Is sexual intercourse safe during the first trimester in a healthy woman with no bleeding, no history of preterm labor, no placental abnormalities, no cervical insufficiency, no uterine anomalies, and no transmissible infections?

Sexual Intercourse in Early Pregnancy is Safe

In a healthy woman with an uncomplicated first trimester pregnancy (no bleeding, no history of preterm labor, no placental abnormalities, no cervical insufficiency, no uterine anomalies, and no transmissible infections), sexual intercourse is safe and poses no increased risk to the pregnancy or fetus. 1, 2

Evidence Supporting Safety

The most recent high-quality cohort study from 2019 demonstrated that sexual intercourse during pregnancy—including the first trimester—had no significant impact on any obstetric or neonatal outcomes when compared to women who abstained from intercourse 1. This study examined 406 women and found that the experience, frequency, and timing of sexual intercourse throughout pregnancy showed no association with adverse outcomes 1.

A 2019 systematic review and meta-analysis of randomized controlled trials (1,483 women) confirmed that in low-risk singleton pregnancies at term, sexual intercourse is not associated with preterm birth, premature rupture of membranes, or low birth weight 2. While this study focused on term pregnancies, the findings reinforce the safety profile established for earlier gestational ages.

Common Concerns and Misconceptions

Despite the evidence of safety, many women harbor concerns about sexual activity during pregnancy:

• 49% of pregnant women worry that intercourse may harm the pregnancy 3
• Common fears include: causing fetal injury, miscarriage, fetal infection, membrane rupture, bleeding, or preterm labor 4
• These concerns are not evidence-based in uncomplicated, healthy pregnancies 1, 2

Clinical Communication Pitfalls

A critical gap exists in patient counseling:

• Only 29% of women discuss sexual activity with their physician during pregnancy 3
• 49% of those discussions are initiated by the patient, with 34% feeling uncomfortable raising the topic 3
• 76% of women who haven't discussed these issues believe they should be addressed 3

Clinicians should proactively initiate conversations about sexual activity during prenatal visits rather than waiting for patients to raise concerns 3.

Screening Requirements During Pregnancy

While sexual activity itself is safe, pregnant women should be screened for sexually transmitted infections that could affect the pregnancy 5:

• Syphilis serology at first prenatal visit (repeat in third trimester for high-risk patients) 5
• Gonorrhea testing at first visit for at-risk women or those in high-prevalence areas 5
• Chlamydia testing in third trimester for women under 25 or with multiple partners 5
• HIV testing offered to all pregnant women at first visit 5

When to Restrict Sexual Activity

The evidence does not support routine sexual activity restrictions in uncomplicated pregnancies 6. However, expert opinion suggests considering restrictions in specific high-risk conditions, though the evidence base for these recommendations is limited 6:

• History of preterm delivery
• Shortened cervix or cervical insufficiency
• Presence of cerclage
• Premature rupture of membranes
• Placental abruption or placenta previa
• Active vaginal bleeding

Your patient scenario explicitly excludes all these high-risk conditions, making sexual activity safe 1, 6, 2.

Practical Counseling Points

• Sexual desire commonly decreases during pregnancy (58% of women report this) 3
• Vaginal intercourse and overall sexual activity typically decrease as pregnancy progresses 3
• These changes are normal and do not indicate a medical problem 3
• Partners should be reassured that sexual activity will not harm the baby or pregnancy in uncomplicated cases 1, 2