Sexual behaviour during pregnancy in suburban women in southwest Nigeria

AI Isawumi Oboro VO

Department of Obstetrics & Gynaecology LAUTECH Teaching Hospital, Osogbo. Nigeria.

Key words: pregnancy, sexual behaviour, culture

Introduction
Sexual activity in pregnancy can be greatly influenced by cultural, social and religious beliefs as well as the physical and psychological changes of pregnancy. Anxieties and fears of complications in pregnancy from sexual intercourse also have some effects on the sexual behaviour in pregnancy. Ignorance, old wives’ tales and some times inappropriate medical advice compound such fears. Many studies on sexuality in pregnancy have yielded conflicting reports such as sexual activity being a contributory factor in Premature Rupture of Membranes (PROM) or premature labour. The majority of these reports involved women in industrialized society where sexual liberalism occurs (1-5) and may not be representative of what occurs in other cultures. Although sexuality has been implicated in premature rupture of membranes (6), but other studies have not confirmed this (7). The main objective of this study is to investigate the patterns of sexual behaviour in pregnancy vis-à-vis the beliefs and fears of pregnant women in relation to their sexuality during all the three trimesters. In addition, the sources of information with regard to sexual behaviour in pregnancy will be determined.

Methods:
This cross-sectional study was conducted between June 2001 and July 2002 at LAUTECH Teaching Hospital, Osogbo, a semi-urban area of South Western Nigeria. Semi-structured questionnaires were administered to women six to twenty-four hours after delivery once verbal consent was obtained. The same questionnaire was used to interview those who were not literate enough to fill them by two well-tutored interns. Excluding their names ensured the confidentiality of those women.

The indices in the questionnaires included socio-demographic details, sexual behaviour and pleasure during pregnancy compared with pre-pregnancy, complications, beliefs, and sources of information in regarding to sexual activity in pregnancy. Any woman who was advised by her physician to avoid sexual intercourse for medical reasons such as threatened abortion, ante partum haemorrhage and cervical cerclage insertion was excluded from the study. Analysis of data was with SPSS 10.0 for Windows (SPSS Inc. Chicago, Illinois,USA) using descriptive statistics and comparisons were made between the trimesters of pregnancy. Multiple logistic regression analyses were performed to assess the association of a variety of factors with a number of outcomes relating to sexuality in pregnancy.

Results:
The demographic characteristics of all the 550 women who participated in the study are summarized in Table 1. Among these women, 7.3% of them did not practice any form of sexual activities in pregnancy (40/550). This was due to various socio-cultural taboos (35%) and the fact that their husbands were not living in the same place with them (65%). There was reduction in the mean frequency of sexual activities during pregnancy (1.3 times/week) when compared with pre-pregnancy (2.5 times/week) period. The mean frequency of sexual activities especially vaginal intercourse also decreased as the pregnancy advanced particularly in the third trimesters (P=0.008).This and other aspects of sexuality in pregnancy are shown in Table 2. Out of all the patients studied, 410 practiced vaginal intercourse and among this subgroup, 264 (64.4%) expressed various forms of fears and anxieties. These are summarised in Table 3. The various types of sexual activities practiced during pregnancy are shown in Table 4. The perceived advantages of sexual activities and women’s source of information are summarized in Tables 5 and 6. respectively. Multiple logistic regression was used to determine if multiple factors such as maternal age, parity, educational level, religion, occupation and trimester of pregnancy have influence on the sexual activities during pregnancy. The only significant factor was the trimester of pregnancy especially on vaginal intercourse (P<0.001). The influence of sexual intercourse on gestational age of delivery was not statistically significant (P=0.749). About one in ten of women changed their positions for sexual intercourse during pregnancy from front to back or side whereas 47.1% used the missionary position (front) throughout. All women who complained of discomfort (15.2%) used front position only.

Discussion:
In this study, sexual activity especially vaginal intercourse progressively decreased through pregnancy. This observation has been reported by some early studies (5,9) but contradicts the findings in others(1,4). This may be due to physical and psychological changes in pregnancy as well as fears and concerns that sexual intercourse may cause obstetric complications. The belief that sexual intercourse can lead to premature labour or prevent prolonged pregnancy was not substantiated in this study just as was reported by the previous studies (6,11). Sexual positioning was found not to have influence on the gestational age of delivery. This was in agreement with the work done by Ekwo et al (6,11). In a similar report by Oboro et al (7), the occurrence of PROM was not significantly affected by sexual intercourse in Nigerian women. Majority of the women in this study used missionary position with no adverse effects.

Pregnant women should be counselled to use the coital position suitable for them and their partner but there may be a need to change position in the advanced stage of pregnancy in order to avoid any discomfort. It is noteworthy that 45.5% of the women in this study contributed to initiation of sexual activity unlike what was reported in some early studies (5,9,10). This may be due to beliefs of the women that coitus widens the birth canal and facilitates labour as well as to promote marital harmony. Midwives in the antenatal clinic were found to be the major source of information on sexuality in this study unlike in Western countries where books are the major source (5). The health talks on sexuality in pregnancy given by midwives in the maternity centres in developing countries should be encouraged in order to dispel some myths/taboos surrounding sexual activity in pregnancy and also to promote marital harmony and husband infidelity. Doctors attending to pregnant women should also encourage women to discuss without inhibition their sexuality during pregnancy and give appropriate counselling. The health care provider should initiate sexual discussions, as Oboro & Tabowei (12) have found that only 12% of Nigerian women who felt the need for sexual counselling sought help.

Conclusion: 
It is important that couples understand the psychosexual changes in pregnancy like moods, fears and anxieties. Health care providers should promote complete sexual satisfaction during pregnancy by dispelling fears and clarifying any misconceptions regarding such matter through appropriate counselling. This will go a long way to enhance marital harmony. 

Table 1: Demographic characteristics of the 550 women.
Values expressed in mean ± SD [range] or as n (%)

Table 2: Various aspects of sexuality in pregnancy 
Values are given as n/N (%) or mean ± SD

Table 3: Fears/Concerns for complication of vaginal intercourse in pregnancy.
Values expressed as n/N (%)

Table 4: Types of sexual activity practised in pregnancy.

Table 5: Perceived advantages of sexual activity in pregnancy.

Table 6: Sources of information concerning sexual activity in pregnancy.

Acknowledgement: The author would like to thank Dr (Miss) AO Odetunde and Dr (Miss) OA Adeniran, the two female interns who administered the questionnaires on the participants.

References:
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Correspondence to:
Dr AI Isawumi
Dept of Obstetrics & Gynaecology
LAUTECH College of Health Sciences
PMB 4400, Osogbo. Nigeria
E-mail: isawumi@yahoo.com

©2002 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough, UK
ISSN 1469-7556
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