Sexuality

The word sexuality is scattered liberally throughout contemporary sexual health literature, but the text frequently fails to explore what sexuality actually means. The word itself did not come into being until the modern era, and many authors are reluctant to confine it to a simple definition. This may well be because sexuality is fundamentally dynamic. It has different meanings culturally, its definition changes throughout history, and an individual’s feelings and values concerning their sexuality alter as they gain more life experience.

Lion (1982:8) embraces sexuality as a concept that is open to transmutation as ‘all those aspects of the human being that relate to being a boy or girl, woman or man, and is an entity subject to lifelong dynamic change. Sexuality reflects our human character not solely our genital nature.’ This definition alone demonstrates clearly that sexuality is more than overt sexual behaviour encompassing the complete range of human experience (Pratt 2000). A more recent definition, courtesy of the Royal College of Nursing (RCN 2000, cited on contents page), states that sexuality is: ‘an individual’s self concept, shaped by their personality and expressed through a heterosexual, homosexual, bisexual or transsexual orientation’. This definition may reflect a more contemporary view of sexuality.

The word ‘sex’ is usually employed to mean the act of having sex or to distinguish between the ‘sexes’ – that is, male or female. Gender is the name given to socially and culturally defined characteristics of the sexes – that is, masculinity and femininity.

Puberty and teenage pregnancy

Please see website and Chapters 19, 23 and 32 for more information.

Sex during pregnancy

Sex during pregnancy has historically been shrouded in myth, misconceptions and old wives’ tales. The advice offered during traditional British antenatal care has been one of abstention, without any evidence to substantiate this stance.

During pregnancy, many couples are fearful of continuing their sexual relationship. They may feel that they may somehow provoke miscarriage, premature labour or damage the fetus; some men have expressed fear of breaking the ‘bag of waters’ (Kitzinger 1985). Couples can be reassured that this is not the case.

The overriding message from most well-conducted studies is that sex during pregnancy for the vast majority of women is safe and does not lead to any increase in complications (Enkin et al 2000), though male superior position (Ekwo et al 1993) and a vagina colonized with specific micro-organisms, for example Trichomonas vaginalis (Read & Klebanoff 1993), have both been associated with preterm birth. More studies are required in this area to provide definitive results. The National Institute for Clinical Excellence (NICE) (2003) antenatal care guidelines stated that health professionals can inform healthy pregnant women that sexual intercourse during pregnancy is not known to be associated with any adverse outcomes.

There are a few definite or relative contraindications to different sexual practices or sexual intercourse during pregnancy. Forceful blowing of air into the vagina during oral sex is an absolute contraindication, as this may lead to fatal air embolism (Aston 2005, Lumley & Astbury 1989). The insertion of a foreign body into the vagina may cause damage to the internal structures and introduce infection (Walton 1994). Placenta praevia, vaginal bleeding, history of premature birth and rupture of membranes are often cited as clinical reasons to avoid sex during pregnancy (Aston 2005).

Whilst sex can be enjoyed by couples throughout the whole of pregnancy, other factors may play an important role. Change of body image (see website), tiredness, breast changes, backache and frequency of micturition are some of the things that can affect a pregnant woman’s sexuality (Aston 2005). There are many accounts that give a very negative view of sexuality and pregnancy. Kitzinger (1985) states that some women have a distorted view of their bodies during pregnancy, they feel bigger than they really are and think that their partners must find them ugly when in fact the partners often delight in pregnant women and find their physical changes exciting and beautiful.

Conversely, some women have a very positive ‘body image’ during pregnancy. They feel incredibly attractive and womanly. It is viewed as the ultimate expression of femininity and an eminently powerful symbol of potency and fertility.

Physiological hormonal changes during pregnancy mean that oestrogen and progesterone act together to procure marked pelvic vasocongestion, which occurs as a result of increased vascularity and venous stasis. The results can mean a heightened manifestation of all aspects of sexual intercourse, including orgasm (Aston 2005). For some, this may be the first time that they experience orgasm (Walton 1994). For others, however, vasocongestion may predispose the woman to discomfort during sexual intercourse (Aston 2005).

It is often assumed that there is a linear decrease in sexual activity as pregnancy progresses, but for some women sexual activity may well increase during the second trimester. This may be due to the disorders of pregnancy subsiding and the woman developing a sense of wellbeing. However, it is also well recognized that sex diminishes during the third trimester (Frohlich et al 1990), most probably due to the discomfort and mechanics of having sex with a greatly enlarged abdomen. Alternative positions to the missionary position, such as the man behind the woman or ‘spooning’, or the woman sitting or kneeling on top of the man, could be explored.. Other non-penetrative options such as self or mutual masturbation, oral sex, fondling or massage or purely kissing and cuddling may also be adopted (Walton 1994).

It is suggested that having sexual intercourse may be an alternative to other methods of induction, the theory being that sperm is rich in prostaglandins, thereby providing a stimulus for ripening the cervix. However, to date, this has been poorly evaluated, and more research is required in this area (Kavanagh et al 2001).

Overall, keeping clear channels of communication open is the most important aspect of maintaining an intimate sexual or non-sexual relationship.

Sexuality and labour

Labour is usually synonymous with anxiety, discomfort and pain. It is not often viewed as being a ‘sexual’ experience. It is clear when reading literature in this area that for some women and their partners it can be an intensely pleasurable and sexual experience. The sounds a woman makes during contractions, the organs that are used in the process of childbirth, the overwhelming energies and powers that are at work during labour, are all intimately related to sex and sexuality (Aston 2005, Gaskin 2002, Kitzinger 1985, Williams 1996). Kitzinger (1985:210) describes it thus: ‘the most intensely sexual feeling a woman ever experiences, as strong as orgasm, even more compelling than orgasm’. In her book Spiritual midwifery, Gaskin (2002) quotes a number of experiences of the sexual nature of childbirth. One woman recounts her birth experience with her husband: ‘My rushes (contractions) hardly felt heavy at all, but I knew they must be because I was opening up. We just kept making out and rubbing each other. We got to places that we had forgotten we could get to… going through the birthing I felt his love very strong. It was like getting married all over again’ (Gaskin 2002:53). Rabuzzi (1994)

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