Sex drive and pregnancy: what’s normal?

Crop of a young couple

Pregnancy is a time of great change in your body, and can be both extremely exciting, and also quite daunting. Of course, you will be expecting some developments, such as an expanding abdomen and chest, while others may come as more of a surprise to you, such as changes in your mood and changes in your food tastes. The physical changes you see happening to your body, combined with complex internal fluctuations of hormones, and the mental adjustments we undergo, can impact many facets of our lives, including our libido.

Libido is a term interpreted in many ways. A useful working definition for the purpose of this article is thinking of loss of libido as a lack of sexual desire and/or sex drive.1 Medically, lack of libido is often referred to as hypoactive sexual desire disorder (HSDD). HSDD has been defined, in addition to the above, as a condition causing personal difficulty and suffering that is not attributed to a medical or psychiatric problem.2 When thinking of loss of libido purely associated with pregnancy, therefore, it is perhaps best not to define it as HSDD, as there is a process going on in a woman’s body that is likely influencing this condition.

Changes in libido during pregnancy can vary individually; some women may experience a decrease, while for others it increases or stays about the same. Sexual desire and drive is a complicated and multifactorial process meaning it is not binary in predicting how you will feel when pregnant. It is very much dependent on your biological, psychological and physical factors, and of course the interplay these have with your partner’s feelings, desire, and thoughts.

Biological factors such as essential hormonal changes occur in your pregnancy. Libido can be influenced by the balance of these hormones, some of which can promote sexual desire, while others can dampen it. The hormones oestrogen and progesterone rise through pregnancy.3 In a menstrual cycle which doesn’t result in pregnancy, the unfertilised egg degrades and in this process the oestrogen and progesterone hormones decline causing the lining of the womb to shed, resulting in a period. If fertilisation occurs the follicle from which the egg was released (the corpus luteum) stays active and continues to produce progesterone which maintains the lining of the womb allowing the implantation of the embryo and the pregnancy to develop.4 The corpus luteum also produces oestrogen which assists in the development and maintenance of the pregnancy. As the pregnancy develops, both oestrogen and progesterone are produced by the placenta.

Oestrogen has been suggested in having a role in increasing libido while there is conflicting information regarding progesterone: some say it decreases libido while others say the opposite.5,6 Testosterone is also considered to be excitatory with regards to libido, and also steadily increases when pregnant.7 Testosterone belongs to a group of hormones known as the androgens, which are thought to play a role in advancing the pregnancy and in the birthing process.8 Prolactin is another hormone that rises in pregnancy, preparing an expectant mother to nurse her baby with breastmilk. Prolactin, however, is thought to be inhibitory in its effects on libido.9

In addition to the hormone changes, there are other chemicals produced in the brain (neurotransmitters) that influence the biological aspect of libido. As you can see, it is an intricate process that is further complicated by where the hormones are produced in your body and how available they are in their varying forms. This combination of factors assists in explaining how these biological effects may ramp up one woman’s sexual desire when pregnant, but totally diminish another’s.

Psychological influences during pregnancy could include the development of depression, which is known to decrease libido.10 The psychological adaptations of your body altering can be a troubling time. You may find your body unrecognisable and this could be combined with concerns over how your partner may perceive these changes. Women with a previous history of depression or post-natal depression may be more prone to it during or after the pregnancy. If you feel any symptoms of your mood or well being diminishing please contact your midwife or GP for support, you are certainly not alone and psychological support is available.

I commonly find that both partners can be concerned about the safety of intercourse in pregnancy. Current guidance reassures that in uncomplicated pregnancies sex is generally considered safe.11 In certain circumstances such as risk of pre-term labour, or placenta praevia (where the placenta is completely or mostly implanted in the lower segment of the womb), women are sometimes advised to refrain from sexual activity.12 Placenta praevia is diagnosed on an ultrasound scan. This may be on your routine pregnancy scans while you have no symptoms, or it could be on a scan following symptoms of vaginal bleeding during the pregnancy.

Risks for pre-term labour can include a previous history, multiple pregnancy (twins or more), or issues with your cervix being loose generating concerns that it may start to dilate before the end of your pregnancy.13 This is called cervical incompetence and often is picked up in a prior pregnancy due to any complications you may have had secondary to this. If you feel you may fall into these risk categories, or have any other complications concerning you with regard to having sexual relations in your pregnancy please discuss it with your midwife or obstetric team.

The physical changes your body undergoes whilst pregnant can also influence your appetite and drive for sex. Some women suffer from nausea and/or vomiting, back pain, abdominal aches, and other physical symptoms that wane their desire for sex. On the other hand there are many women who feel very well and enjoy their physical appearance changing as the baby grows, boosting their confidence and desire to engage in sex.

The key element of whether your libido changes or not when you’re expecting, is how you personally feel about it. If you’re experiencing a decline in libido perhaps you are concerned about the impact of this on your relationship dynamic, at a time of imminent adjustment to your family. Opening the lines of communication and explaining the various reasons you feel this way can help your partner to interpret the complexity of the changes you are facing and their effect on your sex drive.

Problems may also arise if your libido rockets and your partner may be apprehensive about sex in pregnancy, perhaps for unfounded anxieties of causing damage to the baby or miscarriage. Or perhaps they struggle to satiate your high sex drive, in which case discussion about both your desires and compromise will help to keep your relationship healthy.
The important message here is if you are distressed in any way by these issues do not suffer alone, or feel you are experiencing something embarrassing or unusual. Do discuss your concerns with your midwife or GP.

References

  1. L. Knott, ‘Loss of Libido’, Patient.info Professional Reference, [website], 2015,  https://patient.info/doctor/loss-of-libido, (accessed 8 June 2017).
  2. I. Goldstein, ‘Hypoactive Sexual Desire Disorder: International Society for the Study of Women’s Sexual Health (ISSWSH) Expert Consensus Panel Review’,  Mayo Clinic Proceedings, vol 92, no.1, 2017, pp 114-128.
  3. J. King, J, ‘Physiology of pregnancy and nutrient metabolism’, The American journal of clinical nutrition, vol. 71, no. 5, 2000, pp. 1218s-1225s.
  4. L. Impey and T. Child, Obstetrics and Gynaecology,  5th Ed,  Wiley Blackwell, 2016.
  5. I. Goldstein, ‘Hypoactive Sexual Desire Disorder…’,  2017, pp 114-128.
  6. L. Knott, ‘Loss of Libido’, 2015.
  7. H. Schock et al., ‘Hormone concentrations throughout uncomplicated pregnancies: a longitudinal study’, BMC Pregnancy and Childbirth, vol. 16, no. 146, 2016, DOI: 10.1186/s12884-016-0937-5.
  8. S. Makieva et al., ‘Androgens in pregnancy: roles in parturition’, Hum Reprod Update, vol. 20, no. 4, 2014, pp. 542-559.
  9. L. Knott, ‘Loss of Libido’, Patient.info Professional Reference, [website], 2015,  https://patient.info/doctor/loss-of-libido, (accessed 8 June 2017).
  10. Ibid.
  11. C. Jones et al., ’Sex in pregnancy’, CMAJ : Canadian Medical Association Journal, vol. 183, no.7, 2011, pp. 815-818.
  12. Ibid.
  13. Ibid.

Dr. Nupur Yogarajah BSc Hons MBBS DRCOG PgCert Clin Ed MRCGP

Nupur, a GP, graduated from the Royal Free & University College Medical School in 2006 and after rotating through various specialities she gravitated towards General Practice as it offered continuity with her patients and diversity in her caseload. She has particular interests in women’s, children’s, and sexual health, as well as medical education. Managing a variety of female patients over the years has given her experience of the common queries and misconceptions regarding women’s health. She is passionate about delivering health information in a digestible and accessible way, making The Femedic an ideal opportunity for her writing.

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