The aim of the present study was to examine sexual behavior during gestational using the Pregnancy Sexuality Questionnaire (PSQ). The degree of sexual satisfaction, preferences and changes in sexual habits were examined in individuals during pregnancy. The hypothesis was that physiological, emotional, and behavioral changes during gestation interfere with levels of desire, excitement, and sexual satisfaction compared to pre-pregnancy.

This descriptive cross-sectional study was conducted between July and November 2021 using an online questionnaire. Participants were recruited using snowball sampling from pregnancy groups on social media, e-mail, WhatsApp, and personal contact. The inclusion criteria included pregnant individuals who were in the third trimester of pregnancy with an active sex life who agreed to participate in the study. The exclusion criteria were high-risk pregnancy, psychological disorders, and those undergoing cancer treatment. The consent form was signed by all participants signed prior to study commencement. The Pregnancy Sexuality Questionnaire (PSQ), validated in Portuguese (Savall et al., 2008), was administered and completed by each participant. The PSQ is a semi-structured assessment instrument, divided into two parts with open and closed questions. The first part includes questions on sociodemographic data, health history, lifestyle habits, and obstetric history. The second part evaluates individual sexuality by comparing the pre-pregnancy to gestational period in the areas of self-perception, frequency of sexual activity, preferred sexual positions, sexual desire and satisfaction. Additionally, questions pertaining to orgasm, discomfort during intercourse, and ability to approach healthcare professionals on sexuality are also included in the survey. Data were analyzed in Microsoft Excel (16.42, 2020) and were expressed as percentages and frequencies.

A total of 30 participants were recruited from Brasilia, Brazil. Ten were excluded; due to a high risk pregnancy (n=9) and psychological disorders (n=1). Of the remaining sample (n=20), 35% had a University degree, 55% were married, 50% planned the pregnancy, and 45% had desired to get pregnant, although it was unplanned. Over a third of participants (35%) had been in a relationship with their present male partner for 5 to 10 years.
Sexual behavior data are presented in Table 1. Interestingly, a high response rate was noted for questions pertaining to the first and second trimesters, compared to low response rate for questions pertaining to the third trimester. Prior to pregnancy, 45% did not discuss sexuality with health professionals, 30% discussed sexuality within the first trimester, 20% in the second trimester, and no one reported discussing it in the third trimester. Before becoming pregnant, 50% of the participants reported that sexual intercourse was initiated by both parties. During the first trimester, participants reported their partners initiated intercourse 30% more often. 
Positions adopted during sexual intercourse are illustrated in Table 1 and reported as frequencies.
Sexual response and function data are listed in Table 2. A scale ranging from 0 to 10 (0=poor and 10=excellent), was used to rate arousal, vaginal lubrication, sexual satisfaction, orgasm intensity, and discomfort with intercourse. Prior to pregnancy, sexual arousal received a score of 8 by 35% of individuals, while another 35% scored 6 in the first trimester, 40% scored 2 in the second trimester, 40% scored 2 in the third trimester, while 40% did not respond. When classifying vaginal lubrication, 35% reported 8 or 10 before pregnancy, 40% reported 6 in the first trimester, 25% reported 3, 6, 8 or 10 each in the second trimester, 15% reported 6 in the third trimester, while 60% were non-responsive in the third trimester. Sexual satisfaction was rated a 10 by 40% of participants before pregnancy and 30% in the first trimester, respectively. Sexual satisfaction scores were not reported by 40% in the second and by 65% of individuals in the third trimesters; however, 20% of respondents rated it a 10 in the second trimester, while 10% had a combined rating of 3, 7, or 10 in the third trimester. Eighteen individuals (90%) reported having the ability to orgasm. Before pregnancy, 55% scored orgasm intensity at 8. Interestingly, orgasm intensity had a high non-response rate across first, second and third trimesters (35%, 55%, 70%, respectively). The second highest score was 5 (25%) and 3 (20%) in the second and third trimesters, respectively. Finally, when analyzing questions pertaining to sexual pain or discomfort, 60% reported no pain in the pre-pregnancy period. When asked about sexual pain or discomfort during pregnancy, the majority of our sample were non-responsive across first, second and third trimesters (80%, 75%, 90%, respectively). Of those that responded, 20% reported sexual pain/discomfort in the first trimester, 25% in the second trimester, and 10% in the third trimester.

This study illustrates a decrease a woman’s sexual behaviours, response, and function throughout pregnancy compared to pre-pregnancy. A linear decline in sexual arousal and orgasm intensity occurred over the course of gestation, while vaginal lubrication and sexual satisfaction levels decreased primarily in the third trimester. Participants did not experience pain during sexual intercourse prior to pregnancy; however, pain with intercourse increased, depending on the sexual position. Before pregnancy, less than 50% of individuals discussed sexuality with their health professionals, and this percentage continued to decrease as pregnancy progressed. A limitation of the present study is the small sample size and high non-response rate. Future research should be encouraged with this population using specific questionnaires to access emotional, myths, and behavior of women and their partner during pregnancy. All data cited is in accordance with the study by Grussu, Vicini and Quatraro (2021), and the authors reinforce that health professionals need to provide more accurate and reliable information.

Pregnancy represents a phase of major emotional, physiological, physical, and social changes in romantic relationships and sexual partnerships. Future research should seek to identify the possible influences and interferences of pregnancy-related sexual responses, behaviors, and beliefs from the individual and their romantic relationships. It is important that health professionals discuss sexual issues with pregnant people, as sexuality is an important aspect of a person’s health and well-being during the gestational period.

Grussu, P., Vicini, B., Quatraro, R. M. (2021). Sexuality in the perinatal period: A systematic review of reviews and recommendations for Practice. Sexual & Reproductive Healthcare, 30. https://doi.org/10.1016/j.srhc.2021.100668
Savall, A. C. R., Mendes, A. K., Cardoso, F. L. (2008). Perfil do comportamento sexual na gestação. Revista Fisioterapia em Movimento, 21(2), 61-70. https://pesquisa.bvsalud.org/portal/resource/pt/lil-528926

Continence 12S (2024) 101651
DOI: 10.1016/j.cont.2024.101651