Is sexual intercourse contraindicated after cervical cerclage (cervical stitch) placement?

From the Guidelines

After a cervical cerclage placement, it is generally recommended to avoid sexual intercourse for the duration of your pregnancy or until your healthcare provider advises it's safe, as this can help minimize the risk of infection and other complications that could compromise the cerclage's effectiveness in preventing premature dilation. The primary reason for this restriction is that sexual activity can introduce bacteria into the vagina and potentially lead to infection, which is particularly concerning with a foreign object (the cerclage) in place 1. Additionally, the mechanical stimulation and prostaglandins in semen can potentially trigger uterine contractions or place pressure on the cervix, which could compromise the cerclage's effectiveness.

Key Considerations

• The management of cerclage after previable or periviable preterm prelabor rupture of membranes is similar to cerclage management after preterm prelabor rupture of membranes at later gestational ages, and it is reasonable to either remove the cerclage or leave it in situ after discussing the risks and benefits and incorporating shared decision-making 1.
• There is a lack of consensus surrounding cerclage management after PPROM at any gestational age, and currently, there is only a single randomized clinical trial evaluating the efficacy of cervical cerclage removal after PPROM at 22 0/7 to 32 6/7 weeks of gestation vs expectant management with cerclage retention in situ 1.
• Your doctor may also recommend other activity restrictions such as avoiding heavy lifting (nothing over 10-15 pounds), strenuous exercise, and prolonged standing.
• It's essential to follow all post-procedure instructions carefully and contact your healthcare provider immediately if you experience symptoms like vaginal bleeding, unusual discharge, pelvic pain, contractions, or signs of infection such as fever.

Recommendations for Care

• Avoid sexual intercourse for the duration of your pregnancy or until your healthcare provider advises it's safe.
• Follow all post-procedure instructions carefully.
• Contact your healthcare provider immediately if you experience any symptoms of complications.
• Discuss the risks and benefits of cerclage management with your healthcare provider and incorporate shared decision-making into your care plan.

From the Research

Cervical Cerclage and Sexual Activity

• There is no direct evidence in the provided studies that addresses the question of whether sexual activity should be avoided after cervical cerclage placement.
• The studies primarily focus on the indications, techniques, and outcomes of cervical cerclage for preventing preterm birth and adverse perinatal outcomes 2, 3, 4, 5, 6.
• However, it is generally recommended that women who have undergone cervical cerclage should avoid heavy lifting, bending, and strenuous activities to minimize the risk of complications 2, 6.
• While sexual activity is not explicitly mentioned as a contraindication, it is likely that healthcare providers may advise against it to reduce the risk of disrupting the cerclage or causing other complications, especially in the initial period after the procedure.
• The decision to engage in sexual activity after cervical cerclage placement should be made in consultation with a healthcare provider, taking into account individual circumstances and the specific recommendations for each patient 5, 6.

Management of Cerclage

• The management of cervical cerclage after preterm prelabor rupture of membranes (PPROM) is controversial, with some studies suggesting that cerclage removal may be considered due to the concern for increased risk of maternal morbidity 5.
• The optimal timing of cerclage placement and removal is also a topic of discussion, with guidelines recommending removal at 36-37 weeks in women anticipating a vaginal delivery 2.
• The use of antibiotics, tocolysis, and progesterone after cerclage placement is not recommended, according to the guidelines reviewed in one of the studies 6.

Outcomes of Cerclage

• Cervical cerclage has been shown to be effective in reducing the risk of preterm birth and adverse perinatal outcomes in women with a history of cervical insufficiency or short cervical length 2, 4.
• The placement of cervical cerclage in twin pregnancies with short cervical length or cervical dilatation may be associated with a reduced risk of preterm birth and improved perinatal outcomes 4.