Sex during pregnancy: what changes and what to talk about

“It’s not that I don’t want you. It’s just … what if I hurt the baby?”

The sentence comes somewhere in the fourth month, late in the evening, when she moves closer and he gently pulls away. She doesn’t hear it as worry; she hears it as rejection. She thinks it’s because of her bump, because of how her body has changed. He doesn’t know how to say that he is simply afraid. They both fall asleep feeling the other is far away — in exactly the period when they most want to be close.

Pregnancy changes almost everything: the body, sleep, mood, plans, how you see the future. It also changes sex and closeness in a couple. This is often not talked about — not with friends, not with parents, often not even between the two partners. In this piece I will write about what can change during this time, which fears are common, how a partner experiences it all, and how you can talk about it together. I won’t give instructions on medical questions — those belong with your gynaecologist — but I can help you get there with questions you feel able to ask.

Why sex changes in pregnancy

Sex isn’t only a physical matter. It is a weave of body, emotions, relationship and how a person experiences themselves. Pregnancy reaches into all four at once.

The body changes quickly and without asking. Nausea, tiredness, tender breasts, back pain, needing the loo more often, later the weight of the bump and trouble sleeping. When the body is busy growing a new person, it’s no wonder desire sometimes goes quiet.

How you experience yourself changes too. Some women feel beautiful and full in a pregnant body, others feel strange and clumsy, many feel both depending on the day. What matters is that none of these experiences is wrong.

A couple is becoming a family. Even with a second or third child, the relationship between the partners shifts. Some feel closer during this time than ever before. Others begin to drift apart, because each is preparing for a new role in their own way. I wrote about how deeply parenthood changes your sense of who you are in Parenthood as a transition: who am I now that I am a mother or a father?

New fears appear. For the baby, for the birth, about whether you will cope. Fear and desire don’t sit well together. Where there is a lot of worry, there is less room for relaxed closeness.

What the research says

One of the most cited reviews in this field is the work of the German psychologist Kirsten von Sydow, who in 1999 reviewed 59 studies on sexuality during pregnancy and after birth. She found that for most couples sexual interest and the frequency of sex gradually decrease during pregnancy, most markedly in the third trimester. In the first trimester the picture is mixed, and in the second the differences between women are large — some even report more desire than before.

A more recent systematic review, published in 2017 by Sofia Jawed-Wessel and Emily Sevick, confirmed a similar pattern: the frequency of sex generally decreases over pregnancy. Among the reasons women and their partners give, the fear that sex might harm the baby or the pregnancy comes up often — including in couples for whom there was no medical reason for it at all. Other authors, among them the Portuguese research group of Pauleta and colleagues, also point to this fear as one of the common reasons for having less sex.

Two things follow from this. First: if your sex life is changing during pregnancy, you are in very good company. Second: much of what keeps a couple apart during this time is not physical limits but fears and unspoken questions. And those are things you can talk about.

A body that is no longer entirely yours

Many women describe a feeling during pregnancy that their body is no longer only theirs. It also belongs to the baby growing inside, to the doctors who examine it, and often to strangers who touch the bump without asking. When your body is “public” all day, it can be hard in the evening to want to share it with your partner too — even if you love him.

This isn’t a rejection of your partner. It is a need for the body to become yours again, for a moment. It helps if you can put it into words: “Today I just need you to hold me.” Or: “I’d like a little time on my own in the bathroom, then I’ll come to you.” When your partner knows what is going on, he doesn’t have to guess and interpret things his own way.

With a changed body, a vulnerability that wasn’t there before can surface too: the question of whether you are still attractive, whether your partner sees you differently, whether you will ever be as you were. These thoughts are common and don’t mean anything is wrong with you. But they can become heavy if they stay unspoken.

Fears that are rarely talked about

The fear that sex might harm the baby is one of the most common reasons couples pull away from each other in pregnancy. Often both feel it, but neither says it, because it seems silly or embarrassing. So each concludes privately that the other doesn’t want to, and each suffers privately.

There are other fears as well. If a couple has been through a pregnancy loss in the past, the fear is often much greater and can’t be talked away with the reassurance that everything is fine now. The body remembers the loss and protects itself. If this is your experience, it is right to be patient with it — and to talk about it with your gynaecologist too.

Some women go through pregnancy with a great deal of anxiety that spreads into everything — including closeness. I wrote about how common anxiety is at this time and how it shows itself in Anxiety in pregnancy and after birth: what mothers rarely talk about. If the anxiety persists, disturbs your sleep or your everyday life, it is worth talking to your gynaecologist or GP about it.

What is safe — a question for your gynaecologist

I’ll keep this short, because it isn’t my field. In general, in an uncomplicated pregnancy sex is usually fine. But there are conditions in which a doctor advises caution or advises against sex — and only your gynaecologist knows whether any of them applies to you.

So I suggest you simply ask about sex at your check-up. Many people feel awkward, but gynaecologists hear this question often and treat it as part of caring for the pregnancy. You can go together with your partner so that you both hear the answer — that often reassures more than anything you could tell each other at home. If there is bleeding, pain or anything else that worries you, contact your gynaecologist straight away, not at the next check-up.

What I can do is help you understand what is happening between you emotionally. What is physically safe, though, is not a matter for therapy, nor for this piece.

How the partner experiences it

Pregnancy is mostly written about from the point of view of the pregnant woman, which is understandable. But the partner goes through a big change too, only a less visible one. Partners often describe feeling on the edge of things: everything revolves around the bump, the check-ups, the shopping, and they aren’t quite sure where their place is.

When it comes to sex, a partner’s view often splits. On one side there is desire and tenderness; on the other the fear of causing harm, uncertainty about whether they are still wanted, and the sense that it would be selfish to mention their own desire. Some partners suddenly see the woman mainly as a mother-to-be during this time and find it hard to see her as a lover as well — which only confuses them, and often makes them ashamed.

All of this is understandable. The trouble only starts when it stays unspoken — because then she reads his withdrawal as rejection, and he reads hers as proof that she no longer wants him. Two fears turn into one silence.

Closeness is more than sex

One of the most freeing thoughts for couples in pregnancy is that closeness isn’t the same as intercourse. When a couple understands sex only as a single act that they “either have or don’t”, every change feels as if they have lost everything. If they understand closeness more broadly, a lot of possibilities open up.

A hug that lasts longer than three seconds. A back or foot massage. A bath together. Lying side by side and talking about what the baby will be like. A hand on the bump when the baby moves. None of these is a “substitute”. They are forms of closeness that may mean even more at this time.

It matters that closeness doesn’t become just a prelude to something else. If one of you feels that every touch ends in an expectation, you begin to pull away even from touch you would otherwise enjoy. So it can help to agree explicitly: “Just this today.” That kind of clarity doesn’t kill desire; it often makes room for it.

How to talk about it

Talking about sex is hard even without a pregnancy. In pregnancy there is the added feeling that it would be inappropriate to talk about yourself when the baby is at the centre. But right now the conversation matters a great deal, because without it each of you is left with your own interpretations. I described how to approach such a conversation without blame in more detail in How to talk to your partner about sex without blame. Here is just an example of how it might sound.

“Yesterday, when you pulled away … I felt you don’t want me in this body any more.”
“No, not at all. I was scared. I know it’s probably silly, but I keep thinking I might hurt the baby.”
“I’m scared sometimes too. But when you pull away, I’m left on my own.”
“Shall we ask the gynaecologist next time? I can come with you.”
“I’d like that. And until then … could you just hold me?”

(This dialogue is a composite, not a real person.)

In this short conversation there is a shift from guessing to knowing. She learns that his withdrawal wasn’t rejection. He learns that his fear isn’t silly and that he isn’t the only one who feels it. And together they find a step that doesn’t depend on whether they will “have sex”: a question for the doctor, and a hug.

Exercise: a closeness map for this month

This exercise is for a couple at any stage of pregnancy. It takes about twenty minutes. You can repeat it every month, because your needs keep changing.

1. Each of you writes down three forms of closeness that feel good this month — from touch to conversation or a walk together. Be specific: not “tenderness” but “stroking my hair in the evening”.
2. Each writes down one thing that feels hard or unpleasant this month, and one fear about closeness you are carrying. It doesn’t have to be big.
3. Swap the sheets and read them in silence. Then each of you says only what surprised you. No defending and no explaining.
4. Choose one form of closeness from either list that you will do deliberately this week. Agree, too, to leave aside for now whatever the other finds unpleasant.
5. Write down a question for the gynaecologist if one has come up, and agree who will ask it at the next check-up.

If you need help finding words for your needs at all, the entry need in the knowledge base may help. But the point of the exercise isn’t to fill in a form; it is to learn something about each other you didn’t know before.

This monthly check-in can carry on after the birth, when closeness will change again — often more than a couple imagines. I wrote about what happens to a couple when the baby comes home in The couple after the baby: keeping your partnership alive through parenthood, and about sex in that period in the piece on sex after having a baby. Research, including a long-term study by Brian Doss and colleagues, shows that for many couples relationship satisfaction drops with the transition to parenthood. Couples who learn to talk about closeness during pregnancy have more tools for that time.

When it is about more than sex

I don’t want this piece to sound as if everything were only a matter of talking. Some things need a different kind of help.

Medical questions belong with a doctor. Once again: what is safe in your pregnancy is for your gynaecologist to judge. Pain, bleeding or anything unusual isn’t a topic for a conversation at home but for a call to your doctor. Sexual difficulties that persist and weigh on you are also, first of all, a matter for a doctor or a specialist in sexual medicine. I am not a sexologist or a sex therapist; in couples therapy intimacy can be one of the themes, but not the treatment of sexual dysfunctions.

Pregnancy isn’t a time when anyone has to. If your partner pressures you, gets angry or punishes you when you say no, that isn’t a difference in desire; it’s pressure. Violence in a relationship can also begin or escalate during pregnancy. If you feel unsafe, in Slovenia there is the SOS helpline for women and children affected by violence on 080 11 55, and in an emergency 112 or the police on 113.

When it is not just about sex but about mood. If low mood, lack of motivation, sleeplessness or thoughts that frighten you have been with you for a few weeks, this may be a sign of emotional distress that needs a doctor’s attention. Such distress can begin during pregnancy, not only after the birth — more on this in the entry postnatal distress. If you have thoughts of harming yourself, in Slovenia you can call the crisis line Klic v duševni stiski on 01 520 99 00 (7 pm to 7 am) or Samarijan on 116 123 (every day, 24 hours).

Not all couples want the same thing, and that’s fine. Some couples don’t miss sex during pregnancy and are content with closeness without it. Some want it more than before. Neither path is the right one. The only problem is when one of you is suffering and can’t say so.

Sometimes pregnancy brings out what was already there. If you found it hard to talk about closeness before the pregnancy, pregnancy won’t solve that; it often sharpens it. Then couples therapy can be a place to look not only at sex but at how you are together when things are hard. I also work with English-speaking couples, in person in Ljubljana.

What to remember

• Changes in sex during pregnancy are common; for most couples frequency declines towards the end of pregnancy.
• In an uncomplicated pregnancy sex is usually fine, but what is safe for you is for your gynaecologist to judge — ask without embarrassment.
• The fear of harming the baby is common in both partners; left unspoken, it quickly turns into a feeling of rejection.
• Closeness is more than sex: touch, conversation and tenderness without expectations can be precious at this time.
• Couples who learn to talk about closeness during pregnancy have more support for the time after the birth.