Sex during pregnancy is perfectly safe for most women, though desire for sex may change during pregnancy’s different stages — and certain adjustments may have to be made.

Among the more enjoyable changes pregnancy brings to many women is a heightened sex drive and strong orgasms (during some of those nine months).

But common misconceptions about sex during pregnancy can affect how often pregnant women have sex. A study published in the journal Neuroendocrinology Letters, for example, found that most of the 149 people surveyed had significantly less sex in the third trimester of pregnancy than they did before conceiving, dropping from an average of one to two times a week to one to three times per month. Among the top concerns about sex during pregnancy was the health and safety of the baby.

For most women, intercourse during pregnancy is perfectly safe. If the pregnancy is progressing normally, sex is in no way harmful to the baby, says Faina Gelman-Nisanov, MD, a gynecologist with Maiden Lane Medical in New York City.

Your baby is well protected within your uterus. Amniotic fluid cushions the baby, and a thick mucus plug seals the cervix tight to guard against infection, according to Mayo Clinic. Although an orgasm may cause uterine contractions, they’re not labor contractions, so there’s no need to worry.

A pregnant woman’s sex drive typically spikes in the second trimester, when energy levels rise and nausea subsides. Sex may be on your mind a lot because of an increase in blood flow to the vagina and higher hormone levels, says Dr. Gelman-Nisanov. The vagina becomes engorged and vaginal lubrication increases. As a result, your desire to have sex rises and orgasms become stronger.

As your body changes and you experience pregnancy weight gain, getting the most enjoyment from intercourse may call for changes to your usual routine.

You may find that this is a time of sexual freedom and, if this is your first pregnancy, you may appreciate intimacy more during your last months without the responsibilities of parenthood. But you may need to make some adjustments for your own comfort, depending on the stage of pregnancy you’re in.

Experiment with new sexual positions. As your pregnancy proceeds and your belly grows bigger, you may need to try different positions to see what feels comfortable for you. “I recommend avoiding the missionary position for long periods of time, especially into the second and third trimester,” Gelman-Nisanov says. “A pregnant woman is more likely to have comfort with positioning herself on top of her partner, or with her partner behind her.” Options include lying on your side, getting on your hands and knees, and sitting on your partner’s lap.

Put Safety First

If your partner has a history of sexually transmitted infections (STIs) or if there’s even a possibility of STI or HIV exposure when you’re having sex, always use a condom. HIV can be transmitted to the baby, and some other STIs can be transmitted to the baby during delivery.

While oral sex during pregnancy is generally considered safe, remember that your partner should never blow air into the vagina, because this could cause an air embolism (in which a blood vessel becomes blocked by air bubbles), which could become life-threatening, per the Cleveland Clinic. Gelman-Nisanov says anal sex is safe during pregnancy but should be limited if the pregnant woman has hemorrhoids. But remember: “All sex is contraindicated if one of the partners has a genital or oral infection,” she says.

Communicate Openly

You and your partner may have different ideas about how often you should be having sex. Talk about each other’s changing needs. If intercourse when pregnant becomes difficult, particularly in the final stage of pregnancy, find ways other than penetration to be close, such as using massage or cuddling.

Consider Sex Toys

Remember that partnered sex isn’t the only way women can experience pleasure during pregnancy. Sex toys like vibrators are safe to use during pregnancy as long as your doctor hasn’t told you to avoid sex for a medical reason, Gelman-Nisanov says. She notes that they should be cleaned appropriately before and after use and stored in a clean, dry place.
When Sex During Pregnancy Isn’t Safe
Your doctor may tell you not to have sex while pregnant if:

You’re at risk for a miscarriage.
You’re at risk for preterm labor, or giving birth before 37 weeks.
You have placenta previa, in which the placenta is covering the cervical opening.
You’re experiencing vaginal bleeding.
You have an infection.
Your membranes have ruptured.
You have a short cervix, which increases risk of miscarriage or preterm labor, or if the cervix has opened.
Expect pregnancy to bring waves of changes — physical, emotional, and sexual. By listening to your body and recognizing your needs, you will be better able to enjoy the unique pleasures of this special time in your life.

By Marie Suszynski

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