Assisted reproductive technologies (ART) can enable infertile couples to conceive without the need for sexual intercourse. Patients undergoing ART are often concerned about the safety of intercourse during treatment, and whether having sex may impact the likelihood of successful treatment. As sex is nonessential to reproduction when ART is performed, sexual function may also be affected by undergoing such treatment. We performed a review of the literature regarding the risks and benefits of sex during ART treatment. We also reviewed the psychosocial literature on the impact on ART on sexuality and sexual function. It remains controversial whether sex negatively impacts ART success rates through inducing uterine contractions or infection. There is some evidence that seminal plasma exposure may improve implantation outcomes, but studies are limited. Overt risks such as ovarian torsion are exceedingly rare and difficult to quantify. Ultimately, it is up to a couple’s comfort level. Couples and providers should also be aware that sexual dysfunction rates are high in patients undergoing ART.

Throughout the three trimesters of pregnancy, there is a remarkable adaptation of the whole body to accommodate the growing uterus and fetus, as well as upcoming labor and delivery. Most of these physiological changes gradually regress over the postpartum, returning to prepregnancy levels from a few weeks up to 6 months later. The changes that occur in pregnancy have an important impact on a woman’s sexual functioning (desire, arousal, orgasm, sexual satisfaction). Despite the implications of these physiological changes during pregnancy, which affect intimacy and sexual function, these are seldom discussed by health professionals and care providers. The adjustments and changes in different systems throughout the pregnancy are explained in this chapter, focusing on those with implications for sexual function and the mechanisms behind them.

Twin and triplet pregnancies have been associated with an increased risk for adverse maternal and neonatal outcomes. This chapter discusses select issues about sexual activity and twin pregnancy, especially with relation to preterm birth (PTB) and shortened cervix, two major concerns in this population. Two studies addressed the association of sexual activity with PTB in twin pregnancies. Overall, these studies do not support a relationship between sexual behavior and PTB in uncomplicated twin pregnancies. Unanswered questions still abound regarding twin gestations at higher risk of PTB, the effects of prostaglandins in semen on cervical length, the intensity of uterine contractions with orgasm on a compromised cervix, and sexual activity in the case of cervical cerclage. We suggest that sexual activity of any type should not be discouraged in twin gestations without other obstetric risk factors such as short cervix. Recommendations should be individualized bearing in mind patient history, comorbidities, and emotional needs.

Intercourse is an integral part of human well-being and over the course of a pregnancy its frequency usually declines, at times due to discomfort and prejudice but in some cases due to medical advice. This chapter reviews the evidence for the safety of sexual activity in low- and high-risk pregnancies and establishes the validity of recommendations of abstinence in different clinical scenarios. The main concern regarding sexual intercourse is its ability to cause uterine contractions that could possibly result in premature labor or endanger a pregnancy complicated by placental pathologies. In light of the existing evidence, which is limited in amount and quality, it seems that coitus does not produce contractions powerful enough to precipitate labor, either in women who are at increased risk for preterm labor or in those who are not. Another significant concern is the possibility that sexual intercourse may trigger migration of pathogens to the cervix and cause an ascending infection and chorioamnionitis, especially in the setting of premature rupture of the membranes, and some studies indeed support this hypothesis; however, they were conducted decades ago, and their quality is low. It is clear that there is insufficient high-quality research to establish proper evidence-based guidelines for women who wish to receive medical advisement regarding sexual activity. However, when examining the existing literature and taking into consideration that coitus is part of every couple’s healthy and normal lifestyle, it seems that overall engaging in sexual activity during pregnancy is safe. In selected cases of high-risk pregnancies, recommendations should be tailored individually according to the parturient’s obstetric history.

Sexual function is considered a key feature of the health and personality of both women and men. Adequate sexual activity is associated with better physiological and psychological health indexes. Pregnancy poses a life crisis for pregnant women and their male partners, and changes in the physical, hormonal, psychological, social, and cultural spheres may lead to a decrease in sexual function. In this chapter we attempt to describe changes in sexual function during pregnancy from the perspective of the male. Male sexual dysfunction conditions observed in pregnancy and the postpartum period, such as erectile dysfuntion, premature ejaculation, Couvade syndrome, and paternal perinatal depression, are addressed.

The first trimester of pregnancy covers a major transition period for pregnant individuals and their partners. Sexual satisfaction, including in pregnancy, is an important facet of a fulfilling relationship. The frequency of sexual activity decreases during the first trimester and is accompanied by increased sexual dysfunction, particularly once the pregnancy is identified. This may be secondary to physical factors such as fatigue and nausea and vomiting as well as a fear of miscarriage or harm to the pregnancy. Sexual activity in the first trimester has not been demonstrated to result in miscarriage, adverse obstetric outcomes, or fetal harm. Vaginal bleeding may be associated with an increased risk of miscarriage and therefore caution is advisable for vaginal intercourse in these cases. Obstetric care providers can support couples in early pregnancy by including discussions of the safety of sexual activity, expectations during pregnancy, and alternative mechanisms of intimacy as part of routine pregnancy care.

Sexual practices are strongly influenced by social and cultural norms and hence encompass a wide degree of heterogeneity between different cultures. Cultural diversity in sexual practices is subject to an even more complex array of sociocultural, physical, and psychological influences in pregnancy. The literature in this area demonstrates both this diversity and also commonalities among cultures, with universally high rates of female sexual dysfunction (FSD), unnecessary avoidance of sexual activity in pregnancy due to ill-informed fears, and unmet desire for antenatal education and assessment of sexual issues by health practitioners. This chapter presents the current evidence on rates of sexual activity and FSD in pregnancy and influences upon these in different cultures. Increasing awareness of common rates of sexual activity in pregnancy may normalize a reduction in activity and consequently reassure couples that such changes are not necessarily indicative of relationship issues. Conversely, identifying and addressing preventable issues affecting sexual health in pregnancy could potentially improve parental well-being, strengthen family bonds, and positively impact the development of offspring.

Sexuality is an important part of health and quality of life at all ages and thus is an important area for health-care providers to address. The number of years of potential sexual activity in later life is increasing. There are both physical and emotional aspects to sexuality, and the desire for intimacy continues throughout life. Studies have shown that most older adults desire more activity than what they have. Lack of partners and lack of privacy are significant obstacles for sexual expression. The physiological changes with age alone are insufficient cause to cease sexual activity, and for some these changes are felt to enhance their sexual activity. A number of medical conditions contribute to sexual dysfunction and raise patient concerns regarding health consequences of sexual activity. For older adults, negotiating safer sex may be unfamiliar and challenging, they lack knowledge to identify HIV/AIDS risk factors, and they are less likely to use condoms. Health-care providers lack awareness of seniors’ sexuality, fail to engage in conversations about risks, and are less likely to test for the virus. As with many potentially sensitive issues, it appears that patients are waiting for their health-care providers to raise the topic.