Francisco Javier Fernández-Carrasco1
Cirenia Batugg-Chaves2Azahara Ruger-Navarrete1Francisco Javier Riesco-González2,3Rocío Palomo-Gómez4
Juan Gómez-Salgado5,6*
Luciano Rodriguez Diaz1María Dolores Vázquez-Lara7Javier Fagundo-Rivera8Juana Maria Vázquez-Lara1- 1Nursing Department, Faculty of Health Sciences of Ceuta, University of Granada, Granada, Spain
- 2Nursing Department, Faculty of Nursing of Algeciras, University of Cádiz, Cádiz, Spain
- 3Department of Obstetrics, La Linea de la Concepción Hospital, Andusian Health Service, Seville, Spain
- 4Hospital Punta de Europa, Algeciras, Spain
- 5Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- 6Escuela de Posgrado, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
- 7Health Area Campo de Gibraltar, Andusian Health Service, Seville, Spain
- 8Centro Universitario de Enfermería Cruz Roja, Sevilla, Spain
Objectives: Pregnancy is a stage in which different physical and psychological changes take place that can affect the sexuality of the couple. The aim of the study is to identify how the physical and psychological changes derived from pregnancy affect the sexual desire of women and men.
Methods: A systematic review of the literature was carried out in five databases, from which a total of 16,126 documents were obtained. After applying the PRISMA selection criteria, a total of 19 documents were selected.
Results: Levels of sexual desire fluctuate during pregnancy, being the second trimester of gestation the period in which desire is at its highest and in which physical limitations and emotional changes decrease. Women have lower levels of sexual desire in the first trimester, while men have the lowest levels of desire in the third trimester.
Conclusion: Pregnancy is a stage marked by physiological and psychological changes that modify several areas, including sexuality. Healthcare professionals should promote a healthy sexuality, avoiding the appearance of fears or sexual dysfunctions caused by the changes that occur during pregnancy.
Introduction
Sexual and marital relationships are influenced by physiological and anatomical changes that occur during pregnancy, as well as psychological and social factors, economic conditions, religious beliefs, and gender discussions, and these vary and progress as gestation increases [1–3]. Altered body image, reduced sense of charm for the spouse, fear of injury to the foetus or fear of abortion, and early childbirth can affect women’s sexual response and ultimately the couple’s relationship [4, 5]. These factors could lead to abandonment of sexual activity and feelings of guilt regarding sexual relations during pregnancy [6]. Other couples showed a preference for sexual positions that provide for greater control over vaginal penetration and may differ from non-pregnant habits. There also appears to be greater engagement in noncoital sexual relations [3]. Some authors concluded that sexual desire could be described as a motivational state [7, 8], and pregnant women may avoid sexual intercourse or inevitably suffer from many problems in their sexual lives [1].
There is diversity in women’s and men’s sexual desire variability, with relevant practical implications in the couple sexual self-concept and sexual relationship. Women appear to show greater variability in sexual attitudes, behaviours, and attraction [9]. The first trimester is linked to a decrease in sexual relationships frequency due to nausea, sickness, breast sensitivity, and a worsening sense of wellbeing [10, 11]. Increased age is a significant risk factor for sexual distress and low sexual desire in this stage [6, 12]. In the second trimester, the frequency of sexual intercourse increases, and relates to a higher sense of security and increasing sexual interest [13, 14]. In addition, a smaller number of physical symptoms connected with pregnancy are experienced during the second trimester, improving women’s sense of wellbeing and, thus, increasing sexual desire [10, 15]. In the third trimester of pregnancy, women suffer from pain during sexual relations significantly more than in previous trimesters. Also, anatomical changes affecting the pregnant body and concerns about the health of the child influence this trimester. Thus, a great decrease in sexual interaction in this stage is associated with the pain domain [3, 10, 16, 17].
A man, even though it is not his body that has to gestate, can also experience psychological and physiological changes during pregnancy. The most extreme example is the so-called Couvade syndrome, which consists of experiencing symptoms such as vomiting, dizziness, abdominal pain or changes in appetite in a strange empathy with your partner [18].
Pregnancy can affect male sex drive. There are men who declare to have a lower sexual desire during pregnancy, and this may be due, apart from the changes that their partner is going through, to certain fears such as being able to harm the woman or the foetus during intercourse or the feeling of guilt that the pregnancy does not develop properly due to the fact of having sexual intercourse [19].
Likewise, poor relationship quality may negatively affect sexual functioning, and the link between the quality of the couple’s relationship and women’s sexuality during pregnancy has already been noted [17]. The sexuality of new parents plays an important medical and psychological role, but pregnant couples tend to avoid discussing their sexual problems [3]. Is has been assumed that women’s desire is more sensitive to the psychosocial context, and hence more variable and sensitive to major life events [9]. In this context, desire for pregnancy could be an indicator of more committed, intimate, and long-term relationships, being relevant for women’s desire in the antenatal period [20].
The aim of this review was to determine the current state of sexual desire during pregnancy by assessing the available literature to identify the most relevant physical and psychological factors that may affect couple’s sexual desire in the prenatal period.
Methods
Research Design
A systematic literature review was conducted to assess changes in sexual desire in pregnant women and their partners during pregnancy. The review was conducted using the systematic review format, following the criteria of the updated PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) [21]. The implemented protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42023391131.
Search Strategy
For the formulation of the research question, the PECO (Patient, Exposure, Comparison, Outcomes) format was used (Table 1).
TABLE 1. Research question in Patient, Exposure, Comparison, Outcomes format (Sexual desire, Spain, 2023).
Research Question
How do the physical and psychological changes derived from pregnancy affect the sexual desire of women and their sexual partners?
The following medical subject heading (MeSH) descriptors were used: sexual desire, libido, sexual dysfunctions, and pregnancy. To expand the scope of the search, free terms were added to the search using the Boolean operators AND and OR (Table 2).
TABLE 2. Terminology used in the search (Sexual desire, Spain, 2023).
Table 3 shows the selection process, which was carried out between 6 and 10 May 2023 in several databases (Scopus, Pubmed, WOS, Cuiden, and Embase) using the different search strings and filtering from 2013 to February 2023.
TABLE 3. Document search and selection strategy (Sexual desire, Spain, 2023).
Selection Criteria
The following inclusion and exclusion criteria were used for the selection of articles.
Inclusion Criteria:
• Experimental, analytical, and observational studies.
• English or Spanish language.
• Published between 2013 and 2023.
• Related to the objective of the study.
• After reading full text: articles were excluded if they were out of the scope of this review, whether they were not related to the main objective, or if data analysis was too limited or biased [22].
Exclusion Criteria:
• Bibliographic reviews, opinion articles, letters to the editor.
• Studies conducted on animals.
Data Collection and Extraction
The search was carried out independently by two reviewers using MeSH descriptors and Boolean operators in the search strategy. The articles were selected according to the selection criteria. In case of disagreement, a third independent author, through a feedback process, made the decision.
Methodological Quality Assessment
The assessment of methodological quality was performed independently by both reviewers using the critical appraisal tool for different studies of the Joanna Briggs Institute (JBI) at the University of Adelaide [22]. These critical assessment tools are instruments designed to help reviewers assess the methodological quality of the primary studies included in a systematic review. These tools have made it possible to standardise the review criteria, as well as to facilitate decision-making when it comes to including or excluding studies. As mentioned, JBI provides specific tools to evaluate different types of studies, such as quasi-experimental studies, observational studies, or qualitative studies, among others. This ensures that the assessment is relevant and specific to the type of study design included in the review, which contributes to the rigor and validity of systematic reviews.
In this sense, three questionnaires were used in this review, depending on the design of the selected studies. One was the eight-item JBI checklist for analytical cross-sectional studies, for which the cut-off point for eligibility was set at 6/8 by consensus of both researchers. Another one was the ten-item JBI critical appraisal checklist for qualitative research, for which the cut-off point for eligibility was agreed at 8/10. Finally, the 9-item JBI checklist for quasi-experimental studies (non-randomized experimental studies) was used, with a cut-off point of 7/9.
Results
In the previously mentioned databases and using the search strings in Table 3, a total of 16,129 articles were identified. After removing duplicate articles (290), a total of 15,836 remained eligible. Then, 12,330 articles were excluded as they did not meet the inclusion criteria, leaving a total of 3,506. After reading the titles and abstracts, 3,383 other articles were excluded as they were out of the scope of this review. Subsequently, 104 articles were eliminated after reading the full text, as the data analysis was too limited (n = 80), or they were not related to the main objective (n = 24). Figure 1 shows the process followed for the identification, screening, and selection of the studies included in this review. Finally, 19 articles that assessed the changes in sexual desire in the couple during pregnancy were included in the review [1, 19, 23–39].
FIGURE 1. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databasesiregisters). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.
Of the 19 articles, there were 14 cross-sectional studies, one quasi-experimental study, and one qualitative study. Five of these articles were conducted in Turkey, five in Iran, three in Spain, one in the USA, one in Greece, one in Cuba, one in Brazil, one in Lebanon, and one in Paraguay.
The characteristics of the different studies included in this review are shown in Table 4.
TABLE 4. Characteristics of the studies included in the systematic review (Sexual desire, Spain, 2023).
Sexual Desire and Pregnancy
Gestation is a period marked by different factors, including physiological and psychological ones [32], which affect women to a greater extent, but also men [19].
On the one hand, the pregnant partner assumes the role of motherhood/parenthood [23–25] and readjusts their sexual and cohabitation expectations (p < 0.01). This poses a new sexual response that must be readjusted as the pregnancy progresses and the circumstances of the pregnancy change.
Expectant parents need to be informed by healthcare professionals about the changes that occur in this regard and how they can adapt to them [33–36]. This would decrease the prevalence of sexual dysfunction during pregnancy by 80%–90% [1, 33, 34], as anxiety [34] and fear related to misinformation in this area would be directly associated with sexual distress [26] and, thus, sexual dysfunction (p < 0.01).
Changes in Women’s Sexual Desire During Each Trimester of Pregnancy
For women, the first trimester of pregnancy is generally marked by symptoms such as sickness or nausea, which prevent them from feeling well enough to engage in sexual intercourse. Thus, both solitary and dyadic sexual desire decrease, resulting in reduced frequency of sexual intercourse [24].
In the second trimester of pregnancy, levels of both solitary and dyadic sexual desire increase to levels similar to pre-pregnancy levels (p < 0.02) [25, 26, 28]. This is favoured by decreased discomfort and emotional changes associated with pregnancy [24, 25].
In the third trimester of pregnancy, levels of both sexual desire and sexual satisfaction are lower (p = 0.004). In the last weeks of gestation [27–33], abdominal distension in the pregnant woman and concern for the baby’s wellbeing often lead to the cessation of sexual intercourse (p < 0.01) [28].
Modification of Men’s Dyadic Sexual Desire in Each Trimester of Pregnancy
As with women, psychological changes and concerns arise in men, which affect their sexual response during this new stage. Men’s sexual attitude during pregnancy is often negative [28, 38]. Fear of harm to the pregnant woman or foetus results in a significant reduction in frequency of sexual relations [24].
Another important factor affecting men’s sexual desire is the change of roles within the couple. Some men report that they see their partner more as a mother than as a sexual partner [19, 25, 39].
In the second trimester, the limitations are lower, which results in a positive attitude on the part of the woman. This positively affects the man’s sexual desire, which increases [24, 33]. The fact that women demand more sexual attention from their partners increases sexual desire in men [19].
In the third trimester, the new body image of women [30] and the difficulty in having sex with a protruding abdomen [30] result in a decrease in the frequency of sexual intercourse, even stopping altogether in many cases (Chi squared = 38.420; p = 0.000). In this trimester, and for the same reason (weight gain and increase in abdominal size), men may find their partners less attractive, and this may cause a decrease in dyadic sexual desire at the expense of an increase in solitary sexual desire [19, 37].
Similarities and Differences Between Male and Female Sexual Desire Throughout Pregnancy
Though not in the same way or at the same time, changes occur during pregnancy that affect the sexual desire of both partners. For instance, serum testosterone levels decrease in both partners, which affects dyadic sexual desire (p < 0.001; 95% CI [−0.03, −0.01]) [27]. In this regard, women have the lowest levels of dyadic sexual desire, particularly in the first trimester. In contrast, men have the lowest levels of dyadic sexual desire in the third trimester [19].
Levels of solitary sexual desire in women drop sharply during the first trimester of pregnancy, increase slightly in the second trimester, and continue to increase in the third trimester, but without reaching pre-gestational levels. In men, however, although solitary sexual desire also decreases, it does so only slightly in comparison with their partner [19].
Discussion
Among the most relevant findings of this review, it is noteworthy that women reported a decrease in sexual desire during pregnancy, both in terms of dyadic and solitary desire. This was attributed to different particularities, some of them related to the pregnant woman, such as her sentimental situation or educational level, and others related to the gestation, such as the trimester or the appearance of bleeding or pain, and all of them evidenced a negative influence on sexual response [1, 19, 33]. These findings are consistent with other studies that report a decrease in frequency of sexual activity during pregnancy (intercourse and orgasm, among others), although other research found that some women experienced an increase in sexual desire during pregnancy, owing to emotional and physiological reasons [40].
Conversely, changes during pregnancy can have a negative influence on the sexual activity of both the pregnant woman and her partner [41], even causing sexual dysfunctions such as dyspareunia, inhibition of sexual desire, and erectile or orgasmic difficulties. These dysfunctions are usually transitory, but when the problem is not timely identified and treated, such dysfunctions may be persistent and even extend beyond the end of pregnancy [42–44]. Changes are observed in the sexual response of both partners, as they readjust their sexual priorities and cohabitation expectations and prepare for a new stage where the role of parent takes on utmost importance [24]. However, it has been found that during the third trimester, men’s sexual desire for solitary sex increases [19].
How age affects sexuality during pregnancy is a matter of debate, as different studies show differing results. Some studies indicate higher levels of sexual desire and greater coital frequency in young pregnant women (<35 years) [45, 46], in line with the results obtained in the present study, which indicate that with increasing age, the prevalence of sexual dysfunction also increases, both in women and their partners [34]. In contrast, other authors find no association between the age and sexuality during pregnancy variables [47]. The same is true for parity; some authors describe decreased coital frequency throughout pregnancy in multiparous women [48, 49], while other studies have found this decline to be typical of nulliparous pregnant women [50]. The selected results show that nulliparous women had significantly lower means for lubrication and sexual satisfaction. This may be due to the fact that nulliparous women may be more vulnerable to emotional factors due to lack of experience and to fears and anxieties related to the first pregnancy [32].
Education plays a key role in this issue, as the knowledge acquired during pregnancy related to sexuality and its components leads to reduced sexual dysfunction [33]; these results are in line with other findings that reveal that educational level plays an important role in sexual behaviour during pregnancy [51]. Lack of information, especially in nulliparous pregnant women, often inhibits sexual practices due to fear of complications, premature birth, or miscarriage [52]. In addition, cultural and religious beliefs also affect sexuality during pregnancy [53]. The study by Sapién and Córdoba [44] proves that men’s beliefs that sex during pregnancy can be harmful to the foetus affect sexual relations with their pregnant partners. This particularly affects vaginal intercourse, the frequency of which decreases as pregnancy progresses and may even be suppressed as soon as the pregnancy is medically diagnosed [40], findings that fully coincide with the ones found in the present study. Many couples become very fearful of causing any kind of harm to the pregnant woman or the foetus, so they decrease coital frequency [24] or in some cases, they may even completely interrupt sexual relations. This can be due to concerns about childbirth [28] or because the man regards his partner as a mother rather than as a sexual partner [19].
A relationship exists between sexual desire and the marital status of the pregnant woman. Marital status has a decisive influence on the desire for pregnancy; women who are married have greater willingness to become pregnant than unmarried women. There is a statistically significant relationship between the desire for pregnancy and the pregnant woman’s perception of sexual desire for her husband. This is why most married women, during pregnancy, continue to find their partners sexually desirable, and in turn their sexual desire for their partner is greater [54]. However, the results found in the present research indicated that arranged marriages and marriages of more than 10 years had a negative effect on the sexual activity of pregnant women [1].
Concerning psychological aspects, pregnancy is a new stage in a couple’s life that involves readaptation, for which communication is fundamental. It is therefore important to examine how the pregnant woman and her partner perceive physiological changes as, in some cases, her new physical image can make the pregnant woman feel insecure or less attractive [41]. During pregnancy, it has also been observed a state marked by anxiety, fear and concern about what is or is not correct in terms of sexual behaviour. This leads to attitudes that are influenced by fear of obstetric and gynaecological complications and which are often misunderstood by the partner. In addition, beliefs and myths about harming the foetus lead many couples to decrease or suppress sexual relations [55], as discussed above. The results found in the present study reinforce how pregnancy is, in many cases, marked by sexual distress stemming from the psychological changes experienced by both partners [26]. Women’s body image differs by trimester and the perception of this construct became more negative in the third trimester. A positive body image positively influenced the sexual behaviour of the partners, and a significant positive correlation was found between body image and sexual behaviour in pregnant women [30].
Finally, many studies warn of the need for healthcare professionals to provide sexuality education to expectant parents [33, 34], especially the healthcare workers involved in pregnancy control (obstetricians, midwives and nurses) having a good opportunity to educate couples during childbirth preparation courses, as well as in successive follow-up consultations throughout the pregnancy. As Brtnicka et al. [56] determined, sexual dysfunctions may exist during pregnancy, and these are often guided by fear of harming the foetus. Men also reported fear of hurting women during pregnancy, and women are afraid of insufficient satisfaction from their partner. To prevent sexual dysfunctions, which may even persist after pregnancy, it is important for the couple to readjust their sexuality. In other words, myths and fears must be eradicated, new positions and sexual games must be adopted, and even sexual relations in which penetration does not exist or is not the central axis, so that sex during pregnancy can be satisfactory for both partners [24, 26]. These findings concur with others that point to the lack of information many couples have about their sexuality and the changes that occur during pregnancy [25].
This systematic review has a number of limitations. Firstly, there are not many studies on sexual desire (dyadic and solitary) during pregnancy in the last 10 years. In addition, studies on male sexuality during this stage are also very scarce. For this reason, the literature found was limited, which poses the need to carry out further research on this topic in the future. Besides, although heterosexual couples are the most common, there are also other homosexual family models or even those with different sexual orientations, so it would be interesting to know in future investigations how sexual desire during pregnancy affects these types of family models, currently considered a minority. Likewise, this review has been carried out on studies in several countries and continents, so it would be equally interesting to investigate each specific context to identify the religious or cultural differences that can affect the sexual behavior of the couple at a global level. The language in which the search was carried out (English and Spanish) can also be established as a limitation, although we are aware that most scientific publications are made in English, since it is possible that some relevant work published in any other language has not been selected. At the same time, it is worth mentioning within the limitations that the period of time where the search was framed was the last 10 years, with the possibility that some work that was previously published may have been lost.
Conclusion
Sexual desire changes during pregnancy in both the pregnant woman and her partner, decreasing for couples in the first trimester due to the physical discomfort of pregnancy as well as the psychological changes experienced by each partner in the face of assuming the new role of parents. Conversely, desire increases in the second trimester, motivated by an improvement in the physical discomfort typical of early pregnancy and emotional stabilisation, only to decline again in the third trimester. This reduced desire may be due to various reasons, such as the father’s fear of harming the foetus or his partner, or the difficulty in having sexual relations when there is abdominal distension, which leads to a decrease in the coital frequency and, in many cases, to the complete interruption of sexual intercourse.
Healthcare professionals should have a clear understanding of how pregnancy affects the sexual desire of both men and women, as they should provide objective information and clarify any doubts about sexuality during pregnancy. Therefore, pregnancy control visits and childbirth preparation courses allow healthcare professionals involved in pregnancy care to interact with the couple, to advise them (so that they can experience a satisfactory sexuality), and to prevent the appearance of possible sexual dysfunctions due to the changes brought about by pregnancy or to explore interventions and strategies to address it.
Author Contributions
Conceptualization, FF-C, CB-C, AR-N, FR-G, RP-G, JG-S, LR, MV-L, JF-R, and JV-L. Methodology, FF-C, CB-C, AR-N, FR-G, RP-G, JG-S, LR, MV-L, JF-R, and JV-L. Software, FF-C, FR-G, LR, JF-R, and JV-L. Investigation, FF-C, CB-C, AR-N, FR-G, RP-G, JG-S, LR, MV-L, JF-R, and JV-L. Data curation, FF-C, CB-C, AR-N, FR-G, RP-G, JG-S, LR, MV-L, JF-R, and JV-L. Writing—original draft preparation, FF-C, CB-C, AR-N, FR-G, RP-G, JG-S, LR, MV-L, JF-R, and JV-L. Writing—review and editing, FF-C, CB-C, AR-N, FR-G, RP-G, JG-S, LR, MV-L, JF-R, and JV-L. Supervision, FF-C, CB-C, AR-N, FR-G, RP-G, JG-S, LR, MV-L, JV-L. All authors have read and agreed to the published version of the manuscript.
Conflict of Interest
The authors declare that they do not have any conflicts of interest.
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Keywords: pregnancy, sexual desire, pregnant women, sexual partners, sexual dysfunctions, public health
Citation: Fernández-Carrasco FJ, Batugg-Chaves C, Ruger-Navarrete A, Riesco-González FJ, Palomo-Gómez R, Gómez-Salgado J, Rodriguez Diaz L, Vázquez-Lara MD, Fagundo-Rivera J and Vázquez-Lara JM (2024) Influence of Pregnancy on Sexual Desire in Pregnant Women and Their Partners: Systematic Review. Public Health Rev 44:1606308. doi: 10.3389/phrs.2023.1606308
Received: 14 June 2023; Accepted: 21 December 2023;
Published: 19 January 2024.
Edited by:
Sarah Mantwill, University of Lucerne, SwitzerlandReviewed by:
Maribel Carvalhais, Escola Superior de Enfermagem da Cruz Vermelha Portuguesa de Oliveira de Azeméis, PortugalAbbas Ebrahimi-Kalan, Tabriz University of Medical Sciences, Iran
Copyright © 2024 Fernández-Carrasco, Batugg-Chaves, Ruger-Navarrete, Riesco-González, Palomo-Gómez, Gómez-Salgado, Rodriguez Diaz, Vázquez-Lara, Fagundo-Rivera and Vázquez-Lara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
PHR is edited by the Swiss School of Public Health (SSPH+) in a partnership with the Association of Schools of Public Health of the European Region (ASPHER)+
*Correspondence: Juan Gómez-Salgado, salgado@uhu.es