1

Changes in the Sexual Function During Pregnancy

Iwona Gała˛zka, PhD, Agnieszka Drosdzol-Cop, MD, PhD, Beata Naworska, PhD,
Mariola Czajkowska, PhD, and Violetta Skrzypulec-Plinta, MD, PhD
Sub-Faculty of Women’s Health, Medical University of Silesia, Katowice, Poland

DOI: 10.1111/jsm.12747

ABSTRACT

Introduction. The physiological changes during each trimester of pregnancy have a significant impact on women’s
sexual behavior.
Aim. The aim of the work was to assess changes in the sexual function during pregnancy.
Methods. The prospective study encompassed 520 pregnant women aged between 18 and 45, of whom 168 were
qualified for the final analysis. The research tool was a purpose-designed research questionnaire and the standardized
Female Sexual Function Index.
Main Outcome Measures. To assess changes in the sexual function among pregnant women aged 18–45 in the three
pregnancy trimesters.
Results. All the studied parameters, i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain, decreased
significantly with the progression of pregnancy. Analyzing the frequency of sexual intercourse in the studied group
before and during pregnancy, a statistically significant decrease (P < 0.000001) was observed. Sexual desire changed
statistically significantly (P = 0.0004). The direction of change concerned decreased sexual desire in the three
trimesters compared with the situation before pregnancy. Statistical significance was demonstrated for: decreased
sexual desire (P = 0.00007), partner’s reluctance (P = 0.002), and pregnancy-related changes in appearance (P = 0.03).
Conclusions. Sexual function was compromised and sexual activity decreased as the pregnancy progressed. Changes
in the domains of arousal, lubrication, and orgasm were particularly notable in primaparae in the third trimester of
pregnancy. Unsatisfying partner relationship was a significant factor affecting the quality of sexual life during
pregnancy. Gała˛zka I, Drosdzol-Cop A, Naworska B, Czajkowska M, and Skrzypulec-Plinta V. Changes in
the sexual function during pregnancy. J Sex Med **;**:**–**.
Key Words. Pregnancy; Sexual Behavior; Sexual Function in the Three Trimesters of Pregnancy; Partner
Relationship

Introduction nia increase, especially in the second half of the

pregnancy. At the same time, pregnant women and

T he physiological and anatomical (including

increased weight) changes that occur in
women during each trimester of pregnancy have a
significant impact on their sexual behavior. Clini-
cal tests show that in many women during physi-
ological pregnancy, and particularly in the third
trimester, the frequency of sexual contacts, sexual
desire, and satisfaction decrease significantly. Fur-
thermore, it has been demonstrated that during
physiological pregnancy, the ability to reach
orgasm decreases, whereas instances of dyspareu-
their partners abstain from sex life and some posi-
tions for fear of inducing pregnancy complications
[1–4].
The sexual excitability and sexual satisfaction in
the first trimester vary considerably. Hormonal,
somatic, and psychological factors underlie a range
of behaviors, from complete abstinence from any
form of sexual activity to normal sex life. In the
first trimester, approx. 40% of sexually active
women report a decrease in sexual desire and, as a
result, sexual satisfaction (35%) [5,6].

© 2014 International Society for Sexual Medicine J Sex Med **;**:**–**

2 Gała˛zka et al.
In the case of physiological pregnancy, there is
no need to change the couple’s sex life. No
contraindications have been demonstrated con-
cerning the use of various sexual positions.
However, sexual activity in the first trimester
should be limited if early pregnancy pathology has
been diagnosed. Limiting of sexual activity is also
true in other trimesters—for example, if there is
concern of ruptured membranes in the second and
third trimester. The couple will be told to refrain
from vaginal intercourse for fear of increasing the
risk of prenatal infection [5,6].
In the second trimester, sexual interest (imagi-
nation and erotic dreams) usually increases as do
the expectations to satisfy the sexual needs. This
period is characterized by greater self-confidence,
acceptance of pregnancy, better mood, lesser
physical symptoms, and greater emotional support
from the future father [5,6].
The third trimester is usually characterized by a
decrease in women’s sexual desire (75%) and
sexual satisfaction (55%). The dysfunctions may
be the result of a general bad mood, body changes
(the pregnant uterus can make sexual contacts dif-
ficult), and fears about the well-being of the fetus
[5,6].
There are considerable differences between
primaparae and multiparae regarding their sex life
in the third trimester. The frequency of sexual
intercourses in primaparae decreases, whereas the
sexual life of multiparae does not undergo major
changes [6].
Aims
The aim of the work was to assess changes in the
sexual function during pregnancy. Emphasis was
put on the assessment of: the impact of pregnancy
on domains of sexual function and the impact of
partner relationship on female sexual life quality.
Material and Methods
Study Population
The prospective study encompassed 520 healthy
pregnant women at the beginning of the preg-
nancy, aged between 18 and 45, who reported to
the Obstetrics and Gynecology Outpatient Clinics
of the Medical University of Silesia in Katowice,
Poland. Initially, 520 pregnant women, meeting
the inclusion criteria, were qualified to participate
in the study. Every woman completed a study
questionnaire consequently in the first, second,
J Sex Med **;**:**–**
and third trimesters during consecutive checkups
and childbirth classes.
After the first trimester, 424 out of the 520
questionnaires were returned (96 renounced).
After the second trimester, another 123 women
renounced participation. In the third trimester,
127 women did not complete the questionnaire.
Some respondents renounced without stating the
cause. In many instances, the returned surveys
were incomplete; six women were excluded due to
the absence of a sexual partner during pregnancy.
The final study population was composed of 168
pregnant women.
For more reliable assessment of sexual function
the study sample was divided in primaparae
(n = 95) and multiparae (n = 73). Moreover, addi-
tional analysis of sexual function in age range
groups: 18–30 and 31–45 years was also provided.
The study inclusion criteria were: age 18–45;
physiological pregnancy; correct completion of
the entire questionnaire throughout all three tri-
mesters; and informed consent. All the investi-
gated women signed a conscious consent.
Excluded from the study were pregnant women
with diagnosed any pregnancy pathology (e.g., pla-
centa praevia, cervical incompetence, intrauterine
growth restriction, gestational diabetes, and
pregnancy-induced hypertension); systemic dis-
eases (e.g., cardiovascular diseases, diabetes, bron-
chial asthma, and arterial hypertension); multiple
pregnancy; pregnancy after assisted reproductive
technology, women using any medication that
changes sexual function, with the presence of
sexual dysfunction before pregnancy, whether the
partner had any sexual dysfunction and absence of
a sexual partner.
The study was approved by the Bioethics Com-
mittee of the Medical University of Silesia in
Katowice, Poland.
Methods
The research instrument in this study was a ques-
tionnaire designed to provide general group
characteristics. The questions concerned: sociode-
mographic aspects, obstetric and gynecological
aspects, partner relationship, relationship dura-
tion, partner’s attractiveness, number of sexual
partners to date, frequency of sexual intercourses
in the subsequent trimesters, sexual desire as com-
pared with data before pregnancy, sexual positions
preferred by pregnant women, sexual satisfaction,
and evaluation of the quality of sex life (Female
Sexual Function Index [FSFI]). Partner relation-
ship was evaluated through expressing whether the
Sexuality in Pregnancy
respondents feel satisfied with their relationship,
share their partner’s feelings and activities, and
express positive emotions toward their partners.
The FSFI is used to assess the sexual function; it
is standardized and adjusted for the differentiation
of sexual dysfunctions in women according to
current classifications and recommendations. The
FSFI has a confirmed and clinically proven cred-
ibility, sensitivity, reliability, internal consistency as
well as result stability and repeatability in diagnos-
ing disorders of sexual desire, arousal, lubrication,
orgasm, satisfaction, and pain-related sexual disor-
ders. The FSFI questionnaire is composed of
19 items grouped into six domains (subscales):
I—sexual desire (two questions), II—arousal
(four questions), III—lubrication (four questions,
IV—orgasm (three questions), V—satisfaction
(three questions), and VI—pain (three questions).
The interpretation of partial results concerns
the linear relationship—a higher number of points
corresponds to a better sexual functioning in a
given category. Clinically significant sexual dys-
function in women is diagnosed with a score ≤3.9
for each domain and 26.55 for the entire FSFI
[7,8].
Statistical Analysis
The statistical analysis made use of computer soft-
ware: Excel 2007 and STATISTICA 9.1 (StatSoft,
Inc., Krakow, Poland). The results of statistical
analysis were considered statistically significant if
the P value was ≤0.05. The following were used for
continuous data: mean, standard deviation, and
median. Statistical comparison of results was per-
formed with: the Shapiro–Wilk test, the Friedman
test, The Wilcoxon signed-rank test, the Kruskal–
Wallis test, the Mann–Whitney U-test, Spear-
man’s test, the Kendall test, Fisher’s exact test,
McNemar’s test, χ2 test with Yates correction, and
Cochran’s Q test.
Results
General Characteristics of the Study Population
General characteristics of the study population
were presented in Tables 1 and 2. In the studied
Table 1 Characteristics of the study population
Standard
Data Mean deviation
Age (years) 27.8 4.7
Relationship duration (years) 6.5 4.1
Age at sexual initiation (years) 18.8 2.6
3
population, 56.5% were primaparae, 29.2% were
pregnant for the second time, 11.9% for the third,
1.2% for the fourth, and 1.2% for the fifth time.
Among the studied women, 8.3% miscarried once,
2.4% twice; most of the women (89.3%) declared
no previous obstetric failures. Most of the respon-
dents previously had full-term pregnancies and
delivery (97.6%). Only 2.4% had a preterm birth.
Assessment of Sexual Function
Most women (39.9%) declared to have had one
sexual partner, although a relatively large group of
the respondents (26.2%) declared two sexual
partners, 17.3%—three, 5.4%—four, 6.6%—five,
4.8%—six and more (Table 2).
The overall FSFI assessment of all domains of
sexual function in the studied population showed
statistically significant changes, both in primaparae
and in multiparae. The differences between the
studied groups in subsequent trimesters generally
were not statistically significant (Table 3). The
highest percentage of women with dysfunctions in
all domains of sexual function was recorded in the
third trimester (dysfunction in FSFI total: 56.8% in
primaparae and 52.1% in multiparae, respectively)
(Table 4).
The sexual function of pregnant women
changed statistically significantly (P = 0.0001) in
primaparae and multiparae over the consecutive
trimesters (Table 5). The biggest drop in sexual
function was observed in primaparae between the
second and the third trimester (FSFI total score
28.7, 23.2, respectively) (Table 3). Nevertheless,
the assessment of sexual function was lower in
primaparae (Table 5).
According to the respondents, both primaparae
and multiparae, their partnership self-assessment
did not change significantly over the subsequent
trimesters. Most frequently the women declared
no change in their relations with the partner.
The results obtained with the FSFI, especially
in primaparae who declared a worsening of their
partner relationship, lowered significantly in sub-
sequent trimesters. The results obtained in the
third trimester were very low and may indicate the
presence of sexual dysfunction.
5th 95th
Median percentile percentile
28.0 20.0 35.0
6.0 1.5 13.5
18.0 16.0 24.0
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4 Gała˛zka et al.

Table 2 Sociodemographic characteristic of the study population

Distribution
Percentage of
the respondents
Data Values (n = 100%)
Place of living Village 5.5
City up to 100,000 inhabitants 14.9
City from 100,000 to 499,000 inhabitants 58.3
City over 500,000 inhabitants 21.4
Education Primary 7.7
Vocational 15.5
Secondary 31.0
Tertiary 45.8
Marital status Unmarried 25.6
Married 70.8
Divorced 3.6
Living conditions conducive to intimacy No 13.1
Yes 86.9
Professional activity Blue collars 25.6
White collars 46.6
Do not work 27.8
Physical activity Every day 27.4
Once a week 25.0
Several times a month 16.7
Less than once a month 31.0
Lifetime number of sexual partners 1 39.9
2 26.2
3 17.3
4 5.4
5 6.6
6 and more 4.8

Table 3 FSFI domains in primaparae and multiparae over the three trimesters of pregnancy (median, 5th, and 95th
percentile)
Trimester of Primaparae Multiparae Mann–Whitney
pregnancy FSFI domain (n = 95) (n = 73) U-test
I Sexual desire 4.2 (1.8; 6.0) 4.2 (1.8; 5.4) NS (P = 0.18)
Sexual arousal 4.8 (0.0; 6.0) 4.5 (1.4; 5.7) NS (P = 0.22)
Lubrication 5.4 (0.0; 6.0) 5.4 (1.1; 6.0) NS (P = 0.76)
Orgasm 4.8 (0.0; 6.0) 4.8 (0.5; 6.0) NS (P = 0.41)
Sexual satisfaction 4.8 (2.4; 6.0) 5.2 (3.0; 6.0) NS (P = 0.86)
Pain 5.2 (0.0; 6.0) 5.2 (2.0; 6.0) NS (P = 0.40)
FSFI total 29.0 (6.8; 35.3) 29.0 (10.3; 33.5) NS (P = 0.81)
II Sexual desire 4.2 (1.8; 6.0) 4.2 (1.8; 5.4) NS (P = 0.39)
Sexual arousal 4.8 (0.0; 6.0) 4.5 (0.2; 6.0) NS (P = 0.87)
Lubrication 5.4 (0.0; 6.0) 5.4 (0.2; 6.0) NS (P = 0.55)
Orgasm 4.8 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.20)
Sexual satisfaction 5.2 (2.6; 6.0) 4.8 (2.9; 6.0) NS (P = 0.77)
Pain 5.2 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.90)
FSFI total 28.7 (6.7; 35.8) 28.6 (5.8; 34.6) NS (P = 0.75)
III Sexual desire 3.6 (1.2; 6.0) 3.6 (1.2; 5.4) NS (P = 0.93)
Sexual arousal 3.0 (0.0; 6.0) 3.6 (0.0; 5.7) NS (P = 0.12)
Lubrication 4.2 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.13)
Orgasm 3.2 (0.0; 6.0) 4.4 (0.0; 6.0) P = 0.01
Sexual satisfaction 4.4 (1.4; 6.0) 4.8 (2.4; 6.0) NS (P = 0.29)
Pain 4.4 (0.0; 6.0) 4.4 (0.0; 6.0) NS (P = 0.22)
FSFI total 23.2 (4.0; 34.9) 25.6 (5.5; 34.0) NS (P = 0.12)

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Sexuality in Pregnancy 5

Table 4 Sexual dysfunction (FSFI scale) in primaparae and multiparae over the three trimesters of pregnancy
Trimester of Primaparae Multiparae χ2 test with Yates
pregnancy Sexual dysfunction (n = 95) (n = 73) correction
I Sexual desire 45.3% 49.3% NS (P = 0.71)
Sexual arousal 33.7% 45.2% NS (P = 0.17)
Lubrication 21.1% 19.2% NS (P = 0.92)
Orgasm 32.6% 19.2% NS (P = 0.07)
Sexual satisfaction 19.0% 15.1% NS (P = 0.65)
Pain 22.1% 17.8% NS (P = 0.62)
FSFI total 39.0% 32.9% NS (P = 0.52)
II Sexual desire 45.3% 48.0% NS (P = 0.85)
Sexual arousal 40.0% 42.5% NS (P = 0.87)
Lubrication 30.5% 23.3% NS (P = 0.39)
Orgasm 32.6% 19.2% NS (P = 0.07)
Sexual satisfaction 19.0% 15.1% NS (P = 0.65)
Pain 22.1% 19.2% NS (P = 0.79)
FSFI total 37.9% 38.4% NS (P = 0.92)
III Sexual desire 62.1% 61.6% NS (P = 0.92)
Sexual arousal 59.0% 54.8% NS (P = 0.70)
Lubrication 46.3% 38.4% NS (P = 0.38)
Orgasm 52.6% 35.6% P = 0.04
Sexual satisfaction 39.0% 23.3% P = 0.05
Pain 39.0% 35.6% NS (P = 0.78)
FSFI total 56.8% 52.1% NS (P = 0.64)

The analysis of sexual function (assessment Analysis of Sexuality and Realization of

of all FSFI domains) between age range groups:
18–30 and 31–45 years showed no statistically
significant differences (Table 6). The frequency
of sexual dysfunction was comparable in subse-
quent trimesters of pregnancy irrespective of
age. However, the highest percentage of women
with dysfunctions in all domains of sexual
function was recorded in the third trimester (dys-
function in FSFI total: 54.4% in younger and
55.8% in older women, respectively) (Table 7).
The sexual function of pregnant women changed
significantly in age range groups: 18–30 and
31–45 years over the consecutive pregnancy
trimesters (P < 0.000001 and P = 0.0003, res-
pectively). Nevertheless, the sexual function
was generally higher in younger women
(Table 5).
Sexual Needs
Analyzing the frequency of sexual intercourse in
the studied group before and during pregnancy, a
statistically significant change was observed
(P < 0.000001) toward lowering the frequency
(Figure 1).
Sexual desire changed significantly during preg-
nancy (P = 0.0004). The direction of changes
concerned the decrease of desire in the subsequent
trimesters as compared with the time before preg-
nancy (Figure 2).
The sensations most frequently reported by the
respondents were: vaginal discomfort or pain
(23.4%, 24.2%, 26.6% in first, second, and third
trimesters), lower abdominal pain (17.2%, 17.4%,
20.3% in first, second, and third trimesters), and
increased fetal movement (7.8%, 20.5%, 22.7% in

Table 5 The changes of FSFI domains in primaparae, multiparae, and age range groups: 18–30 and 31–45 years over
the three trimesters of pregnancy (Friedman test to assess statistical significance of changes)
Primaparae Multiparae Age 18–30 years Age 31–45 years
FSFI domain (n = 95) (n = 73) (n = 125) (n = 43)
Sexual desire P = 0.002 P = 0.004 P = 0.000003 P = 0.05
Sexual arousal P < 0.000001 P < 0.000001 P < 0.000001 P = 0.0002
Lubrication P = 0.0001 P < 0.000001 P < 0.000001 P = 0.006
Orgasm P < 0.000001 P = 0.00005 P < 0.000001 P = 0.0004
Sexual satisfaction P = 0.00007 P = 0.05 P = 0.0007 P = 0.0009
Pain P = 0.002 P = 0.002 P = 0.00005 P = 0.001
FSFI total P = 0.00001 P = 0.00001 P < 0.000001 P = 0.0003

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6 Gała˛zka et al.

Table 6 FSFI domains in age range groups: 18–30 and 31–45 years over the three trimesters of pregnancy (median,
5th, and 95th percentile)
Trimester of Age 18–30 years Age 31–45 years Mann–Whitney
pregnancy FSFI (n = 125) (n = 43) U-test
I Sexual desire 4.2 (1.8; 6.0) 3.6 (1.8; 5.4) NS (P = 0.07)
Sexual arousal 4.8 (0.0; 6.0) 4.8 (0.0; 5.7) NS (P = 0.23)
Lubrication 5.4 (0.0; 6.0) 5.7 (0.0; 6.0) NS (P = 0.71)
Orgasm 4.8 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.98)
Sexual satisfaction 5.2 (2.8; 6.0) 4.8 (2.4; 6.0) NS (P = 0.74)
Pain 5.2 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.80)
FSFI total 29.0 (7.6; 34.8) 28.2 (7.0; 33.7) NS (P = 0.50)
II Sexual desire 4.2 (1.8; 6.0) 4.2 (1.8; 5.4) NS (P = 0.46)
Sexual arousal 4.5 (0.0; 6.0) 4.8 (0.0; 5.4) NS (P = 0.93)
Lubrication 5.4 (0.0; 6.0) 5.7 (0.0; 6.0) NS (P = 0.35)
Orgasm 4.8 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.30)
Sexual satisfaction 5.2 (2.8; 6.0) 4.8 (1.7; 6.0) NS (P = 0.70)
Pain 5.2 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.54)
FSFI total 28.7 (6.8; 35.9) 28.7 (5.0; 33.6) NS (P = 0.97)
III Sexual desire 3.6 (1.2; 6.0) 3.6 (1.2; 5.3) NS (P = 0.52)
Sexual arousal 3.3 (0.0; 5.9) 3.3 (0.0; 5.7) NS (P = 0.98)
Lubrication 4.5 (0.0; 6.0) 4.8 (0.0; 6.0) NS (P = 0.73)
Orgasm 4.0 (0.0; 6.0) 4.0 (0.0; 6.0) NS (P = 0.99)
Sexual satisfaction 4.8 (2.0; 6.0) 4.8 (1.7; 6.0) NS (P = 0.51)
Pain 4.4 (0.0; 6.0) 4.0 (0.0; 6.0) NS (P = 0.16)
FSFI total 24.2 (5.1; 34.9) 23.7 (4.3; 33.4) NS (P = 0.63)

first, second, and third trimester)—the latter was a
statistically significant change (P = 0.009) over the
subsequent trimesters.
Statistical significance was demonstrated for:
decreased sexual desire (P = 0.00007), partner’s
reluctance (P = 0.002), and pregnancy-related
changes in appearance (P = 0.03). Decreased
sexual desire occurred more frequently in women
in the second trimester, whereas partner’s reluc-
tance and change of appearance caused absence of
sexual intercourses in the third trimester. The
majority of women declared concern for the well-
being of the baby as the main cause of sexual
abstinence. However, the dynamics of these
changes over the three trimesters was not statisti-
cally significant.

Table 7 Sexual dysfunction (FSFI scale) in age range groups: 18–30 and 31–45 years over the three trimesters of
pregnancy
Trimester of Age 18–30 years Age 31–45 years χ2 test with Yates
pregnancy Sexual dysfunction (n = 125) (n = 43) correction
I Sexual desire 44.8% 53.5% NS (P = 0.42)
Sexual arousal 36.8% 44.2% NS (P = 0.50)
Lubrication 20.0% 20.9% NS (P = 0.93)
Orgasm 27.2% 25.6% NS (P = 0.99)
Sexual satisfaction 19.2% 11.6% NS (P = 0.37)
Pain 19.2% 23.3% NS (P = 0.73)
FSFI total 35.2% 39.5% NS (P = 0.77)
II Sexual desire 45.6% 48.8% NS (P = 0.85)
Sexual arousal 41.6% 39.5% NS (P = 0.95)
Lubrication 28.8% 23.3% NS (P = 0.61)
Orgasm 28.8% 20.9% NS (P = 0.42)
Sexual satisfaction 17.6% 16.3% NS (P = 0.97)
Pain 24.0% 11.6% NS (P = 0.13)
FSFI total 39.2% 34.9% NS (P = 0.75)
III Sexual desire 61.6% 62.8% NS (P = 0.97)
Sexual arousal 58.4% 53.5% NS (P = 0.70)
Lubrication 44.0% 39.5% NS (P = 0.74)
Orgasm 45.6% 44.2% NS (P = 0.99)
Sexual satisfaction 32.0% 32.6% NS (P = 0.90)
Pain 34.4% 46.5% NS (P = 0.22)
FSFI total 54.4% 55.8% NS (P = 0.99)

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Sexuality in Pregnancy
Figure 1 The frequency of sexual
intercourse before pregnancy and in
the subsequent trimesters.
Discussion
Literature shows that many couples are unpre-
pared for the occurrence of sexual problems
during pregnancy; this is partly due to insufficient
information concerning sex life as well as numer-
ous factors, which usually tend to decrease sexual
function [9–11]. There are still many controversies
regarding sexual activity and behavior during
pregnancy as well as their possible impact on the
pregnancy and the developing fetus [12].
Psychometric methods based on standardized
patient history, questionnaires, and event logs
Figure 2 Sexual desire in pregnancy.
7
seemed to be the optimal tools for the assessment
of sexual function. Additionally, the patients’ sub-
jective sensations described in their diaries, and
not the medical procedures requiring specialist
medical equipment, were considered [13–15].
The validity of use of the FSFI questionnaire to
assess sexual function of pregnant women was con-
firmed by prospective studies based on larger than
before groups of gravidae: 107 women [3] and 271
women [16]. In the study by Pauls et al. [3], the
FSFI score in the first trimester for all pregnant
women was 28.37; however, in the third trimester,
it dropped to 23.52.
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8 Gała˛zka et al.
With regard to the study method and research
tool, in order to obtain a reliable comparison, our
results were compared with other prospective
studies implementing the FSFI [3,16,17]. The
reports of the aforementioned authors confirm
the progressing decrease in sexual functions with
the development of the pregnancy. Other authors,
regardless of the methods and tools used, also
observed a general tendency toward decreased
sexual functions in the third trimester [4,18–21].
However, in those studies, it is difficult to estimate
the direction of changes toward the presence or
absence of dysfunctions as no standardized
research tools were used, making it thus impos-
sible to compare the obtained results.
Only in the prospective study by Leite et al. [16]
a slight drop in sexual function can be observed as
early as in the first trimester, and as in other
studies, a significant drop in the third trimester.
Other studies also show a decrease in sexual satis-
faction during pregnancy [1,11,17,19].
Numerous studies have shown pregnant
women’s negative perception of their bodies with
the development of the pregnancy [3,11,18,22–
25]. Changes in the appearance influence the
women’s perception of pregnancy and sexuality,
leading to lowered sexual functioning [3]. This is
also confirmed by our results. Nonacceptance of
one’s own appearance was a statistically significant
(P = 0.03) cause of sexual abstinence during preg-
nancy. However, the percentage of gravidae
reporting this problem was relatively low (first tri-
mester: 0.0%, second trimester: 4.8%, third tri-
mester: 8.2%).
In their study, Pauleta et al [2] show that as
many as 41.5% of women have a negative self-
perception regarding their body. Aslan et al. [17]
pointed out that a woman’s attractiveness during
pregnancy is seen from two points of view: the
woman’s and her partner’s. That is why in the
study by Pauleta et al. [2], despite the very high
percentage of women who felt less attractive, as
many as 75.0% did not report decreased sexual
interest on the part of their partners.
In our study, the highest percentage of gravidae
named concern for the baby’s well-being as the
main reason from abstaining from sexual inter-
course. Our results are in compliance with those of
Fok et al. [21] who, in a prospective study, assessed
the sexuality of Chinese women. An overall reduc-
tion of sexual intercourses was reported by 93.0%
of couples; in 80.0% of cases, the drop may have
been connected with concerns about causing
damage to the fetus as a result of a sexual inter-
J Sex Med **;**:**–**
course. The concern that sexual intercourse may
be harmful for the well-being of the fetus was also
expressed in other studies: 23.4% [2], 31.0% [4],
46.2% [20], 35.0% [23], 49.1% [24], 25.0–50.0%
[25], and 45.4% of women [26].
Literature analysis shows a general tendency
toward a reduction of sexual intercourse with the
progression of pregnancy, especially in the third
trimester [2–4,17,18,21–23,27]. Regardless of the
character of the study, i.e., prospective or retro-
spective, a similar tendency in this regard can be
observed [1,19,21,28]. In our study, we observed a
significant drop in the frequency of sexual inter-
course (P < 0.000001) with the progression of
the pregnancy as compared with the time before
pregnancy.
In the studied population of women, sexual
desire in the subsequent trimesters decreased sig-
nificantly compared with the period before preg-
nancy. A similar correlation was observed by other
authors [1,3,4,11,16–18,20,29].
In order to minimize pain, sexual positions were
modified. Women abandoned the classic and
reverse missionary position, favoring a lateral posi-
tion (statistically significant directly proportional
to the progression of pregnancy). A similar ten-
dency concerning the lateral position was observed
by others [1,2,4,30–33].
No statistically significant changes were
observed between the trimesters with regard to
genito-anal contacts (1.3%; 1.9%; 1.5%), oral-
genital contacts (16.5%; 16.0%; 21.4%), and mas-
turbation (10.1%; 11.3%, 8.3%). During
pregnancy, the women did not show an increased
interest in these forms of satisfying their sexual
needs. The low percentage of these forms of sexual
contacts may be connected with the religious
beliefs of Polish women. It is also possible that the
gravidae participating in the study did not report
this type of sexual contacts, considering them
inappropriate or embarrassing.
According to Pauleta et al. [2], oral-genital sex,
genito-anal sex, and masturbation were used by
38.1%, 6.6%, and 20.4% of women, respectively.
The analysis of a Spanish population [31] showed
that 14.0% of women masturbated during preg-
nancy. The Iranian population study [23] showed
than only 6.0% of women reported this form of
sexual contact. Analyzing this parameter, cultural
and social aspects should not be underestimated.
In our study, we observed that a large percent-
age of the women declared breast fondling as a
preferred method of sexual contact (first trimester:
62.5%, second trimester: 60.7%, third trimester:
Sexuality in Pregnancy
53.6%), which decreased significantly (P = 0.01)
throughout the pregnancy, as well as erotic dreams
(first trimester: 38.1%, second trimester: 35.7%,
third trimester: 31.5%). Von Sydow et al. [32] also
observed a drop in nipple stimulation. The
decrease of interest in this form of sexual contact
may have been connected with lactation symptoms
and the approaching labor.
The results of Bartellas et al. [4] are slightly
different from ours. The authors focused on the
analysis of breast stimulation as a discomfort
factor. They demonstrated that the percentage of
women whose discomfort caused by this form of
caressing was the highest at the beginning of preg-
nancy (56.0%) and the lowest in the third trimes-
ter (20.0%). It would seem that the interest in this
form of caress increased with the progression of
pregnancy, as the discomfort decreased.
Literature data show that the sexual activity of
pregnant women is often conditioned by the desire
to satisfy their partner’s sexual needs [34] and to
assure him as to their faithfulness and trust
[11,30,35,36].
The sensations of women connected with sat-
isfying their needs by their partners changed sig-
nificantly during pregnancy (P < 0.000001). A
positive sensation was expressed by 85.7% of
women in the first trimester, 79.8% in the second
trimester, and 67.9% in the third trimester. We
may conclude that the sexual needs of most of the
pregnant women were satisfied by their partners.
However, this did not necessarily mean sexual
contacts but probably referred to other forms of
sexual activity, such as tenderness, touch, warmth,
i.e., emotional closeness. In other words, the
pregnant women felt sexually satisfied when their
partners were satisfied, as seen in the earlier
analysis of decreased sexual desire in pregnant
women, frequency of intercourse, and sexual
needs.
Similar conclusions were presented by Pauls
et al. [3] who showed that pregnancy does not lead
to a decrease in the forms of contact preferred by
the partner but may lead to limiting woman-
centered activities due to the decreased sexual
desire of pregnant women.
At the end of this article, it is worth noting a few
limitations of the present study. It is one of the first
prospective studies in Poland dealing with the
sexual behaviors and functions of pregnant women.
The lack of randomization and the small popula-
tion of the study are also a limitation for the
extrapolation of the results to a general population.
It was also not investigated whether the respon-
9
dents had a history of sexual abuse and whether
sexual disorders occurred before pregnancy were
diagnosed. We did not assess the presence of genital
tract infections (especially candidiasis) that may
predispose to pain disorders and sexual withdrawal
as a result of the fear from transmission the infec-
tion to the partner. Furthermore, we did not
monitor precisely the weight gain among investi-
gated women and could not estimate whether
excessive weight gain was a predictor of sexual
function. It seems, however, that all the aforemen-
tioned limitations did not have a major effect on the
results of the study.
Summing up, the prospective character of the
study, the use of a standardized FSFI question-
naire, the division of the study population into
primaparae and multiparae, and study execution in
all three trimesters in the same gravidae were
intended to ensure reliable and comparable results.
The study can, therefore, be considered a valuable
contribution to the development of the knowledge
of the influence of pregnancy on female sexuality.
Our study puts a basis for further prospective
studies exploring female sexual functioning in
pregnant women.
Conclusions
Sexual function was compromised and sexual
activity decreased as the pregnancy progressed.
Changes in the domains of arousal, lubrication,
and orgasm were particularly notable in
primaparae in the third trimester of pregnancy.
Unsatisfying partner relationship was a significant
factor affecting the quality of sexual life during
pregnancy.
Corresponding Author: Agnieszka Drosdzol-Cop,
MD, PhD, Woman’s Health Institute, Medical Univer-
sity of Silesia, ul. Medykow 12, Katowice 40-752,
Poland. Tel: 048322088751; Fax: 048322088751;
E-mail: cor111@poczta.onet.pl
Conflict of Interest: The author(s) report no conflicts of
interest.
Statement of Authorship
Category 1
(a) Conception and Design
Iwona Gała˛zka; Agnieszka Drosdzol-Cop
(b) Acquisition of Data
Iwona Gała˛zka; Beata Naworska; Mariola
Czajkowska
J Sex Med **;**:**–**
10
(c) Analysis and Interpretation of Data
Iwona Gała˛zka; Agnieszka Drosdzol-Cop; Beata
Naworska
Category 2
(a) Drafting the Article
Iwona Gała˛zka; Agnieszka Drosdzol-Cop; Beata
Naworska; Mariola Czajkowska
(b) Revising It for Intellectual Content
Agnieszka Drosdzol-Cop
Category 3
(a) Final Approval of the Completed Article
Agnieszka Drosdzol-Cop; Violetta Skrzypulec-
Plinta
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