Sexual problems associated with infertility, pregnancy, and ageing
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7465.559 (Published 02 September 2004) Cite this as: BMJ 2004;329:559
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We read with great interest the clinical review on ABC of sexual
health which is informative and educational.
We are however concerned with one of the sections which lists the
indications for abstaining from intercourse in pregnancy.
The author states that intercourse in multiple pregnancy is
contraindicated.We are surprised by this as our experience in this group
of women is that they need not abstain from intercourse in the absence of
pregnancy complications like placenta praevia,ruptured membranes or
premature dilatation of cervix.
Indeed a published report supports this view.1
We therefore would like to bring this to the notice of all health care
advisors that intercourse need not be discouraged in women with
uncomplicated twin pregnanacies.
Reference
1.Neilson JP,Mutambira M.American Journal of obstetrics and
Gynecology.1989 February;160(2):416-8.
2.British Medical Journal 2004;329:559-561(4 September)
Competing interests:
None declared
Competing interests: No competing interests
Editor
Read gives six contraindications to intercourse during pregnancy in
the ABC of sexual health 1. However there is very little evidence to
support some of these recommendations. Elsewhere in the article she
states that it is a myth that intercourse causes miscarriage, premature
labour or fetal damage. Several studies have shown intercourse to be safe
during pregnancy and not related to an increase in perinatal mortality or
premature delivery 2,3. It therefore would seem unreasonable to recommend
that women with multiple pregnancy or a history of premature delivery
should be advised to abstain throught their pregnancy.
Women and their partners are known to have concerns regarding
complications of pregnancy as a result of sexual activity 4. It is
important that women, and their doctors, are reassured that sexual
intercourse is not associated with an adverse outcome.
1 Read J. Sexual problems associated with infertility, pregnancy, and
ageing. BMJ. 329: 559-561
2 Klebanoff MA. Nugent RP. Rhoads GG. Coitus during pregnancy: is it
safe? Lancet. 2(8408):914-7, 1984 Oct 20.
3 Mills JL. Harlap S. Harley EE.Should coitus late in pregnancy be
discouraged? Lancet. 2(8238):136-8, 1981 Jul 18
4 Bartellas E. Crane JM. Daley M. Bennett KA. Hutchens D. Sexuality
and sexual activity in pregnancy. BJOG: an International Journal of
Obstetrics & Gynaecology. 107(8):964-8, 2000 Aug.
Competing interests:
None declared
Competing interests: No competing interests
While constructive psycotherapy can be very helpful, anorexia and
bulimia tend to be regarded by therapists as related to sexual abuse or
hang ups from parental mismanagement. In fact many suffers are dyslexic,
which is usually ignored. There are genes increasing susceptibility to
both dyslexia and anorexia. Suffers from either condition are likely to be
zinc deficient , have copper zinc problems, malabsorption etc - all of
which interferes with brain function and is usually undiagnosed, and
untreated. Zinc, magnesium and essential fatty acid deficiencies are a
major cause of polycystic ovaries which also cause infertility in anorexia
and bulimia. Like becoming vegetarian, many women become anorexic or
bulimic when using oral contraceptives. Maternal use of hormones just
before or during pregnancy is also a suspect cause of the increases in
these conditions in young women.
Among my infertility patients, thyroid disease is uncommon but
nutritional deficiencies are virtually universal.
Competing interests:
None declared
Competing interests: No competing interests
Read mentions changes in body image/shape in preganancy which can be
an anxious time for women. However for many women with a history of
anorexia nervosa (and indeed other eating disorders) they have
difficulties with body image and sexuality. Infertility is a major risk in
anorexia nervosa and despite knowing this continues to have a high
mortality rate. it is very important that women seeking treatment for
infertility are assessed properly and sensitively for eating disorders. I
run an eating disorders support group and many women talk of secret
bulimia that no one knows about or the infertility risk and their
anxieties associated with this. there are women with eating disorders who
have a history of sexual abuse and find intercourse and sexual
relationships difficult as a result. this cannot be ignored by infertility
teams yet it is ignored on many occasions as when asked about whether a
woman has any eating issues or problems with food behaviour it is not
disclosed.However if a woman or in fact a man presents with a low or high
BMI then the reasons for that BMI need to be thought about a bit more if
it is not a dysfunctional thyroid problem.Some women may have a normal BMi
and still have an eating disorder however that is another issue and eeds
careful handline as well, as chronic bulimia has infertility
implications.sensitivity is the key however until those fears, anxieties
and realities of those affected are addressed women will continue to cost
the State a lot of money in unnecessary investigations and treatment and
go through unnecessary lengthy, uncomfortable invasive procedures..
Competing interests:
None declared
Competing interests: No competing interests
Editor - I am surprised that a sex relation therapist Jane Read still
assumes women should be taking HRT or using oestrogen cream.1 The
randomised controlled Women’s Health Initiative HRT study results found
increases in strokes, dementia, heart attacks, breast cancer and
endometrial cancer with HRT. The decline in cognitive function with both
progesterone-dominant and oestrogen-alone HRT is even mentioned in today’s
POEM.2
The first story line for last night’s new GP soap on ITV was about
two men consulting the GP because of gynaecomastia. The woman they were
both having intercourse with was overdosing on vaginal oestrogen cream.
In reality the woman would also have had endometrial hyperplasia and
irregular bleeding, which is why oestrogen cream is not to be prescribed
to a woman with an intact uterus.
The contents of this Clinical Review remind me of the course in
Psychosexual Medicine which I attended in the 1960s. The psychotherapist
apparently had no knowledge of the importance of relevant biochemical
investigations. I was so unimpressed I organised some research and found
that loss of libido and depression with progesterone dominant/ low dose
oestrogen oral contraceptives related to high endometrial and platelet
levels of monoamine oxidase.3
Read still dwells mentions the same comical anatomical anecdotes but
does not mention the best known aphrodisiac – oysters, which are
exceptionally high in zinc. Exogenous hormones also cause zinc deficiency
and raise copper levels. Zinc and magnesium deficiencies are major causes
of unexplained infertility, pregnancy complications and loss of libido and
vaginal dryness.4 Zinc deficiency causes blocks in essential fatty acid
pathways which also causes dry skin and mucous membranes. Progesterones in
particular cause endometrial atrophy, vaginal dryness and dyspareunia.5
The women most likely to be referred to me for sexual dysfunction are
usually 20 year olds who have been taking progesterone-dominant
contraceptives since their teens.
The commonest causes of unexplained infertility and recurrent
miscarriages are nutritional deficiencies and undiagnosed infections in
the hundreds of preconception couples I have assessed. It is about time
Psychosexual Medicine evolved into using biochemical and microbiological
tests.
1 Read J. Sexual problems associated with infertility, pregnancy, and
ageing.BMJ 2004; 329: 559-561
2 POEM*: Postmenopausal oestrogen does not improve cognitive
function. BMJ 2004;329, doi:10.1136/bmj.329.7465.0-f
3 Grant ECG, Pryce Davies J. Effect of oral contraceptives on
depressive mood changes and on endometrial monoamine oxidase and
phosphatases. BMJ 1968; 3: 777-80
4 Grant ECG. Nutritional supplements to prevent pregnancy
complications.http://bmj.com/cgi/eletters/329/7458/152#67502, 16 Jul 2004
5 Grant ECG. Biochemical and microbiological investigations needed
for female dyspareunia. http://bmj.com/cgi/eletters/328/7452/1357#61807, 4
Jun 2004
Competing interests:
None declared
Competing interests: No competing interests
Re: Sexual problems associated with infertility, pregnancy, and ageing
Simple instruction on sexual activity in pregnancy in the view of Traditional Persian medicine
Roshanak Mokaberinejad, Ghazaleh Heydarirad
Assistant Professor, Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
In recent decades a great part of maternal commands in pregnancy contain recommendations on activities, habits, intercourse, diet and hygiene. A great amount of this advice is unreliable, and possibly causing harm as well as good (1).
Traditional Persian medicine (TPM) or Traditional Iranian Medicine, as a several thousand year old medical practice, has had valuable experiences in the field of pregnancy and maternal lifestyle, which have been noted by prominent Iranian scholars such as Rhazes and Avicenna (2). Since there are notable controversies in the results of recent controlled trials, reviews of historical manuscripts on medical science authored by Persian scholars provide valuable information in the field of pregnancy. Sexual activity in pregnancy is meticulously stipulated with simple recommendations in TPM. These advices will be minimized the hazards of intercourse like cervical dilatation, stimulation of the fetus, and miscarriage in pregnancy (3). Because of the emotional and physical motivation in sexual activity, it should be done with some limitations in pregnancy, especially in high-risk cases. Recommendations can be categorized into four simple and major groups:
1. All relations or contacts are to be restricted, particularly in the first trimester and last trimester of pregnancy, and are strictly forbidden whenever there is a tendency to abortion.
2. Too much sexual relations should be avoided, particularly in early and late pregnancy and also in the first pregnancy.
3. If intercourse is done, full penetration should be avoided and intense movements during intercourse should be omitted.
4. Sexual intercourse should be severely prohibited during the last months of gestation (3, 4).
References
1. Bryce RL, Enkin MW (1984). Lifestyle in pregnancy. Can Fam Physician, 30: 2127.
2. Shahabi S, Hassan ZM, Mahdavi M, et al. Hot and cold natures and some parameters of neuroendocrine and immune systems in traditional Iranian medicine: a preliminary study. J Altern Complement Med. 2008;14:147-156
3. Avicenna. Canon of medicine. 1st edition. Vol 3. Lebanon: Darelhilal Institute; 2009.
4. Aghili Khorasani MH. Kholasat Al-Hekmah. Nazem E, ed. Tehran, Iran: Institute of Medicine History Studies, Islamic and Complementary Medicine; 2009.
Competing interests: No competing interests