“Mom, what is sex?” my seven-year-old asked me in the middle of a chaotic weekday breakfast recently. After nearly choking on my Cheerios, I was able to further investigate and discovered that, luckily, he was only referring to gender. I had bought myself a little more time to prepare for the bigger talk. I’ll admit, I was relieved. While sex is a normal healthy part of life, talking about it can sometimes be a little awkward. Still, if you have medical concerns about sex, you should talk to your doctor. One of the questions I hear from my patients is whether it’s safe to have sex at certain times. Medically, there are only a few instances where sex should be avoided.
Before a Pap smear
The Pap smear has improved over the years, but the basic technology still involves the analysis of individual cells under the microscope. Semen can make the Pap smear less sensitive, so sex should be avoided the night before your annual exam. Honestly, your gynecologist probably prefers not to encounter semen during an exam, so it would be courteous to abstain before any pelvic exam – Pap smear or not (perhaps I can get this added to Emily Post’s next book of etiquette).
Unexplained vaginal bleeding or pain
Most women will experience occasional spotting or twinges of pain with ovulation, but if you are experiencing persistent pain or bleeding, then you should avoid from intercourse. Pain during intercourse or bleeding after intercourse can be signs of abnormalities of the cervix and should prompt a visit to your provider.
“Is it OK to still have sex?” is often one of the last questions I get asked at a patient’s first pregnancy visit, usually said in a slightly embarrassed whisper as I place my hand on the door knob. If your pregnancy is uncomplicated, you can have sex from conception until your water breaks. If you are having unexplained pain or bleeding, you should put a halt to bedroom activity until you see your doctor. Pregnancy complications like placenta previa and preterm labor can be exacerbated by sex, so intercourse should be avoided in those situations also.
After both a cesarean section and vaginal delivery you should abstain from intercourse until you have seen your provider at your six week postpartum visit and confirmed that everything has healed normally. Most women will experience some amount of tearing after a vaginal delivery, and even patients that are lucky enough to avoid stitches will often have abrasions on their labia that can be very sensitive. Having intercourse before the vaginal is completely healed can cause wounds to reopen and increase the risk of infection, not to mention hurt like heck.
When you have an infection
If you are experiencing symptoms of pelvic or vaginal infection such as foul-smelling discharge, severe vaginal itching, burning, or pelvic pain, you should avoid sex until you see a doctor. Having sex with a vaginal infection is not only painful, but can cause the infection to spread to your pelvic organs and become more severe – and obviously, if it is a contagious infection you wouldn’t want your partner exposed.
This one may seem like common sense, but on multiple occasions I have had patients come in with major complications after hysterectomies caused by having sex too soon. Surgical advances have enabled patients to recover quicker and feel back to normal much faster than before. However, sometimes even though someone feels fine, their insides are continuing to heal. With all surgery you should check with your surgeon on when it would be appropriate to resume sex.
For the average healthy woman, there aren’t too many occasions where sex is ill-advised from a medical standpoint. If you are experiencing pain, bleeding, or have recently had a baby or surgery, then please abstain. If you have other medical concerns, then please ask your doctor. While discussing sex might be uncomfortable for some patients, your gynecologist has likely already had several sexual discussions that day, maybe even at breakfast.