The American College of Obstetricians and Gynaecologists (ACOG) states that most sexual activity is safe for women with healthy pregnancies, as the amniotic sac and strong uterine muscles protect the developing baby. However, certain complications can make sex unsafe, and pregnant women should seek individual medical advice, according to Halimat Jimoh, a nurse and midwife who spoke with Premium Times.
When Sex May Not Be Advisable During Pregnancy
In an uncomplicated pregnancy, the baby is protected inside the uterus by the uterus, amniotic fluid, and cervix, Ms Jimoh explained. Yet specific pregnancy complications can change the safety advice. These include unexplained vaginal bleeding, placenta previa or other placental problems, leaking of amniotic fluid, certain cervical conditions, and concerns about preterm labour.
Pregnancy itself is not a blanket reason to stop having sex, Ms Jimoh stressed. Instead, a woman's individual pregnancy and any complications should determine what is safe. "Pregnancy itself is not a reason to stop having sex; it is certain pregnancy complications or medical concerns that may make avoiding sex necessary," she explained.
Oral Sex: Generally Safe but Not Without Risks
Oral sex is generally considered safe during an uncomplicated pregnancy, but precautions are necessary. One critical precaution is that a partner should not blow air directly into the vagina. Though extremely rare, forcing air into the vagina has been associated with air embolism, a potentially life-threatening condition where an air bubble enters a blood vessel and interferes with blood flow.
More importantly, oral sex does not eliminate the risk of sexually transmitted infections (STIs). The National Health Service (NHS) states that infections, including herpes, gonorrhoea, syphilis, chlamydia, HIV, and hepatitis, can be transmitted through oral sex. The risk increases when either partner has sores or cuts around the mouth, genitals, or anus. Thus, the absence of vaginal penetration does not automatically make oral sex risk-free.
Pregnancy Does Not Protect Women from STIs
Pregnancy does not protect a woman from contracting an STI, Ms Jimoh said. An infection acquired during pregnancy can affect the mother and, depending on the infection, may also affect the developing baby. Syphilis is one example. The World Health Organisation (WHO) estimates that about eight million adults aged 15 to 49 acquired syphilis in 2022.
Untreated, late-treated, or inadequately treated syphilis during pregnancy can result in adverse birth outcomes in an estimated 50 to 80 per cent of cases, depending on the stage of the infection, according to WHO. The infection can pass from a pregnant woman to her baby through the placenta and may result in stillbirth, neonatal death, premature birth, low birth weight, or congenital syphilis. WHO stresses that early testing and treatment during pregnancy can prevent these outcomes.
Ms Jimoh advised pregnant women not to wait until after delivery before seeking care for a suspected STI. "Many STIs can be treated or effectively managed, and early testing, diagnosis and appropriate treatment during pregnancy can help protect both the mother and baby," she said.
Herpes Requires Particular Attention
Genital herpes requires particular attention during pregnancy, especially because of the risk of transmission to the baby around the time of delivery. Ms Jimoh explained that genital herpes can be transmitted from a mother to her baby during childbirth. The risk is particularly concerning when a woman develops genital herpes for the first time towards the end of pregnancy, as she may not yet have developed sufficient antibodies to protect the baby.
The Centres for Disease Control and Prevention (CDC) estimates that the risk of transmitting herpes to a newborn is between 30 and 50 per cent when a woman acquires genital herpes near the time of delivery. This compares with a risk of less than one per cent among women with recurrent herpes or those who acquired the infection during the first half of pregnancy.
The CDC recommends that pregnant women with genital herpes inform their healthcare providers. Antiviral medication may be prescribed towards the end of pregnancy to reduce the likelihood of an outbreak around delivery, while a caesarean delivery may be recommended when genital lesions or symptoms are present at the onset of labour.
Herpes is not always accompanied by visible symptoms. Ms Jimoh noted that the infection can sometimes be transmitted even when there are no obvious sores or other symptoms. She advised pregnant women and their partners not to dismiss unexplained sores, blisters, or lesions around the mouth or genitals. This is particularly relevant to oral sex because oral herpes, commonly associated with cold sores, can be transmitted through oral sexual contact.
When Should Sexual Activity Be Avoided?
The presence of sores is not the only reason a pregnant woman may need to pause sexual activity. According to Ms Jimoh, women experiencing unexplained vaginal bleeding, leaking of amniotic fluid, known or suspected STI exposure, unexplained sores or lesions, unusual discharge, pain, or fever should seek medical advice. Women already advised to avoid sex because of a pregnancy complication should not assume that oral sex is automatically safe; they should ask their healthcare provider which forms of sexual activity are appropriate for their specific condition.
Vaginal bleeding during pregnancy should not simply be dismissed as a normal consequence of sex. For pregnant women, regular antenatal care, early testing where necessary, and prompt medical attention when unusual symptoms occur can help identify and manage potential risks early. The message, Ms Jimoh stressed, is not that pregnant women must stop being sexually active, but that they should understand their individual circumstances and seek professional advice whenever complications, warning signs, or concerns about infection arise.
