NEW YORK (Reuters Health) – Recommendations on sexual activity restriction during high-risk pregnancies should be individualized based on a patient’s obstetric history and comorbidities, as well as the fears and emotional needs of the patient and her partner, according to a new evidence review.
About one in 10 pregnancies among U.S. women end in preterm birth (PTB), Dr. Sally MacPhedran of Case Western Reserve University School of Medicine in Cleveland notes in her report, online March 20 in Sexual Medicine Reviews. Women with complicated pregnancies that increase PTB risk are typically told to restrict or abstain from sexual activity, she adds.
“However, the restriction is most commonly ‘pelvic rest,’ which is not defined in terms of what specific sexual acts are to be avoided or are permissible,” Dr. MacPhedran states. “In particular, pelvic rest does not address whether orgasm needs to be limited in pregnancy. This vague restriction on all sexual activity leaves patients confused and disappointed.”
Sexual activity could contribute to preterm labor through three mechanisms, according to the author: endogenous prostaglandin release and prostaglandins in semen causing cervical ripening; release of oxytocin causing uterine contractions; and direct contact with the cervix or lower uterus causing trauma.
Dr. MacPhedran offers the following recommendations on restriction of sexual activity during pregnancy for women with different types of pregnancy complications, based on her review of the evidence:
– Past PTB, without short cervix or other risk factors: No restriction.
– Short cervix with bleeding, increased contraction frequency or intensity, or further shortening of cervical length: Avoid any sexual activity with or without orgasm that causes perceived or painful contractions.
– Prophylactic cerclage placement: Avoid penetrative sex for at least two weeks. Afterwards, non-penetrative activity “need not be discouraged,” and modified penetrative activity can be permitted after a discussion with the patient and her partner.
– Premature rupture of membranes: Avoid oral sex and vaginal penetration due to the risk of infection.
– Placenta previa: Avoid penetrative sexual acts or sexual activity leading to perceived or painful contractions.
– Stable, chronic placental abruption: avoid sexual activity that results in bleeding, but sexual activity need not be limited unless it results in “frequent, intense, or painful uterine contractions.”
– Uncomplicated multiple pregnancy: No restriction.
“While the data are sparse, it is important for clinicians to educate themselves on what information does exist regarding the risks that specific sexual acts may incur on complicated pregnancies to be more comfortable initiating a conversation,” Dr. MacPhedran writes. “Recommendations of pelvic rest or strict pelvic rest are insufficient. Patients need an explicit discussion of the specifics of what is safe and what is not.”
Dr. MacPhedran was not available to comment by press time.
SOURCE: https://bit.ly/2HBtgZe
Sex Med Rev 2018.
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