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Coitus late in pregnancy: risk of preterm rupture of amniotic sac membranes.

Ekwo EE1, Gosselink CA, Woolson R, Moawad A, Long CR.

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Coitus with or without orgasm in late pregnancy is inconsistently associated with preterm rupture
of amniotic sac membranes. We tested the hypothesis that during late pregnancy sexual behaviors
including sexual positioning relate to the occurrence of premature rupture of membranes.
Women aged 15 to 45 years having preterm premature rupture of membranes, term premature
rupture of membranes, or preterm delivery without premature rupture of membranes were
matched singly by age, race, and parity to control women delivered of term infants. Information
about six sexual activities, obstetric history, cervical infections, smoking during pregnancy, and
sociodemographic information was obtained by face-to-face interview.
Only the male superior position was significantly associated with preterm premature rupture of
membranes (odds ratio 2.40, 95% confidence interval 1.16 to 4.97) and preterm delivery without
premature rupture of membranes (odds ratio 1.82, confidence interval 1.02 to 3.25) after
confounding variables were controlled for. No sexual positioning or sexual activities related
significantly to term premature rupture of membranes.
Most sexual positions and activities during late pregnancy are not associated with adverse
pregnancy outcomes.
Sexual activity during late pregnancy and risk of preterm delivery.
Sayle AE1, Savitz DA, Thorp JM Jr, Hertz-Picciotto I, Wilcox AJ.

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To examine the association between sexual activity during late pregnancy and preterm delivery.
Women at least 16 years old and carrying singleton fetuses were recruited between 24 and 29
weeks' gestation from prenatal clinics in central North Carolina. They were interviewed by
telephone about sexual activity before and during pregnancy. One hundred eighty-seven women
delivered between 29 and 36 weeks and had a follow-up interview after delivery. Four hundred
nine women who were selected randomly from the cohort served as controls and had a follow-up
interview between 29 and 36 weeks (mean gestational age 39.2 weeks).
Intercourse during late pregnancy was associated with a reduced risk of preterm delivery. The
conditional odds ratio (OR) was 0.34 and 95% confidence interval (CI) 0.23, 0.51 for preterm
delivery within 2 weeks after intercourse. Similar decreased risk for preterm delivery was found
with recent female orgasm. Adjusting for race, age, education, and living with a partner had little
effect on results. Cases were more likely than controls to report poorer health, medical reasons
for reducing sexual activity, less interest in sex, and receipt of advice to restrict sexual activity
during pregnancy. Results did not differ substantially according to presence or absence of
bacterial vaginosis at 28 weeks.
These data provide evidence against the hypothesis that sexual activity generally increases risk
of preterm delivery between 29 and 36 weeks. However, we cannot exclude the possibility that a
small subgroup of susceptible women might have adverse consequences of sexual activity.
Coitus during pregnancy is not related to bacterial vaginosis or preterm birth.
Kurki T1, Ylikorkala O.

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Our goal was to assess the relationship between bacterial vaginosis and sexual intercourse and
the impact of both on preterm birth.
The presence of bacterial vaginosis was assessed in 790 healthy nulliparous women between 8
and 17 weeks' gestation, and they were then asked to record weekly the number of occasions of
sexual intercourse from registration to term. The end point for each was the occurrence of
preterm uterine contractions, preterm birth, or preterm rupture of the membranes.
A total of 407 women returned the specific follow-up charts on vaginal intercourse. Bacterial
vaginosis was detected at registration in 93 of the 407 subjects (22.9%), but the presence or
absence of bacterial vaginosis had no predictive value as regards the frequency of subsequent
intercourse. Of the 39 women (9.6%) who experienced threatened preterm labor, 16 were
delivered before 37 weeks of gestation. In addition, premature rupture of membranes occurred in
48 women (9 preterm and 39 term). The 95% confidence interval for the weekly frequency of
intercourse was calculated for those women delivered at term; a larger (p < 0.05) proportion of
women delivered preterm, with (6/9, 66.7%) or without (13/16, 81.3%) premature rupture of
membranes, had frequencies less than the 95% confidence interval during the second trimester of
pregnancy; the respective proportions were 75.0% (6/8) and 78.6% (11/14) during the third
trimester. Furthermore, among those women who had stopped having sexual intercourse in the
last trimester, a larger (p < 0.05) proportion was delivered preterm (57.1%), with or without
premature rupture of membranes, than was delivered at term (13.6%). In addition, only three
women (18.8%) delivered preterm, with (two women) or without (one woman) premature
rupture of membranes, reported having intercourse within 1 week before the onset of

For healthy nulliparous women, coitus during pregnancy is not related to bacterial vaginosis and
does not predispose to preterm birth.
Sexuality in pregnancy and premature labour.
Georgakopoulos PA, Dodos D, Mechleris D.
The relation of sexual behaviour during pregnancy to the initiation of labour was investigated in
358 patients of whom 58 were delivered after premature labour and 300 were delivered
spontaneously at term. In all patients the mean weekly coital frequency and the frequency of
orgasm were investigated by means of a retrospective questionnaire. There was no significant
difference in coital or orgasmic frequency between the women who had a premature labour and
those who had a spontaneous delivery at term. This was also true when those having premature
labour were divided into those starting labour with ruptured membranes and those starting with
The association of sexual intercourse during pregnancy with labor onset.
Kafaei Atrian M1, Sadat Z2, Rasolzadeh Bidgoly M3, Abbaszadeh F3, Asghari Jafarabadi M4.
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Pregnancy is one of the most critical periods in women's lives. Sexual relationships change in
this period. Monitoring of uterine contractions has been shown increase in uterine activity after
sexual intercourse in pregnant women.
This study aimed to determine the association of sexual intercourse during pregnancy with labor


This cross-sectional study included 120 pregnant women with signs of labor onset at referral
hospitals of Kashan University of Medical Sciences between November and March 2012. Signs
of labor onset included labor pain, bloody show, or rupture of membrane. Subjects were
investigated in two groups regarding history of coitus in the last week of pregnancy. A
questionnaire containing demographic questions, obstetrical history, and sexual activity was
completed by trained midwife through face-to-face interview. Chi-square test, Fisher's exact test,
and t-test were used to check the homogeneity of the two groups for basic and confounding
variables. Independent-samples t-test was used to compare differences between groups in terms
of mean gestational age.
There was no significant difference between groups in age (P = 0.434), body mass index (P =
0.705), neonatal weight (P = 0.421), maternal education (P = 0.963), occupation (P = 0.381), and
parity (P = 0.925). Gestational age at the time of delivery was significantly lower in intercourse
group in comparison with control group based on last menstrual period (P = 0.012) and
ultrasonography (P = 0.002). There was no correlation between intercourse and cause of
admission (P = 0.720). Type of delivery (cesarean section or vaginal delivery) was not affected
by intercourse (P = 0.820) or contact with semen (P = 0.841). Results showed no significant
difference in neonatal weight based on presence of sexual intercourse (P = 0.422) or contact with
semen (P = 0.583) at the last week of pregnancy.
Sexual activity in last week of pregnancy might be associated with the onset of labor. Therefore,
in the absence of complications in term pregnancy, sexual activity can be considered as a natural
way to prevent post term pregnancy.
Effect of coital activity on onset of labor in women scheduled for labor induction: a randomized
controlled trial.
Tan PC1, Yow CM, Omar SZ.

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To estimate the effect of coitus on the onset of labor.
Women with a nonurgent labor induction at term were recruited. Women randomly assigned to
the advised-coitus group were encouraged to have sex to promote the onset of labor. Controls
were neither encouraged nor discouraged regarding coitus. Participants kept a coital and orgasm
diary until delivery, and standard obstetric care was provided to both groups. Primary outcomes
were reported coitus and spontaneous labor. Secondary outcomes included reported orgasms,
initial Bishop score at the admission for induction, preterm rupture of membranes, use of
dinoprostone, oxytocin, or epidural, meconium-stained amniotic fluid, cesarean delivery,
maternal fever, and neonatal morbidity.
One hundred eight and 102 women randomly assigned to advised-coitus and control groups,
respectively, were available for analysis. Women assigned to the advised-coitus group were more
likely to report coital activity before delivery (60.2% compared with 39.6%, relative risk 1.5,
95% confidence interval 1.1-2.0; P=.004), but the spontaneous labor rate was no different (55.6%
compared with 52.0%, relative risk 1.1, 95% confidence interval 0.8-1.4; P=.68). Cesarean
delivery rate and neonatal and other secondary outcomes were also not different.
Among women scheduled for labor induction who were advised to have sex, the increase in
sexual activity did not increase the rate of spontaneous labor.
Human ejaculate. Effects on the biomechanical properties of the human chorioamniotic
Harmanli OH1, Wapner RJ, Lontz JF.

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To determine the effects of human ejaculate on the biomechanical properties of the human
chorioamniotic membranes.
Equivalent strips of chorioamniotic membranes were obtained from 30 term, uncomplicated
pregnancies immediately after delivery and incubated for 0, 1 and 24 hours with either ejaculate
or pseudoamniotic fluid. Three biomechanical properties--rupture tension, strain to rupture and
work to rupture--were compared.
One hour of incubation with pseudoamniotic fluid alone did not significantly change the
membrane biomechanical parameters, but these parameters were reduced after one hour of
exposure to ejaculate (P < .05). Twenty-four hours of incubation decreased all three properties in
both the ejaculate and control groups without any significant difference between the two groups.
In vitro exposure to human ejaculate for one hour significantly weakens the human
chorioamniotic membranes.
Coitus and chorioamnionitis: a prospective study.
Naeye RL, Ross S.
Amniotic fluid infections have been strongly associated with coitus during pregnancy. If the
relationship is causal it may be possible to identify a time sequence between coitus, penetration
of bacteria through the mucous plug in the cervix, the development of infection in the
extraplacental membranes near the cervical os, spread of the infection to the amniotic fluid and

complications of the infection. The present study looked for such a sequence in an analysis of
541 pregnancies. A peak frequency of chorioamnionitis limited to the extraplacental membranes
was present when labor and delivery took place within two days of the last coitus. In the next
two days the infection spread to the amniotic fluid as evidenced by a peak frequency of maternal
neutrophils migrating through the placental plate toward the amniotic cavity. Premature delivery
was 4 times more frequent when there had been recent coitus and an amniotic fluid infection was
present than when either factor was absent (P less than 0.01). Spontaneous rupture of the fetal
membranes before the onset of and the membranes were inflamed than when these factors were
absent (P less than 0.01). This raises the possibility that orgasm further weakened or ruptured
membranes that had already been weakened by infection.
Effect of prostaglandin and seminal fluid on human chorioamniotic membranes