THE CANADIAN PRESS
TORONTO—Women and their partners who are unsure about sex during pregnancy can breathe easier: hanky-panky doesn’t necessarily have to be on hiatus during those nine months. a primer published in the Canadian Medical Association Journal said sex during pregnancy is generally safe and with few, rare exceptions, poses minimal risks or complications to the mother-to-be. Drs. Claire Jones and Crystal Chan, residents in obstetrics and gynecology at the University of Toronto, co-authored the article with their supervisor Dr. Dan Farine, a U of T professor and maternal fetal medicine specialist at Mount Sinai Hospital. Jones said they wanted to address the issue because there are no Canadian guidelines on how to advise patients about sex and pregnancy. they reviewed the literature with the aim of putting together a sole resource that could be referred to when patients raise questions, she added. The paper outlines potential complications of sex during pregnancy, such as pelvic inflammatory disease. another complication is pre-term labour, which Jones said is a concern particularly for women with a past history of delivering prematurely. Jones said studies they looked at didn’t actually show sex, in itself, was a significant risk factor for going into premature labour. but in cases where women had symptoms of a genital tract infection and a history of pre-term labour, they potentially were at greater risk of premature birth than someone without any of those symptoms, she noted. “A lot of times we don’t know why women go into pre-term labour,” Jones said. “One of the theories is that infections can be a contributor to that. “So, potentially, these are women who have what we call a sub-clinical infection, or something that’s not obviously identified; that maybe there’s an overgrowth of some type of bacteria or something there that’s potentially putting that pregnancy at risk.” There is “limited evidence to guide recommendations” on sex for women at increased risk of premature labour due to a history of pre-term labour, multiple births, or cervical incompetence—a premature opening of the cervix which may lead to loss of a fetus. Yet these women usually are advised to abstain from sex, the authors wrote. another complication of sex in pregnancy is placenta previa. The placenta is the main source of nourishment for the fetus. when it lies low in the cervix rather than higher up in the uterus, there is a potential risk for causing a significant amount of hemorrhage or bleeding, Jones noted. “We worry that by having intercourse that that could disrupt that and cause a significant amount of bleeding, and that provides a significant potential harm to the baby,” Jones said. she noted it’s been routinely recommended that pregnant women abstain from sex if they have a known placenta previa. Venous air embolism also has been reported in pregnant patients having sex. “It’s basically like an air bubble that gets into the bloodstream that gets stuck in the heart or lungs and basically causes an arrest, the heart to stop or being unable to breathe because of it,” Jones explained. anything that causes increased air pressure into the vagina at a high rate would be something that puts individuals at greater risk, she noted, but stressed that the potentially life-threatening event is “very, very, very rare.” “The likelihood of dying from a venous air embolism from having sex when you’re pregnant is incredibly low—lower than being struck by lightning,” Jones said. when it comes to postpartum sex, Jones said most women are having intercourse again three months after birth. but there often are delays as a result of decreased lubrication or vaginal dryness due to breastfeeding. “It’s something we probably don’t tell patients enough that the first time when they try and engage in sexual activity again after they’ve delivered, it might be uncomfortable, and if they use a little lubricant, it might be more comfortable for them.” Chan said one of the goals in publishing this paper was to initiate dialogue between physicians and their patients. “We just want to create an environment where physicians feel comfortable talking about sex and pregnancy to their patients and vice-versa,” she said. Jones said they want people to come away from reading the primer informed that, by and large, sex while pregnant is “very safe.”