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Chapter 15 - Short Cervix and Sex

from Section 2 - Specific Issues

Published online by Cambridge University Press:  09 November 2022

By
Yara Maia Villar de Carvalho ,
Francisco Marcelo Carvalho ,
Beatriz Maria Villar de Carvalho  and
Eduardo Borges da Fonseca
Edited by
Dan Farine  and
Pablo Tobías González
Dan Farine
Affiliation:
Mount Sinai Hospital, Toronto
Pablo Tobías González
Affiliation:
Hospital Universitario Infanta Cristina de Parla, Madrid
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Summary

Spontaneous preterm birth (PTB) refers to a delivery that occurs between weeks 20 and 37 of pregnancy, due to preterm labor, preterm prelabor rupture of membranes. and short cervical length at mid-trimester. The three most common risk factors for PTB are (1) prior history of preterm delivery, (2) twin pregnancy, and (3) short cervix at mid-trimester ultrasound. Several studies have demonstrated that short cervical length is the most powerful predictor for PTB in the index pregnancy for both singleton and twin pregnancies. A short cervical length means the measured length of the cervix is shorter than expected for the current gestational age, with a cutoff value between 20 and 25 mm. Sexual intercourse by itself has not been demonstrated to be a clear risk factor for PTB. Thus, abstinence after pregnancy has been achieved has no role in strategies for prevention of PTB. Also, most sexual positions and noncoital activities (e.g. oral sex, masturbation) during late pregnancy are not clearly associated with adverse pregnancy outcomes. There is no strong evidence that sexual activity affects the risk of PTB or onset of labor in healthy individuals. Pelvic rest may be recommended in selected cases, such as patients with a very short cervix or bulging membranes.

Keywords

short cervixpregnancysexintercourseorgasmpreterm birth
Type
Chapter
Information
Sex and Pregnancy
From Evidence-Based Medicine to Dr Google
 , pp. 104 - 111
Publisher: Cambridge University Press
Print publication year: 2022

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References

da Fonseca, E. B., Damiao, R., Moreira, D. A.. Preterm birth prevention. Best Pract Res Clin Obstet Gynaecol 2020;69:40–9.CrossRefGoogle ScholarPubMed
Romero, R., Dey, S. K., Fisher, S. J.. Preterm labor: one syndrome, many causes. Science 2014;345:760–5.CrossRefGoogle ScholarPubMed
Vogel, J. P., Chawanpaiboon, S., Moller, A. B., et al. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol 2018;52:3–12.Google Scholar
Heath, V. C., Southall, T. R., Souka, A. P., Elisseou, A., Nicolaides, K. H.. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol 1998;12:312–17.Google ScholarPubMed
Heath, V. C., Southall, T. R., Souka, A. P., Novakov, A., Nicolaides, K. H.. Cervical length at 23 weeks of gestation: relation to demographic characteristics and previous obstetric history. Ultrasound Obstet Gynecol 1998;12:304–11.Google Scholar
Gudicha, D. W., Romero, R., Kabiri, D., et al. Personalized assessment of cervical length improves prediction of spontaneous preterm birth: a standard and a percentile calculator. Am J Obstet Gynecol 2021;224:288.e1–17.CrossRefGoogle Scholar
Iams, J. D., Goldenberg, R. L., Meis, P. J., et al. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996;334:567–72.Google Scholar
Hassan, S. S., Romero, R., Berry, S. M., et al. Patients with an ultrasonographic cervical length ≤15 mm have nearly a 50% risk of early spontaneous preterm delivery. Am J Obstet Gynecol 2000;182:1458–67.CrossRefGoogle ScholarPubMed
Romero, R.. Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment. Ultrasound Obstet Gynecol 2007;30:675–86.CrossRefGoogle ScholarPubMed
To, M. S., Skentou, C. A., Royston, P., Yu, C. K., Nicolaides, K. H.. Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study. Ultrasound Obstet Gynecol 2006;27:362–7.CrossRefGoogle ScholarPubMed
To, M. S., Fonseca, E. B., Molina, F. S., Cacho, A. M., Nicolaides, K. H.. Maternal characteristics and cervical length in the prediction of spontaneous early preterm delivery in twins. Am J Obstet Gynecol 2006;194:1360–5.CrossRefGoogle ScholarPubMed
Tsoi, E., Akmal, S., Rane, S., Otigbah, C., Nicolaides, K. H.. Ultrasound assessment of cervical length in threatened preterm labor. Ultrasound Obstet Gynecol 2003;21:552–5.Google Scholar
Fuchs, I., Tsoi, E., Henrich, W., Dudenhausen, J. W., Nicolaides, K. H.. Sonographic measurement of cervical length in twin pregnancies in threatened preterm labor. Ultrasound Obstet Gynecol 2004;23:42–5.Google Scholar
Tsoi, E., Geerts, L., Jeffery, B., Odendaal, H. J., Nicolaides, K. H.. Sonographic cervical length in threatened preterm labor in a South African population. Ultrasound Obstet Gynecol 2004;24:644–6.Google Scholar
Tsoi, E., Fuchs, I. B., Rane, S., Geerts, L., Nicolaides, K. H.. Sonographic measurement of cervical length in threatened preterm labor in singleton pregnancies with intact membranes. Ultrasound Obstet Gynecol 2005;25:353–6.CrossRefGoogle ScholarPubMed
Lipworth, H., Hiersch, L., Farine, D., Barrett, J. F. R., Melamed, N.. Current practice of maternal–fetal medicine specialists regarding the prevention and management of preterm birth in twin gestations. J Obstet Gynaecol Can 2021;43:831–8.CrossRefGoogle ScholarPubMed
Maisonneuve, E.. [Lifestyle recommendations for prevention of spontaneous preterm birth in asymptomatic pregnant women]. J Gynecol Obstet Biol Reprod (Paris) 2016;45:1231–46.Google Scholar
Hernandez-Diaz, S., Boeke, C. E., Romans, A. T., et al. Triggers of spontaneous preterm delivery: why today? Paediatr Perinat Epidemiol 2014;28:79–87.CrossRefGoogle ScholarPubMed
Lerner, R. M., Steinberg, L., eds. Handbook of Adolescent Psychology. Hoboken, NJ: John Wiley & Sons, 2004: 193–6.Google Scholar
Carroll, J. L.. Sexuality Now: Embracing Diversity. Boston: Cengage Learning, 2018: 289.Google Scholar
Sexual intercourse. https://en.wikipedia.org/wiki/Sexual_intercourseGoogle Scholar
Freberg, L.. Discovering Biological Psychology. Boston: Cengage Learning, 2009: 308–10.Google Scholar
World Health Organization, Department of Reproductive Health and Research. Defining Sexual Health: Report of a Technical Consultation on Sexual Health 28–31 January 2002, Geneva. Geneva: World Health Organization, 2006.Google Scholar
Denney, N. W., Quadagno, D.. Human Sexuality. St. Louis, MO: Mosby-Year Book, 1988: 273.Google Scholar
Hales, D.. An Invitation to Health: Live It Now! Brief Edition. Boston: Cengage Learning, 2015: 251.Google Scholar
Kahn, A. P., Fawcett, J.. The Encyclopedia of Mental Health. New York: Infobase Publishing, 2008: 111.Google Scholar
Winn, P.. Dictionary of Biological Psychology. London: Routledge, 2003: 1189.Google Scholar
Rosenthal, M.. Human Sexuality: From Cells to Society. Boston: Cengage Learning, 2012.Google Scholar
Exton, M. S., Kruger, T. H., Koch, M., et al. Coitus-induced orgasm stimulates prolactin secretion in healthy subjects. Psychoneuroendocrinology 2001;26:287–94.Google Scholar
Weiten, W., Dunn, D. S., Hammer, E. Y.. Psychology Applied to Modern Life: Adjustment in the 21st Century. Boston: Cengage Learning, 2011: 386.Google Scholar
O’Connell, H. E., Sanjeevan, K. V., Hutson, J. M.. Anatomy of the clitoris. J Urol 2005;174:1189–95.Google Scholar
Georgiadis, J. R., Reinders, A. A., Paans, A. M., Renken, R., Kortekaas, R.. Men versus women on sexual brain function: prominent differences during tactile genital stimulation, but not during orgasm. Hum Brain Mapp 2009;30:3089–101.Google Scholar
Berkowitz, G. S., Papiernik, E.. Epidemiology of preterm birth. Epidemiol Rev 1993;15:414–43.CrossRefGoogle ScholarPubMed
Solberg, D. A., Butler, J., Wagner, N. N.. Sexual behavior in pregnancy. N Engl J Med 1973;288:1098–103.Google Scholar
Wagner, N. N., Butler, J. C., Sanders, J. P.. Prematurity and orgasmic coitus during pregnancy: data on a small sample. Fertil Steril 1976;27:911–15.Google Scholar
Neilson, J. P., Mutambira, M.. Coitus, twin pregnancy, and preterm labor. Am J Obstet Gynecol 1989;160:416–18.Google Scholar
Mills, J. L., Harlap, S., Harley, E. E.. Should coitus late in pregnancy be discouraged? Lancet 1981;318:136–8.Google Scholar
Klebanoff, M. A., Nugent, R. P., Rhoads, G. G.. Coitus during pregnancy: is it safe? Lancet 1984;324:914–17.Google Scholar
Ekwo, E. E., Gosselink, C. A., Woolson, R., Moawad, A., Long, C. R.. Coitus late in pregnancy: risk of preterm rupture of amniotic sac membranes. Am J Obstet Gynecol 1993;168:22–31.Google Scholar
Read, J. S., Klebanoff, M. A.. Sexual intercourse during pregnancy and preterm delivery: effects of vaginal microorganisms. Am J Obstet Gynecol 1993;168:514–19.Google Scholar
Perkins, R. P.. Sexual behavior and response in relation to complications of pregnancy. Am J Obstet Gynecol 1979;134:498–505.Google Scholar
Goodlin, R. C., Keller, D. W., Raffin, M.. Orgasm during late pregnancy. Possible deleterious effects. Obstet Gynecol 1971;38:916–20.Google ScholarPubMed
Georgakopoulos, P. A., Dodos, D., Mechleris, D.. Sexuality in pregnancy and premature labour. Br J Obstet Gynaecol 1984;91:891–3.CrossRefGoogle ScholarPubMed
Morris, N. M.. The frequency of sexual intercourse during pregnancy. Arch Sex Behav 1975;4:501–7.Google Scholar
Reamy, K., White, S. E., Daniell, W. C., Le Vine, E. S.. Sexuality and pregnancy. A prospective study. J Reprod Med 1982;27:321–7.Google Scholar
Sayle, A. E., Savitz, D. A., Thorp, J. M. Jr., Hertz-Picciotto, I., Wilcox, A. J.. Sexual activity during late pregnancy and risk of preterm delivery. Obstet Gynecol 2001;97:283–9.CrossRefGoogle ScholarPubMed
Harger, J. H., Hsing, A. W., Tuomala, R. E., et al. Risk factors for preterm premature rupture of fetal membranes: a multicenter case-control study. Am J Obstet Gynecol 1990;163:130–7.Google Scholar
Kurki, T., Ylikorkala, O.. Coitus during pregnancy is not related to bacterial vaginosis or preterm birth. Am J Obstet Gynecol 1993;169:1130–4.Google Scholar
Rayburn, W. F., Wilson, E. A.. Coital activity and premature delivery. Am J Obstet Gynecol 1980;137:972–4.Google Scholar
Masters, W. H., Johnson, V. E.. Human Sexual Response. Boston: Little, Brown, 1966.Google Scholar
Romero, R., Conde-Agudelo, A., Da Fonseca, E., et al. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. Am J Obstet Gynecol 2018;218:161–80.CrossRefGoogle Scholar
Conde-Agudelo, A., Romero, R., Da Fonseca, E., et al. Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis. Am J Obstet Gynecol 2018;219:10–25.Google Scholar
Romero, R., Conde-Agudelo, A., El-Refaie, W., et al. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol 2017;49:303–14.Google Scholar
Di Renzo, G. C., Tosto, V., Tsibizova, V.. Progesterone: history, facts, and artifacts. Best Pract Res Clin Obstet Gynaecol 2020;69:2–12.Google Scholar
Rehal, A., Benko, Z., De Paco Matallana, C., et al. Early vaginal progesterone versus placebo in twin pregnancies for the prevention of spontaneous preterm birth: a randomized, double-blind trial. Am J Obstet Gynecol 2021;224:86.e1–19.Google Scholar
Goodlin, R. C., Schmidt, W., Creevy, D. C.. Uterine tension and fetal heart rate during maternal orgasm. Obstet Gynecol 1972;39:125–7.Google Scholar
Sahmay, S., Atasu, T., Karacan, I.. The effect of intrauterine insemination on uterine activity. Int J Fertil 1990;35:310–14.Google Scholar
Weiss, R. E.. Pelvic rest and sex during pregnancy. 2021. www.verywellfamily.com/pelvic-rest-reasons-you-can-t-have-sex-in-pregnancy-4111084 (accessed September 15, 2021).Google Scholar
Medical Professionals of the ISSM’s Communication Committee. Review discusses safety of sexual activity during high-risk pregnancy. 2021. https://issm.info/sexual-health-headlines/review-discusses-safety-of-sexual-activity-during-high-risk-pregnancy (accessed September 15, 2021).Google Scholar
Jondle, J.. Diagnosing and treating a short cervix during pregnancy. 2019. www.healthline.com/health/pregnancy/short-cervix (accessed September 15, 2021).Google Scholar
Burton, W.. Relax, it is (almost always) ok to enjoy sex during pregnancy. 2019. https://maternity-matters.com.au/brisbane-pregnancy-and-babies/2019/04/07/sex-in-pregnancy (accessed September 15, 2021).Google Scholar
What to expect when diagnosed with a short cervix during pregnancy. 2018. https://fitmombirthgeek.com/short-cervix-during-pregnancy/ (accessed September 15, 2021).Google Scholar

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