Does sexual intercourse cause fetal distress?

Sexual Intercourse for Induction of Spontaneous Onset of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Sexual intercourse during pregnancy is commonly believed to trigger the onset of contractions and, therefore, labor. However, in low-risk pregnancies, there is neither association with preterm birth, premature rupture of membranes, or low birth weight, nor with spontaneous onset of labor at term.

AIM

To evaluate the effectiveness of sexual intercourse for spontaneous onset of labor at term in singleton pregnancies.

METHODS

The systematic search was conducted using electronic databases from inception of each database to June 2019. Review of articles also included the abstracts of all references retrieved from the search. Inclusion criteria were randomized controlled trials comparing sexual intercourse in singleton low-risk pregnancies at term with controls (either reduced number of coitus or no coitus) for spontaneous onset of labor. Estimates were pooled using random-effects meta-analysis.

MAIN OUTCOME MEASURES

The primary outcome was the incidence of spontaneous onset of labor. The summary measures were reported as summary relative risk with 95% CI using the random-effects model of DerSimonian and Laird.

RESULTS

Data extracted from 3 trials, including 1,483 women with singleton pregnancy at term and cephalic presentation, were analyzed. Women who were randomized in the sexual intercourse group had similar incidence of spontaneous onset of labor compared with control subjects (0.82% vs 0.80%; relative risk 1.02, 95% CI 0.98-1.07).

CLINICAL IMPLICATION

Sexual intercourse should not be restricted in low-risk term pregnancies. Further studies are needed to properly evaluate the impact of orgasm, penetration, condom use, frequency of intercourse and other factors on induction of labor at term.

STRENGTH & LIMITATIONS

Our study has several strengths. The three included trials had low risk of allocation bias; intention-to-treat analysis was used; this is the first meta-analysis on this issue so far. Limitations mainly depend on the design of the included studies. Firstly, compliance to the protocol relied on self-reporting by patients; in addition, not all the features of sexual intercourse could be adequately assessed (orgasm, nipple stimulation, sexual positions, etc.).

CONCLUSION

In women with singleton, cephalic, low-risk pregnancies, sexual intercourse at term does not significantly increase the incidence of spontaneous onset of labor. Carbone L, De Vivo V, Saccone G, et al. Sexual Intercourse for Induction of Spontaneous Onset of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Sex Med 2019;16:1787-1795.

The impact of sexual intercourse during pregnancy on obstetric and neonatal outcomes: a cohort study in China

The reports about the effects of sexual attitudes and activities on obstetric outcomes were inconsistent or even contradictory. This study aims to investigate the patterns of sexual intercourse during pregnancy and its impact on obstetric and neonatal outcomes. All of the participants delivered their babies between September 2016 and June 2017 at Peking Union Medical College Hospital (PUMCH). An online questionnaire was sent to postpartum women with singleton deliveries at least 6 months after their deliveries. The perinatal outcome data were collected by reviewing the maternal and neonatal medical records. The obstetric and neonatal outcomes were compared between the women without and with sexual intercourse. Five hundred fifty questionnaires were sent out, and 406 (73.8%) women responded. A total of 211 (52%) women had sexual intercourse during pregnancy. There were 113, 67, 22, and 9 women reporting frequencies of sexual intercourse of less than once per month, 1-2 times/month, 3-4 times/month, and >4 times/month, respectively, and 49, 199, and 59 women reported sexual intercourse during their first, second, and third trimesters. The most common complaint was a lack of sexual interest. The experiences, frequency, and timing of sexual intercourse had no significant impact on any obstetric or neonatal outcome compared with those of the women without sexual intercourse. Impact statement What is already known on this subject? The reports about the effects of sexual attitudes and activities on obstetric outcomes were inconsistent. What do the results of this study add? In our study, the experiences, frequency, and the timing of sexual intercourse had no significant impact on any obstetric or neonatal outcome compared with those of women without sexual intercourse. What are the implications of these findings for clinical practice and/or further research? Sexual intercourse is generally safe in healthy pregnant women.

Changes in sexual practices and responses among ante-natal clinic attendees in a Nigerian teaching hospital

A cross-sectional study was carried out among 134 antenatal clinic attendees in a Nigerian tertiary hospital to assess pregnancy-related sexual beliefs and changes in sexual frequency and response. Information was collected through a semi-structured questionnaire, and analysed by SPSS. Only 15% of women believed that religious, social or cultural reasons prevented sexual intercourse in pregnancy. Frequency of sexual intercourse decreased in pregnancy in 37.4% of the respondents, remained unaltered in 46.1% and increased in 16.5%. Age, marriage duration and gestational age were not associated with change in the pattern of coital frequency in pregnancy, but education was significantly associated. Sexual responsiveness diminished in approximately half of our respondents in terms of arousal (54.5%), orgasm (48.5%), pleasure (43.7%) and satisfaction (51.4%). The changes were not associated with pregnancy duration. We concluded that sex in pregnancy is well accepted in our environment, and health workers should promote sexual health and well-being in pregnancy.

Sex during pregnancy and the first postnatal year

Ratings of sexual behaviour and feelings were obtained regularly from subjects of a longitudinal study of psychiatric status and psychological change in pregnancy and the first postnatal year. The results are consistent with previous research, showing a reduction in frequency of sexual intercourse and in interest and satisfaction with sex over the course of pregnancy. Coitus was resumed after childbirth within six weeks by nearly 60% of women, and within three months by eighty. In most cases, ratings of interest in and satisfaction with sex also returned to early pregnancy levels by three months postnatal. Despite clear trends in the group as a whole there was considerable individual variation, investigated using tests of association with measures of subject characteristics and psychological status.

Coitus during pregnancy: is it safe?

The relation between third-trimester coitus and adverse perinatal outcome was studied in 39 217 pregnancies from the Collaborative Perinatal Project. Coital frequencies reported at 28-29 weeks, 32-33 weeks, and 36-37 weeks were each positively related to subsequent length of gestation (p less than 0.001), both before and after adjusting for multiple covariates. Perinatal mortality was compared among women reporting different frequencies of coitus per month. The adjusted odds ratios (compared with women having no coitus) for women having coitus 0.1-2.0, 2.1-4.0, and greater than 4.0 times per month were 0.74, 0.89, and 0.87 for coitus at 28-29 weeks; 0.82, 0.82, and 0.99 for coitus at 32-33 weeks; and 1.15, 1.11, and 1.45 for coitus at 36-37 weeks. None of these odds ratios was statistically significant. Thus, in this data set there was no association between coitus in pregnancy and adverse outcome of pregnancy.

Sexuality and pregnancy: a review

Marital success and failure may be related to sexual satisfaction, including orgasmic capability. Pregnancy represents a life crisis to the pregnant woman and her husband. Complex psychosocial and physiological demands may produce insecurities, anxieties, and somatic complaints. The expectant mother may seek to fulfill increasing nurturant needs through increased physical contact such as cuddling or being held. A pregnant woman's interest in sexual activity may be affected by her changing physical appearance and the hormonal milieu of pregnancy. Although there are marked individual variations and methodological biases and differences among empirical studies, pregnancy appears to be usually accompanied by a decrease in sexual desire, coital frequency, and orgasm. Sexual behavior in pregnancy has been traditionally restricted and is currently poorly defined. Sexual proscriptions may precipitate sexual frustration and marital estrangement. Abortion is only rarely caused by coitus. The relationship of coitus and orgasm to prematurity and distress of the fetus and newborn has not been clearly established. Coitus can indirectly result in maternal, fetal, and neonatal morbidity and mortality through the spread of sexually transmitted diseases. Deaths from air embolism in pregnancy associated with cunnilingus and vaginal insufflation have been reported.

Maternal sexuality during first pregnancy and after childbirth

Information about sexual activity, enjoyment and libido was obtained at intervals from 119 primiparous women during a longitudinal survey of maternal emotional health in pregnancy and for a year after delivery. Most subjects described some reduction in the frequency of sexual intercourse and a diminution of libido and sexual enjoyment during pregnancy; this was most marked in the third trimester. After delivery, about a third of subjects had resumed intercourse by six weeks and nearly everyone had done so by three months. Nevertheless, 77% and 57% of the women were having intercourse less often at three and 12 months after delivery respectively, in comparison with the month before they became pregnant. Selected variables were examined for relationship with a low, or reduced frequency of intercourse and with a lack of enjoyment. Significant associations were found with aspects of maternal personality and childhood relationships, marital conflict, maternal depression, previous miscarriages, difficulties in conceiving and fears of harming the fetus. Nausea and vomiting during pregnancy, the mode of delivery and related obstetric and medical variables, breast-feeding and characteristics of the baby, did not appear to significantly influence maternal sexuality.