Emma Stewart is an Integrative Therapist and Sexologist, with her specialism being in pregnancy and birthing, sexual issues and the sexuality of the birthing experience. She is also a HypnoBirthing practitioner and doula. Within her practice she utilises a variety of modalities, such as counselling, psychotherapy, clinical hypnotherapy and Neuro-linguistic Programming (N.L.P.).
She has a Masters of Sexology and in 2011 was awarded the Russ Davey Student Sexology Award. She has a background in education and consultancy and has provided education programmes and workshops within diverse professional and clinical settings. Institutes that she has presented for have included the Australian Hypnotherapy Association (A.H.A.), Australian Doulas Plc., King Edward Memorial Hospital (Dept. of Midwifery), Edith Cowan University and the Western Australian Sexology Association (W.A.S.S.).
Workshops have included subjects such as post-natal sexuality, working with survivors of sexual abuse during birth and how to empower women within clinical settings to make informed decisions. She works in private practice in Roleystone, WA.
Today we are talking Emma, who is an Integrative Therapist and Sexologist, and specialises in pregnancy and birthing. She’s a really awesome, local doula and HypnoBirthing practitioner in my town in Perth, Australia. The reason I invited her on the show is because a lot of people who are pregnant (particularly in the early days or if it’s their first pregnancy) ask me if it’s safe to have sex. And the answer, you’ll be very happy to hear, is a resounding yes! There are even some benefits to having sex. All will be revealed!
Newborn Mothers: Hi Emma, and welcome to Newborn Mothers free pregnancy podcast. I’m really happy to have you here.
We’re just going to talk today about sex, particularly in the first trimester. I know I get a lot of questions, particularly when people are pregnant for the first time and it’s one of the things they’re thinking about. Is it safe, is usually the first thing that comes to mind. Is it safe to have sex, and will it harm the baby. So Emma, I’m hoping you can help us with that one.
Emma Stewart: I certainly can. Sex in the first trimester is perfectly safe. So if we’re talking about sex, that can mean a multitude of things as well. So maybe I should clarify what sex means. Very often people ask questions about pregnancy, and it’s often to do with penetrative sex (so, penis in vagina). This sex, as well as oral sex and lots of other different types of sex, is perfectly safe during the first trimester, with an uncomplicated, low-risk pregnancy. So there are some risks with certain pregnancies, and I think we’ll talk about that as well in this session.
NM: Great. So there’s no way that it can harm the baby at all?
ES: No, not at all. Penetrative sex, in fact, is associated with a reduced risk of miscarriage. So if a woman is having sexual pleasure, and she’s having good, positive sexual experiences, she’ll have reduced stress. And probably a greater sense of emotional well-being, and therefore there is actually a reduced risk of miscarriage.
NM: Oh, that is so good to know Emma, thank you!
ES: You’re welcome. And it’s something that women are often very concerned about. They’re worried that either they’re going to lose the baby; they’re going to miscarry, or that there’s going to be a risk of premature birth later on in their pregnancy. And actually, research has shown that the risk of both of those things are very reduced by having an active, positive sexual experience with themselves or their partners. And that’s because of the hormones that are reduced with good, positive experiences, and the greater sense of emotional well-being with the connectedness with themselves or their partners.
NM: That’s so good. So that’s obviously for penetrative sex; what about if people are into anything like sex toys, or any sort of kinky things that they might usually do? Is there anything that they should stop doing?
ES: That’s a good question. Penetrative sex and orgasm or sexual pleasure, is not linked to miscarriage or vaginal infections. But even if you were using toys, or having other forms of sex, there are some things to take into account. For example, although penetrative sex is not linked to miscarriage or vaginal infections, there are some attendant risks with using toys.
Toys must be well-cleaned and kept clean, to avoid any sort of vaginal infections. And also, there are some attendant risks with things like anal sex. So it’s good to know you can still continue to use toys; vibrators are fine, using toys are fine. But it’s also listening very closely to your body. So if you’re used to using a vibrator, or used to using a sex toy, and you use it during your pregnancy and it feels uncomfortable, then listen to your body.
It’s actually perfectly fine to still use those things, but you may find that your body responds differently when you are pregnant. For example, some women will notice during their first trimester that sex, or sexual intercourse, or using toys or vibrators, can cause some genital engorgement. So the genitals will become very engorged, they’ll become swollen, and a bit more sensitive. So they may find having penetrative sex or engaging in using a toy or having oral sex, may be a lot more pleasurable because of this heightened sensation that’s caused by genital engorgement. But it can also be uncomfortable.
NM: Interesting. So because it’s more sensitive, it can go either way. People can enjoy it more, or it can tip them over too far.
ES: Some women might enjoy it more because there’s more blood flow, the nerve endings are more energised; they’re feeling more positive. But they may notice that that engorgement causes oversensitivity and it can be uncomfortable. For example, some women notice that their clitoris may be more sensitive, or less sensitive. They might find that they get more powerful orgasms, or less powerful orgasms. Because of the engorgement and changes in the hormones, and also to do with their emotional state during that time.
So, it’s listening very carefully to your body and what its needs are. You are the only person who is going to know what’s positive for you. Some women may find it more pleasurable to actually have what more we call non-penetrative intercourse, so no penetration with the penis in the vagina or using toys, but more ‘outercourse’. What I mean by outercourse is more foreplay, maybe more oral sex, masturbation or mutual-masturbation. That may be more pleasurable for them at this time.
NM: Great. And are there any other ways that sex might feel different for a woman who has just found out she’s pregnant?
ES: I think so. I think again, women may notice, and also their partner or partners may notice, changes in their sexual desire, in their sex drive, and in their bodies’ responses to sex. Be very open and communicative and honest with everybody in the relationship, because there are such wide variations in sexual desire and sexual response during this time.
For example, intimacy or sexual response may be affected because of emotional changes that women and their partner or partners are experiencing during the pregnancy. If the pregnancy was unexpected there may be worries or concerns that may occur. Emotional responses will affect sexual desire or sexual response, so if the partner is worried about hurting the baby, or worried about the mother’s health, or if the partner or partners are worried about financial burdens with parenthood, then there may be changes to their sexual desires. Things like being self-conscious in front of an unborn child; lots of people become self-conscious of making love or having sexual experiences in front of an unborn child.
And women themselves may experience changes in their emotional and physical responses, because of concerns about their body image, or they may just be feeling very nauseous and tired. Which is a sure passion-killer.
ES: Physiological changes can occur at this time. Breasts and nipples can become more tender. We’ve talked about genital engorgement. There may be more urgency to urinate, so she becomes more anxious about having a sexual experience. Or fluctuations and changes in hormones may change things like vaginal lubrication or sexual desire. It may even mean that she gets more vaginal lubrication, but it can be stronger in its scent or taste, and she could become self-conscious about that. So it’s knowing that there’s lots of changes that occur emotionally, physically, biologically. There’s so much that occurs at this time, and it’s just about being very open and communicative with everybody that’s involved in the relationship, and about your sexual desires, and how you’re feeling about your body.
There’s no right or wrong when it comes to sex and sexual desire. It’s very much a personal thing. Some women may become rampant during their first trimester. They can’t get enough of sex; their partner or partners just love their new body. And other women may find that their just too tired to engage in any form of sexual pleasure, or exchange, or intimacy at that time.
NM: Sure. So what you’re telling me is really there’s no normal, and a woman just has to be guided by her experience and her own body, and find pleasure in whatever works for her?
ES: Absolutely. And it should be a very individual experience. Lots of women, for example, become quite anxious at this time when they’re worried, what if I had sex and it harms the baby. It’s just about reassuring and communicating with their partner.
For example, if the women is concerned that the penetration is going to harm her baby, it doesn’t matter who tells her that this is going to be fine, if she stills feels concern she’s going to be uncomfortable during the sexual exchange. It may be that she talks to her partner about either not engaging in penetration, or she talks to her partner about being more in control of penetration. So, she can control the penetration by choosing a particular position. Or she may notice that when she has deeper penetration it may cause some abdominal tightening or hormones being released that can cause her to have some abdominal tightening, so she prefers to have more outercourse. And it’s just listening to women and their bodies, and for her to be able to communicate what feels good.
NM: Great. And one thing I see in movies all the time is that (in Hollywood), the women are worried about their bodies, and the men are worried about hurting their babies. I hear what you’re telling me in real life it’s not really this awkward.
ES: It doesn’t have to be, particularly with good communication and education. For example, if it’s a male partner, letting him know with penetration that he’s never going to be able to penetrate deep enough to cause a problem, which most people aren’t aware of. They think, I’m going to touch the baby or I’m going to knock the baby or I’m going to hurt it in some way, and actually the baby is very well protected. It’s almost in two big pillows. It’s in the amniotic sac which surrounds the baby, which is filled with the amniotic fluid. And then, the baby is then encased in another pillow, which is the uterine muscles.
So it’s letting the partners know they’re really well protected. If it’s a male partner, knowing that their penis is never going to hurt the baby. Even men of porn-star-proportions aren’t going to affect or be able to penetrate deep enough. And the baby not only is well protected and cushioned, but also that there are the muscles of the cervix which will protect the baby from penetration from going too far, and that there’s a thick mucus plug or uterine seal on the opening of the cervix during pregnancy, which will stop infection or anything else getting to the amniotic sac. The baby is very well protected; the body keeps it well protected and cushioned.
So, as you were saying about Hollywood’s concerns about men hurting the babies, it’s maybe just a little bit more education about what actually is protecting the baby.
NM: Sure. The actual physiology of the situation means that baby is never going to get a donk on the head or anything like that when the parents are having sex.
ES: That’s exactly right. And that’s quite a real concern for many couples. In some research that I’ve read, it’s up to 80% couples are worried that the baby will be harmed in some way by penetrative intercourse.
So, it’s listening to your body. Knowing that deep, vigorous, rough sex may be uncomfortable at this time, or it may not. You talked about other forms of sex, like using toys and maybe I’ll mention a little bit more about that as well.
NM: Yes, please do.
ES: For example, oral sex is a great alternative during the time of pregnancy. It tends to follow the same rules: anything with oral sex is fine. So you could use fingers, your tongue, you can do all sorts of different things while you’re engaging in oral sex. But it’s just the same as any other time: you don’t blow in the vagina. Which is something that I read quite commonly as a concern; what can cause harm, is there anything about oral sex that can cause harm during the pregnancy, and the answer is ‘no’. It’s the same as any other time. You can do whatever you like, but just don’t blow in the vagina. But it’s not something that you tend to see in many information leaflets or booklets about oral sex anyway; it’s not a technique that most people use.
NM: Ok, that’s good to know. What about contraception-
NM: ...you go. I was going to ask you about contraception but we can come back to that. You were going to say about anal sex?
ES: Anal sex has some attending risks, and it’s being aware of this. So just at any other time, there are some risks with anal sex; the risk of vaginal infection. If you’re having anal sex then the penis must not go into the vagina after it’s been in the anus, because there’s risks of vaginal infection. Obviously the anus is going to have bacteria and possible infections that wouldn’t normally be found in the vagina.
Make sure you’re keeping your practice positive, but also there are some other attending risks. For example, when women are pregnant they’re more likely to have haemorrhoids and if you engage in anal sex when the women has haemorrhoids there are risks with that. It can be very painful, and also there’s a risk of rupture. So if you’re engaging in penetrative anal sex then it could be that there’s a risk of haemorrhoids being ruptured, and with rupture you get quite significant blood loss. Which would put the mother and the baby at risk. So anal sex does have some attending risks; it’s being aware of that.
NM: And again, that’s just about really being guided by your comfort isn’t it? You should be able to listen to your body and know if that’s not right for you.
ES: Exactly. You mentioned contraception at this time. That’s another thing that very often gets omitted or not discussed with pregnant women during their first trimester, because very often she’s thinking, why do I need condoms? I’ve got no risk of pregnancy now I’m pregnant. Often condom use will be forgotten, so that’s a very good point that you made and it’s still a time during the first trimester and throughout the pregnancy where condom use should still be considered.
So if the partner or partners have a Sexually Transmitted Infection (STI), particularly if they have an active genital herpes lesion, then it’s a really good idea to still be using condoms. If the relationship is not mutually monogamous; if it’s an open or poly relationship and there are all the people involved who are fluid bonded, then it may be that condoms should still be used.
Also, if the women during her pregnancy has a new partner and she’s not sure of their STI status then condom use should also still continue. And some women do develop vaginal infections during their pregnancy, and these should be treated, but also to avoid passing on the infection, it’s a good idea for the partner to use condoms. Even for things like candida or thrush, a condom should be used during pregnancy to avoid contaminating each other.
NM: That’s really good to know. I imagine that’s something that people often just assume and don’t really give much thought, so thank you for adding that.
ES: It’s something that’s not really thought about. And also, there are certain times (if we’re going to talk about risks during pregnancy) where caregivers such as midwives or obstetricians may actually say that it’s not a good idea to have penetrative intercourse. So there are certain times where caregivers may encourage you not to be having penetrative intercourse. So maybe we want to talk about that as well?
ES: So, for example I just mentioned if a partner has an active genital herpes lesion, there are risks not only to the mother, but to the unborn child. If your partner has gential herpes and they have a lesion that’s active, you may choose to either not have penetrative intercourse or to use condoms at that time.
But there are other times where caregivers may advise against penetrative intercourse. For example, if the woman has a low-lying placenta (so this means the placenta is lying low in the uterus), or she has a situation which is called placenta previa (where there is a partial or full covering of the cervix by the placenta). The caregiver may advise against penetrative intercourse because this may cause trauma to the placenta because of its placing, which could cause health concerns for the baby and the mother. If there’s a low-lying placenta, or the placenta is covering the cervix (either partially or fully), that may be a time where intercourse is discouraged.
There are other times where they may discourage intercourse. If the mother has multiple babies, if she has a history of premature or preterm labour, if there’s any unexplained vaginal bleeding, if she’s experiencing abdominal cramps, or if her waters have broken. These may be times where they discourage having penetrative intercourse. Also, things like if the women has any cervical dysfunction or weakness or premature opening, they may discourage it.
Some caregivers will also discourage some women against penetrative intercourse if she has a history of miscarriage, but actually there’s no clinical evidence to suggest that intercourse causes miscarriage. It’s just that she become very anxious and therefore they will advise against it, but there’s no actual clinical evidence to suggest that penetrative intercourse causes miscarriage; in fact, it’s the very opposite. It may just be for a psychological reason.
NM: Certainly. So given a woman is experiencing a healthy pregnancy and she has no extra risk factors, then it’s totally fine. But in case she does have any sort of health issues or any extra risks, it’s well worth talking to her midwife or doctor to just get the okay.
ES: Absolutely. And if there’s any spotting or bleeding after intercourse, this is something to talk to your midwife about as well. That two or three out of ten women will have some vaginal spotting or bleeding during the first 20 weeks of their pregnancy, so it’s actually a very common-
NM: Quite a lot.
ES: ...yes, it is quite a lot. And it’s knowing that very often this is perfectly normal, but if you’re concerned, speak to your midwife. If the spotting becomes profuse or very red, or doesn’t stop an hour after penetrative intercourse, and is accompanied by any severe abdominal cramps or discomfort, or any dizziness or faintness, then that would be a time to contact your caregiver immediately.
It’s normal for there to be some blood spotting after sex, particularly if it’s vigorous, because the cervix during pregnancy is what we call friable (breakable), because there’s so much more blood supply there, so many more blood vessels there, that it’s more likely to spot with vigorous intercourse. If this continues or there are any signs of unwellness, this should be investigated.
NM: Sure. So if a woman’s healthy and not got any risk factors, it’s fine to continue having sex. But I guess what I’m hearing you say is, a lot of the reasons people might go off sex during pregnancy is they’re actually psychological more than medical risks as such. Psychological, emotional, or maybe even just the physical side effects of hormones and blood flow, and things like that.
ES: That’s right. And so many changes are occurring. It’s just best to listen to your body, try different positions, take the pressure off the uterus or the breasts if they’re uncomfortable (by trying more on-top positions, or sitting on laps). There’s a lot that can be done as well that has nothing to do with intercourse. For example, some women may feel that they don’t want to engage in any sexual experience with their partner or partners during this time, because of the effects of hormones and emotions upon their libido and their sexual desire.
And also on their sexual response. Hormonally we all respond differently, and she may find that she just doesn’t lubricate well or that she’s just not feeling sexual desire. So there’s lot of ways in which couples and polyfamilies can have togetherness with each other that has nothing necessarily sexual about it. Having a good cuddle, a massage, a relaxing bath or shower together, kissing and touching, maybe going for a walk or a meal or a movie. There’s lots of ways in which couples can still enjoy intimate time with each other that doesn’t include penetration or any other forms of sexual activity. Which can still be a really positive way of being together; being intimate.
NM: Yes, and I imagine it would still carry a lot of the benefits, like the release of oxytocin, and relaxation, and general pleasure and well-being. Sounds like a really good idea. For everyone, not just if you’re pregnant!
ES: Yes! So there are certain risks when you’re pregnant in terms of sexual intercourse, but they are usually are not with low-risk, uncomplicated pregnancies. There’s just some considerations to take into mind when you’re pregnant, and most of those are very much about listening to your body and your individual needs, and knowing that this is perfectly safe in a low-risk, uncomplicated pregnancy. But there are also lots of ways in which you can engage in positive, intimate communication with your partner or partners, that don’t necessarily include sexual intercourse and that’s perfectly fine.
NM: That’s really good to know. Thank you Emma, I think we’ve covered everything. Is there anything that we’ve missed out?
ES: No, I think we’ve covered everything there. I can’t think of anything at the moment.
NM: You’ve answered all the questions I’ve had, and a lot more too, so I really appreciate that. Thank you!
ES: Wonderful, great. And when we talk about a second and third trimester, there are some changes that occur during that time as well.
NM: Yes, excellent. I’ll be booking you in for another interview for second trimester and third trimester sex. So if anyone has got any more questions, you can just send me an email or get in touch on Facebook and we can arrange to ask Emma all of your questions about sex during pregnancy.
Thank you so much for your time, Emma, and we’ll catch up with you in the next podcast.
ES: That would be great.
NM: Thank you.
ES: Thank you.
Well, that was cool! It’s always a pleasure to have a chat to Emma, and always great to hear her say ‘oral sex’ in her wonderful accent! Thank you, Emma. And if you want to check out any more of her work, you can connect with her via her websites, Blissful Birth and Yoniverse, or via Facebook.
Please share this with your partner, or maybe if you’ve got any pregnant friends who’ve been wondering, like you, if it’s safe to have sex. Please share this with them so they can go and enjoy having lots of pregnancy sex too!