlikely to be the thing to put you into labor if you aren't already in labor.
[33:44] Now, earlier in the episode, I answered the question about miscarriage and damage and if sex during pregnancy can cause miscarriage, damage, pregnancy loss or early labor. And the answer was, is that with normal sexual behavior without violence or any unnaturally long implements, sex will not cause damage. But let's talk about the possibility of bleeding after sex. And it's true that after vaginal sex you may have some spotting with some blood a very small amount of bleeding from your vagina, and if one of my clients ever calls me reporting that they having vaginal blood loss, part of what we do is we'll ask a thorough history and I ask questions about what happened and one of those questions is have you recently had sex and if they say oh yeah yeah we did last night or this morning or whatever just then.
[34:38] Then that can help clear up if there's an actual problem with the pregnancy or if it's related to sex. So yes, sex can sometimes be the cause of bleeding, but you shouldn't be having bleeding every time you have sex. It's not like that. It's just if you're having a bleeding episode and we ask about it, sex can be one of the catalysts, but it shouldn't be happening to you every single time you have sex. And if it does happen on occasion, it should be minimal and it shouldn't keep going. It should have just like a moment where maybe there's a little bit of bright blood, just maybe on the toilet paper or a patch on your undies or on a pad.
[35:17] And then nothing more again. If it was related specifically to sex, it's usually a little bit and it doesn't continue. And red blood means it's fresh. And if you're then losing brown blood, brown loss out of your vagina, that's old blood. So it's just old blood clearing itself out. It's not like you are still bleeding. You're just getting rid of the blood from the previous bleeding event.
[35:42] Now, one of the reasons for this is that your whole body during pregnancy becomes a lot more vascular. So your gums, more vascular, more blood volume, and your circulation sort of starts to come more so to the edges of your body and your blood vessels dilate, and some of them become more permeable. So more easily damaged, softer. Women are more prone to nosebleeds, bleeding gums, And as it turns out, bleeding cervixes and vaginas. And this can mean that after sex, you can get some minimal surface level bleeding from your cervix and vagina, which kind of seeps a bit of blood out, or if a little blood vessel was burst, in one of those areas, just because of disturbance during sex.
[36:33] And this can become more prominent later in pregnancy, more so than early pregnancy, because it's specifically related to the blood flow, circulatory changes during pregnancy. Other things can happen. I had a client who had a polyp develop through pregnancy on her cervix, and the polyp was what was bleeding during sex, which was, you know, the first time it happened was concerning to them. But in the following times, they knew exactly what it was. It wasn't problematic to the pregnancy. It just so happened to grow there during pregnancy and when it was disturbed it bled so, mild spotting with some discoloration of your normal vaginal discharge for 24 to 48 hours after sex can be normal however if you have vaginal bleeding that's heavy enough to need a pad or, it comes through and leaks onto the bed.
[37:26] You need to contact your care provider because that's an unusual amount of blood that's caused by sex. So as I said, red blood is fresh and this means it is still or just happened, and brown means that it's old blood that it's happened prior. I do think that any bleeding in pregnancy should be reported to a healthcare provider. However, one of the questions they will ask you is, have you recently had sex, and done some screening around what could have been the possible causes because most of the time, bleeding is not going to be a serious event in pregnancy, specifically if it's related to sex.
[38:06] Now, another question that the women were asking on my social media pages, is it okay for my partner to ejaculate their semen inside of me? And we talked about the prostaglandins and how they might also contribute to this crampy feeling after sex. But some of the other questions were even more detailed, like, can I get double pregnant? So let's clear this up. No, you cannot get double pregnant unless you have, two uteruses and this is a thing not very common but of course if you've got two uteruses you could get pregnant in both, uteri however most women have one uterus and you are not going to ovulate during pregnancy and your cervix is closed and shut with a mucus plug in between and there's a baby inside your uterus and you shouldn't ovulate while you're actually pregnant. So while you're already pregnant it doesn't matter how many more sperms enter your vagina you're not going to get pregnant again. So yes it is completely fine for your partner to ejaculate inside you unless.
[39:14] Your partner or you have some kind of sexually transmittable diseases. So if you have been using barrier methods as a technique to prevent you or your partner from becoming infected, it's important that you keep using those for the protection of both of you from sexually transmitted diseases. If the only reason you are using barrier methods like condoms was in order not to get pregnant, you're not in danger now. You're already pregnant. You can't get pregnant again. So it's okay not to use barrier methods. However, if you're using condoms and barrier methods and techniques, to protect each other from sexually transmitted diseases, it's important that during pregnancy you continue to do so because pregnancy will not protect you from contracting or spreading a sexually transmitted disease. So for most women, the only adjustments that you'll have to make during pregnancy, for sex are based on your own comfort and your own body changes. But if you are dealing with things like communicable diseases, you need to keep maintaining your techniques to prevent the spread of those.
[40:28] But generally speaking, during pregnancy, you might find it less comfortable to do things like sit on top of your lover with your hips wide because they'll start to become tender and laying on your back with a big belly, like big large belly might become difficult. So you have to start considering different position techniques and I'll talk about those in a minute. But your vulva can change and that includes becoming more engorged with blood. Your labia can become more lush and pillowy. And during pregnancy, your vaginal fluid can also change. It can either become more copious or some women find their vagina to become more dry. But certainly if you are in the copious camp, sex is going to be more messy and a more slippery adventure. So you need to just do things like extra towels in order to contain the extra fluids that are going to accompany your sexual activity while you're pregnant.
[41:26] And it can be exciting for some, but others might struggle. The other thing that might change is because the hormonal aspects of your body are changing, so too does the smell of everything. It doesn't smell offensive, but your vulva may smell different to usual because of the hormone changes that happen during pregnancy. And that does change the microbial organisms in your body and in your vagina. And so you or your partner may notice a smell, a change in the smell of your vulva.
[42:01] The other thing that could happen is that your vulva might develop varicose veins, what we call volvular varicosities and hemorrhoids and these two things can interrupt and get in the way of lovemaking either because they feel sensitive and uncomfortable or maybe you're feeling emotionally sensitive and uncomfortable about them.
[42:24] Now, another thing that can interrupt your sexual adventures during pregnancy, is how you feel about your changing body. Some of you may love how you look when you're pregnant and then make you more adventurous with sex and others might just shut off completely because of how you're feeling about your body. And it can also be the other way around is that your partner's feeling uncomfortable and unsure about how to navigate your new pregnant body. And these are things that you need to speak about together. This is not something that a simple podcast can solve. How you feel about your body and how your partner feels about your body is a unique and intimate and individual experience. And so you need to come up with times that you can speak about it openly and honestly. Again, you're about to have a baby together. You are also about to have to advocate for yourself during pregnancy, birth and postpartum and to care for your children. If you can't talk about each other's bodies with each other, again, it speaks to a deeper issue. But pregnancy has a way of showing you what needs working out before you are both parenting a baby together. So now's the time to start having these conversations gently.
[43:40] And whatever happens to your body, skin, vulva, vagina, muscles during pregnancy, please note that sex in any circumstance during pregnancy should not be painful. It's common that it's painful but it's not normal. Pain during sex is a big red flag that something's not right. You may need to change position. There may be a pathological issue with your pelvic floor or your vulva or your vagina. Maybe some of the toys that you are using are no longer appropriate. Maybe some of the sexual techniques that you're using are no longer appropriate. And pain is just a sign that something is not right and that you should stop that. So if you feel pain during sex, I would suggest having an appointment with a healthcare provider.
[44:26] First stop could be a women's health physiotherapist because they can assess your pelvic floor for issues of tension or muscular imbalance to start with but also educated in other issues of why sex might hurt. The other person that you might need to see is your maternity care provider or a gynecologist and this is specifically if there's some kind of infection or condition that could be contributing to painful sex.
[44:56] There is a condition called vaginismus and many of you may not have heard of it. In fact it's something that women seem to live with and not realize has a solution but vaginismus cause painful sex and it's rooted in both emotional and physical circumstances. So it's frequently misdiagnosed and medical practitioners are actually not highly skilled in diagnosing it, but a woman's health physiotherapist or an osteopath or chiropractor who's been trained in, pelvic floor health and adjustments, or maybe they've got skills in internal pelvic floor release, can help you with this circumstance. And some women also need to engage the care of a counsellor or a therapist who can help navigate the emotional and mental elements that come along with vaginismus. Or there's another condition called vulvodynia again, have a look at these terms vaginismus and vulvodynia see if these mimic what you're feeling and what sex feels like.
[46:01] With some of these conditions it's about your pelvic floor and literally the inability for you to relax your pelvic floor to allow things into your vagina and as it were maybe allow things out, some things that are getting in the way of you having comfortable sex may also get in the way of you having, a comfortable vaginal birth. So addressing these things during pregnancy will hold you in good stead as you move through into your birth and postpartum. Now I once had a client who I referred to a woman's health physiotherapist for kind of a routine pelvic health assessment. She'd never seen a physiotherapist, a woman's health physiotherapist before and it was her first baby and part of my routine care is to recommend a kind of initial assessment with a women's health physiotherapist partly to find somebody they feel they might be able to work with in the long term as they go on through their journey in life but also, as a way of assessing if there's any pelvic floor weaknesses or over reactivity and so I like to incorporate as a routine part of my care and this is one of the reasons I recommended the physiotherapist to her, and this woman discovered that.
[47:20] In this appointment that she had vaginismus because the physiotherapist went to assess her and then seeing her reaction asked her questions about her sex life and discovered that sex, was always painful for this woman.
[47:36] And she didn't realize it wasn't supposed to be so with the diagnosis though this woman was able to overcome the vaginismus because it is curable you do not have to live with it, and was not only able to have painless sex but also comfortably push her baby out of her vagina. So, It's important that if it does hurt, that this is a sign that something's not right and it's your opportunity to explore why. And a women's health physiotherapist is a great start, particularly if it's muscularly related. But some other things can make sex uncomfortable, such as vaginal thrush or a candida and yeast infection, same thing.
[48:18] You can be more prone to thrush during pregnancy because of the progesterone-dominant circumstance of pregnancy, it makes your vagina more alkaline. Whereas normally when you're not pregnant, your vagina is an acidic environment and that prevents the overgrowth of certain organisms, specifically the candida organism. And if you have an overgrowth of candida, you get symptoms of thrush or candidiasis or what we call yeast infection. And sometimes this can cause bacterial vaginosis or bacterial infection imbalance it can include urinary tract infections as well so, those can if it's hurting inside and like burning on the inside of your vagina or there's some unusual discharge or your partner is also finding that they're also getting symptoms after having sex it may be possible that there's a communicable, situation going on, like thrush or a sexually transmitted disease or bacterial vaginosis, all of which should be managed. And we do have podcast episodes on most of those things. So have a look. I'll put those in the show notes down below.
[49:32] Okay, the next three things that I will speak about and the final things for this episode, are how to avoid urinary tract infections when pregnant as a result of sex, because sometimes sex can cause UTIs that you're even more prone to when you're pregnant, how to manage vaginal dryness in pregnancy, and some comfortable sex positions while you are pregnant. And then I will list off some of the conditions that will prevent you from having sex during pregnancy or where you shouldn't have sex during pregnancy and which ones you shouldn't have orgasms with. I'm so sorry to you, ladies. But let's get started. Firstly, urinary tract infections. Now, in all of life, whether you're pregnant or not, stay hydrated so that not only can you do a big wee before having sex, but you can also do a big wee after having sex. This is the main strategy that you can use to prevent urinary tract infections, particularly during pregnancy, you are more prone to urinary tract infections.
[50:35] But also, fun fact, and this will go with the question that a woman posed in the Instagram question poll thing that I asked about having sex during pregnancy. She said, why during sex do I feel like, or even during orgasm, do I feel like I need to do a wee? Now, I'll tell you how this is connected to UTI. But inside your urethra, which is where your wee comes out, just slightly inside your urethra, there's a part of our anatomy called skein's glands. S-K-E-E-N-S because there's a number of them. your skin glands.
[51:20] They hold fluid, which is known to ejaculate itself during orgasm or during arousal. And the skin glands holds the fluid that you would ejaculate during the very crass. Well, I'm going to say it just, I mean, I don't know if there's another way of saying it, But if you squirt during sex or during arousal and fluid comes out from your urethra instead of your vagina, that's fluid being ejaculated from your skein's glands. And some of the research on skein's glands says that during sexual arousal, this fluid is released and it actually helps prevent urinary tract infections because it's got sort of, it's got this salty and antibacterial. Contents that gets sort of flushed through your urethra in order to prevent you from having urinary tract infections but also helps to lubricate the whole area and add a little bit of fun to the whole, sex journey while you're pregnant. So urinary tract infections are.
[52:33] Stay hydrated. Wee both before and after sex to help flush out your urethra. But if you have a tendency to squirt when aroused or you're orgasming, that's because your skin's glands are doing that. That's pretty normal. Now, the reason why it feels like you're going to wee is because it's in your urethra. And so some women will actually think that they're going to wee and tense up your pelvic floor in order to prevent what you think is a wee from coming out. But maybe it's just your skin's glands fluid. And if you soften your pelvic floor, you might actually find it is not urine and a new part of your sexual journey. So try it, experiment and see when you feel that sensation of, oh my gosh, I think I need to wee during sex. Maybe it's just your skin's glands wanting to get involved and you're not about to wee, you're about to squirt. Okay, that got super detailed and you're welcome. Next, managing vaginal dryness during sex. I feel like part of that conversation could help with the skin's glands, but you might notice that you either get way more wet or way more dry during.
[53:52] Sex when you're pregnant. So lubricants would be your friend, but also foreplay. Part of the reason for foreplay is to lubricate and moisten your vagina, make it slippery and accessible to a penis and also to make it grow. So the vaginas could just be a result of pregnancy and the change in hormones. It could be related to a lot of mental and emotional stuff or potentially it's just a symptom of having not been adequately prepared. That lubricant could be your friend.
[54:28] Now, regarding to your comfort level, as your belly and your baby grow, consider trying different positions and choosing the one that's most comfortable for you. So being on your back when you're heavily pregnant will likely not be uncomfortable. Having your legs very spread, particularly later in pregnancy, may not be very comfortable. So some strategies that can help where your hips and pelvis are actually better aligned, could be a hands and knees position especially the most important thing actually is to not be having to fully hold up your whole weight especially if your belly's very pendulous and hanging, I would suggest putting as many pillows as you can some pillows under your hips pillow under your belly pillow under your breast you may be able to kind of hold on to a pillow in a hands and knees position, and you don't need to completely open your hips very wide in the hands and knees position. And so you can feel very supported on your sort of pillow fort scenario while having sex. And it just takes the pressure off your back, off your belly, and you don't have to hold yourself up. Whatever pillows you are using to prop yourself up during a good, comfortable sleep, then you can adopt those to use for sex.
[55:51] The other one that you might be able to tolerate more is a side-lying position. And again, you could throw your top leg over the side or get creative with how to position your legs so that they're comfortable. But essentially, any position that doesn't hurt and that feels comfortable is the right position to be in. And people were asking about how to get deeper penetration during pregnancy. Again, the positions are no different than if you aren't pregnant in terms of deeper penetration, but they may not be as comfortable. But I think a hands and knees position is probably the best one if you want deeper penetration.
[56:35] All right, I'm going to work through a list of scenarios under which penetrative sex would not be advised. So I said at the beginning of the podcast that sex is generally safe in normal conditions unless you have particular complications in your pregnancy that would mean that you shouldn't have sex. So if your waters are broken or if your membranes are ruptured, you should not put anything in your vagina. You shouldn't put fingers, toys, penis, nothing in your vagina if your waters are broken because the barrier between your vagina and the baby is now, compromised and your baby and uterus could be prone to infection. So if your waters are broken, your membranes are ruptured, don't have penetrative sex.
[57:33] In that circumstance, though, you can have orgasms, but external clitoral orgasms, or one lady mentioned in the, Instagram question time, the only way that she can orgasm during pregnancy is nipple stimulation. Amazing. So you could still have orgasms if your waters are broken, but you can't have anything in your vagina. The next category of women who would want to, not have sex during pregnancy is if you are at high risk of preterm labor for example if you have a short or funneling cervix, if you require a cervical stitch or you've had preterm rupture of membranes or you're in preterm labor you want to prevent orgasms and admitting anything into your vagina anything that's going to disturb your cervix again if any of these are part of your history discuss that topic with your camper about it. So next, if you have a sexually transmittable disease and you have been having sex, you can, but make sure you use barrier methods and the same protections that you always have used. Again, do not have sex if it hurts. Find out why it's hurting before you continue. Don't have sex if you don't want to. Sex during pregnancy should always be consensual.
[58:54] Also, don't have sex if you have unexplained vaginal bleeding. This could be caused by something minor like a little burst vessel on your cervix, or a cervical polyp, as I mentioned earlier, or there might be more sinister reasons. It could be from something pathological and bleeding during pregnancy should always be investigated. So I would wait to have sex until you've discovered what the cause of the bleeding is. Also if you have grade four a complete placenta previa where the placenta is completely covering your cervix, often women are advised to be careful during sex because sex can penetrative sex can disturb the placental bed and cause bleeding from the placenta, again if that is your scenario your care provider will be caring for you and you can ask questions about what you can and can't do These are some general reasons why. The other reason why you would not have...
[59:57] Sex is if you or your partner have oral or genital herpes to prevent transmission that goes along with sexually transmitted diseases. Now, orgasms, because sometimes you can have orgasms when you can't have sex. But there are a few reasons during pregnancy when orgasms are not recommended. And these are the conditions under which you are trying to avoid having contractions because an orgasm releases the oxytocin and that's the hormone that can help you start contraction. So if you're on bed rest because you're trying to prevent preterm labor or you've got the cervix, cervical stitch in or you're threatened preterm labor, you may be told not to have orgasms in order to prevent your uterus from contracting and your cervix from changing any further.
[1:00:52] All right. Now, there was two questions, two more questions that I wanted to address from the Instagram sex question thing. One of them, and this was asked by a number of women, is can sex replace perineal massage? So the backstory is, is that some practitioners will recommend perineal massage to repair perineum before labor and birth.
[1:01:16] And some of the research suggests that it can reduce the chances of you, Terry. Now, if you're doing perineal massage correctly, it's focused on the opening of your vagina and it does involve some pain and discomfort. So the pressure that's exerted is actually really different to the pressure that's exerted during sex. So no, sex doesn't replace perineal massage. The sensations and the technique is really not the same so I wouldn't, say that if you're having heaps of sex that means you don't have to do perineal massage but if you're having heaps of sex you might be chilled and relaxed enough that it's also going to keep you safe during birth, okay now this was one of my favorite questions mostly because it included an eggplant emoji so is my husband's eggplant emoji penis, poking the baby in the face okay I hope this question has been answered.
[1:02:19] Earlier when I explained your anatomy. So firstly, you've got your vagina, which gets longer when you're aroused, but is usually capable of admitting a regular sized penis, whatever that would be. Then you have your cervix, which is longer closed. Then you have the very muscular structure of your uterus and the baby is in a sac and amniotic fluid. So that's the long-winded way of saying no, your husband's eggplant emoji is not poking the baby in the face. Even more importantly, because when babies are positioned in your uterus, their head's tucked down, so their chin is actually tucked to their chest, if anything if per chance eggplant emoji gets anywhere near the baby it'll actually be poking it in the very top of its head on its skull, or if it's breech it might be poking their foot or bum cheek but it doesn't though, so that's the answer to that question Now, on a much lighter note...
[1:03:31] And purely out of an insane desire to include everything that I've learned while creating this podcast. Over my career and a midwife and a researcher and a script writer for the podcast, I've come across some very interesting research papers regarding sex, sperm, and some ill-advised sexual activities during pregnancy.
[1:03:54] And for these reasons, I need to tell you that there are actually a number of research papers about oral and vaginal consumption of semen and it's linked to a reduction in pre-eclampsia incidence in women who are having their first baby.
[1:04:10] I know there's actually more research on the vaginal and oral consumption of sperm than there are to support things like routine vaginal examinations during labor and the benefits of CTG use during labor. I'm telling you that more research has been done on exposing women to sperm and semen than there have been on routine monitoring procedures for labor and birth. So that's where we're at. And the research specifically makes reference to swallowing sperm and barrier-free vaginal sex for a reduction in the number of first-time mothers who will get preeclampsia. So they don't understand the exact mechanism for why this happens but more than one paper has made this conclusion, I don't know what we're supposed to do with this information but all I know is is that there was more research done on the benefits of giving therapeutic blowjobs for the prevention of preeclampsia, and we only just in 2005 understood the full anatomy the clitoris so we understand the benefits of.
[1:05:26] Oral and vaginal consumption of semen before they even started to research our very crude female anatomy. So that's me being incredibly cynical, except also to say that this research exists and this is a topic of pregnancy and sex, and I thought I should mention it. If you want to read those papers, they are all in the resource folder for this podcast. And as with every episode, if you're on the mailing list for the Great Birth Rebellion podcast, you can get access to all the research papers that I've used today. And if you do go to that resource section, you'll see that there's a few mainstream brochures that have been provided there that women might be offered by care providers.
[1:06:06] Interestingly there's more than one research article and this is maybe why you'll see these pointers given in those brochures there's more than one research article that strongly discourages blowing air into the vagina during oral sex because it can cause a rare but recorded complication called venous air embolism there are recorded cases of women dying from this this is why when you search online or when you get given a brochure about sex during pregnancy, some of the pages will explicitly state not to allow air to be blown into your vagina during oral sex so if anyone has the habit of blowing air up their vagina or allowing that to happen during sex play pregnancy is apparently the time to stop that. On that note, that has been today's episode of the Great Birth Rebellion podcast. We were talking all about sex during pregnancy. To get access to the resources for each podcast episode, join the mailing list at melanethemidwife.com. And to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanieTheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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