I’ve been diagnosed with a complete placenta previa (at 20 weeks), and it is continuing while at 26 weeks now. I was put on full pelvic rest by my perinatologist, and while I understand the seriousness of the potential outcomes of this condition, my husband and I can’t seem to find any tangible information about why this is the case. I’m asking for selfish reasons — I miss the intimacy with my husband, and I’ve been feeling great during my second trimester, so I’m reluctant to let it go by as I move closer to the third trimester, when I will inevitably be bigger, more tired, and feeling less like having sex or engaging in intimate activities. But what are the real risks involved with sexual activity, even non-intercourse, for this condition?
I should also add that we conceived via IVF, so in general we are being very cautious during this pregnancy given our difficulties to get here, but this is one area where I personally feel a real impact to my (and my husband’s) quality of life, and there doesn’t seem to be much evidence to support it.
—Anonymous
Placenta previa is a condition in which the placenta is situated over the cervical opening, either partly or fully. The major concern with the condition is bleeding — if it persists until delivery, you will need a cesarean section, since a vaginal delivery would be extremely dangerous to you and the baby. The main concern during pregnancy is also severe bleeding.
Before we get into sex: let’s briefly touch on the resolution of this condition. Because of uterine and fetal growth, placenta previa that is diagnosed early in pregnancy is very likely to resolve. Among those who are diagnosed at 20 weeks, about 90% resolve by the time of delivery. If the previa persists to 26 weeks, as yours has, there is still about a 50% chance that it will resolve before delivery. When someone still has previa at 32 weeks, doctors then begin to assume that it will be present at delivery (and they will plan a C-section).
The concerns about bleeding mean that there are a number of restrictions put on behavior. You will not get digital cervical exams, where a doctor sticks their gloved fingers through the cervix to measure dilation. In addition, there is a recommendation of no sex. The concern here is twofold. First, sex can lead to uterine contractions, which might prompt bleeding. Second, the penetration of the penis could effectively bump up against the cervix, leading to bleeding. Unfortunately, the restrictions here extend to any sex leading to orgasm for you, due to the uterine contractions.
There is no actual data suggesting whether this happens and how often. The recommendation is based on theory and extrapolation from the dangers of digital exams through the cervix.
This is a complicated one — I hear you about second-trimester sex — but there is some biological basis for this restriction. But no actual evidence.
What to do? I can’t tell you! What I will leave you with is that you can have intimacy without sex, and maybe this is an opportunity to explore that. Also, your husband can have orgasms. I don’t know if that’s especially comforting, though. Where’s the equality? I’m hoping for you that the previa resolves by the next ultrasound and that the third trimester is full of fun.
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