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The Nuts and Bolts of Safe Sex During Pregnancy

The Nuts and Bolts of Safe Sex During Pregnancy

Ali Monaghan | June 12, 2019 | 10 min. read

Pregnancy is a common and intense event experienced by many women, trans and non-binary people. While pregnancy comes up in private and public conversations often, discussions around pregnancy sex and the sexuality of parents-to-be are notably absent. As a mother and director of porn for women, I have wanted to address this for a long time and I’m happy to announce that on June 20 I will be releasing an explicit sex documentary about sex and pregnancy featuring adult performer Tiffany Doll & her husband Bruno.

In the upcoming weeks, the Erika Lust Blog will host a number of highly experienced women’s health and sexuality professionals to discuss everything around the topic of Pregnancy & Sexuality. From safer sex during pregnancy, to pelvic floor health, changing body images, BDSM during pregnancy, mental health and the power of eroticism.

In the second article, expert Ali Monaghan discusses the hormonal and physiological changes during pregnancy and she also addresses the most common question women have about sex and pregnancy: safety. She talks about safety in relation to sex toys, anal sex and cleanliness.

Physiological Changes in Pregnancy

There are many physiological changes that occur during pregnancy which can affect sexuality, most of which are orchestrated by the sex hormones estrogen and progesterone, which rise to levels never before experienced prior to pregnancy (Stables & Rankin,2010). Estrogen helps to increase blood flow and circulation in pregnancy, with the total blood volume increasing by 50% by the end of the second trimester. These changes to circulation make the veins more prominent in a woman’s body, but also increase blood flow and congestion in the labia, clitoris and vulva, causing these areas to swell slightly from about 16 weeks onward; the clitoris may emerge further from its hood, and the labia minora (inner lips) may begin to protrude beyond the labia majora (outer lips) (Bright, 2008). All of these changes increase sensitivity, which in turn can heighten sexual pleasure. It’s also very normal for a woman to experience an increase in a clear, odourless vaginal discharge known as leukorrhea, which aids with lubrication during sex and can create a near-constant wet, turned-on feeling (Aduboffour, 2010).

Estrogen and progesterone are also responsible for the changes to a woman’s growing breasts, which become larger, heavier and more tender and sensitive during pregnancy. From the second trimester onwards, some women may find that their breasts leak a small amount of colostrum, the first type of breastmilk the body produces, which is usually bright yellow or orange in color. This leaking can sometimes occur after orgasm as well once the baby has been born, since oxytocin (the hormone of love and human connection) is released during orgasm, and is also responsible for releasing breastmilk in the postnatal period (Bright, 2008; Stables & Rankin, 2010). While the idea of leaking during sex (or otherwise) can be unsettling, it’s a visible sign of arousal, which some people find to be incredibly sexy and liberating (Bright, 2008). Some pregnant women may find their larger, more sensitive breasts a huge turn-on, while others may find the changes uncomfortable and won’t want their breasts handled much at all. Regardless, your preferences for how and when your breasts are touched, and for different types of touch, are things you can explore and communicate with your partner(s).

The uterus also changes dramatically during pregnancy, growing from an organ the size of a small pear to one that sits just below your ribs, able to accommodate a full-term baby, placenta and amniotic fluid. This growth means that everything is bigger—including orgasms! It’s very normal for the pregnant uterus to spasm or contract with orgasm, just as the non-pregnant uterus often does, except that in pregnancy these contractions will be bigger, and may continue for awhile once sex is finished (Lichtman, Simpson & Rosenfield, 2003). These contractions may become more noticeable in the third trimester as well, as the uterine muscle bulks up considerably due to oestrogen and becomes more sensitive to the effects of oxytocin, the hormone responsible for uterine contraction in labour (Stables & Rankin, 2010). The cervix also becomes more sensitive and friable during pregnancy, so some women may see a small amount of spotting or brown discharge after penetrative sex as well. In nearly all cases, contractions or spotting after sex is usually mild, and will generally resolve on its own. However, if at any point the contractions start to become stronger or more painful, or are accompanied by increasing pressure or back pain, or the bleeding becomes heavier or bright red, it’s important to seek medical advice.

The Nuts and Bolts of Safe Sex During Pregnancy

Many couples are concerned about the safety of sex during pregnancy. In nearly all cases,sex is a healthy and normal part of pregnancy (with only a few cautions and exceptions to this—see below), and the baby is cushioned in a balloon of amniotic fluid and well protected behind the woman’s cervix (which is plugged with mucus to prevent infection) and layers of muscle and fat. Any penetrative sex occurs in the vagina, below the closed cervix, and several inches from the baby. Orgasm is also safe in a healthy, low-risk pregnancy, and any small contractions which may occur as a result of it won’t increase the risk of premature labour (Aduboffour, 2010). In fact, the baby will probably enjoy the rush of oxytocin caused by orgasm (although don’t worry—your baby has absolutely no idea what you’re up to!).

Masturbation, fingering, fisting, perineal massage, the use of sex toys and oral sex are also safe during pregnancy, although oral sex should be avoided if there are any active lesions in the mouth or on the genitals, or if there is an active infection such as yeast(thrush) or bacterial vaginosis (BV). Similarly, if you’re engaging in anal sex, it’s imperative that vaginal penetration occurs first before anal penetration, and that anything used during anal play is thoroughly cleaned with soap and water before vaginal re- insertion (this helps to minimize the risk of infection). The same holds true for sex toys, which should always be washed thoroughly with soap and water before and after use, and never shared (Aduboffour, 2010). In some rare cases, sex should be avoided for medical reasons. This includes placenta previa or a low-lying placenta, preterm labour or a history of preterm labour in a previous pregnancy, any vaginal bleeding, if your waters have broken, if you’re experiencing any symptoms of miscarriage (cramping, spotting or bleeding), or if you have cervical shortening or a cervical stitch. If you or your partner have an untreated sexually transmitted infection like chlamydia or gonorrhea, it’s best to abstain from sex until both of you have been treated for the infection; in rare cases where the infection is viral rather than bacterial, and therefore cannot be 100% eliminated, condoms should be worn to minimize the risk of transmission (although in general, condoms are always a good idea, especially with new partners). There may be other less common reasons to abstain from sex, and if you have any questions or concerns, you should discuss them with your health care provider.

Sex is also a fantastic way to kick-start labour. Semen contains prostaglandin, a hormone-like substance which can help to ripen and soften the cervix, and in some cases can naturally induce labour in women whose bodies are already close to going into labour anyway (although semen on its own will not induce labour before your body is ready, so there’s no need to avoid it at earlier points in the pregnancy) (Stables & Rankin, 2010).

Similarly, passionate kissing during labour, light touch and stroking, massage and nipple and clitoral stimulation can all help to boost a stalled labour and increase the intensity of contractions, as the sexy energy that helped to get the baby in there in the first place will absolutely help to get it out (Gaskin, 2003). Masturbation during labour also works well to take the edge off of labour pain, keep you relaxed, and keep the oxytocin flowing. Sex expert Susie Bright brought her Hitachi magic wand to the hospital with her, and unsurprisingly, had an incredibly enjoyable an
blissed out labour (Bright, 2008). It’s impossible to separate our sexuality from pregnancy and birth, although our culture tries very hard to do so.

The Sexuality of Birth

While birth is often a medicalised and sanitized event in our culture, it’s important to keep in mind that it’s also, at its very core, the most sexual moment a woman will ever experience in her lifetime—her most primal, sexually powerful, creative and procreative act. Like sex, birth has the capacity to move a woman out of her civilized, neo-cortex(the part of the brain responsible for higher cognition and language) and back into her more primitive “monkey brain”, as Ina May Gaskin has observed (Gaskin, 2011). Like sex, birth has the capacity for transcending us beyond our everyday existence, into realms of ecstasy, emotional openness, connection and vulnerability (Odent, 2009). Birth involves the same hormones which are released during sex, namely oxytocin, beta-endorphins, adrenaline, and prolactin, “the hormones of love, transcendence, excitement and tender mothering, respectively” (Buckley, 2004, pp. 204). Birth can often sound very similar to sex, with women moaning and making primal, animal noises, and moving in rhythmic, instinctual ways as the cultural norms of our society fall away and women enter an altered-consciousness/ liminal state (Davis-Floyd, 2003). And like sex, birth requires similar conditions to work efficiently: privacy, comfort, a quiet environment, low lighting, a sense of safety and security, and feeling unobserved (Odent, 2009).

Unfortunately, birth, like orgasm, can also be easily disturbed and derailed, and our modern obstetrical practices, while well-intentioned, often do this quite handily. However, if left undisturbed, the hormones of birth are capable of bringing forth the profound physiological changes necessary to bring a new life into this world, namely contractions, cervical dilation and the fetal ejection reflex, which obstetrician Michel Odent describes as the highest rung of the ladder—the climax or culmination of human sexuality (Odent, 2009). The hormones of undisturbed birth also literally transform the mother’s brain on a neurological level, flooding her with the biggest oxytocin rush of her life and paving the way for maternal bonding and love, crucial for the survival of our species (Buckley, 2004). Additionally, while the majority of women might not experience labour in this way, there is a distinct minority of women who find labour orgasmic, and will describe it as intensely pleasurable, blissful, euphoric and spiritual (Gaskin, 2003). Sometimes just knowing this fact opens up a world of possibility to women when they are giving birth.


Aduboffour, A.E. (2010) Sex and Romance During Pregnancy and After Birth. Milton Keynes: AuthorHouse UK.

Bright, S. (2008) ‘Egg Sex’ in Bright, S. (ed.), Susie Bright’s Sexual Reality. Santa Cruz: Bright Stuff.

Buckley, S. (2004). ‘Undisturbed birth—nature’s hormonal blueprint for safety, ease and ecstasy’. MIDIRS Midwifery Digest, 14(2): 203-208.

Davis-Floyd, R. (2003) Birth as an American Rite of Passage. Berkeley: University of California Press.

Gaskin, I.M. (2003) Ina May’s Guide to Childbirth. New York: Bantam Dell.

Gaskin, I.M. (2011) Birth Matters: A Midwife’s Manifesta. London: Pinter Martin.

Licthman, R., Simpson, L.L. and Rosenfield, A. (2003) Dr.Guttmacher’s Pregnancy,
Birth Family Planning. New York: New American Library.

Odent, M. (2009) The Functions of the Orgasms. London: Pinter Martin.

Stables, D. and Rankin, J. (2010) Physiology in Childbearing. London: Ballière-Tindall

Ali Monaghan is an American Midwife and a British Student Midwife. Ali’s Book Happy, Healthy Pregnancy: 50 Things You Really Need to Know condenses it all into 50 essential pieces of information, giving you insider tips from real-life experience alon... Read More
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