Sexual Activity Recommendations in High-Risk Pregnancies: What is the Evidence?

Background: While sexual activity in normal, healthy pregnant women is safe, concern regarding elements of the sexual act have led to restrictions in pregnancies experiencing complications that are frequently insufficiently addressed in clinical practice. Aim: To comprehensively review the literature for evidence that supports or refutes specific sexual activity restrictions in high-risk pregnancy conditions. Methods: A search of PubMed, MEDLINE, Ovid, UpToDate, Google Scholar, and Google for relevant publications related to any aspect of sexual activity affecting high-risk pregnancies complicated by history of pre-term delivery, shortened cervix, presence of cerclage, pre-mature rupture of membranes, placenta abruption, placenta previa, multiple gestation, or history of classical cesarean section was performed. Outcomes: The scientific evidence on the pathophysiology of sexual activity and specific high-risk pregnancies, and their interaction. Results: Despite expert opinion restricting sexual acts or intercourse, there are minimal published data that specifically address sexual activity in high-risk pregnancies. Conclusions: Clinicians need to engage in conversations regarding specific sexual activity for patients experiencing complications in pregnancy. Recommendations for or against restricting sexual activity should be based on evidence-based guidelines. Significant advances in this area of obstetrics are necessary to make validated recommendations. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.