Maternal sexuality in high- and low-risk pregnancies: a cross-sectional comparison

Sexual health during pregnancy remains an under addressed aspect of prenatal care, despite its significant impact on women's well-being. This study examined sexual activity, perceptions, satisfaction, and counseling patterns among women with high-risk and low-risk pregnancies in a culturally diverse population. The study was conducted at a single medical center in northern Israel between March and October 2024. A total of 198 pregnant women participated (response rate 91.9%), of whom 126 (63.6%) were classified as high-risk based on conditions such as diabetes or gestational diabetes (36.5%), prior preterm birth or cervical shortening (27.8%), two or more cesarean deliveries (18.3%), fetal abnormalities (7.9%), polyhydramnios (10.3%), hypertension (7.1%), hypercoagulability (5.6%), and twin pregnancies (4.0%). Maternal characteristics were generally comparable, although high-risk women were surveyed at an earlier gestational age than low-risk women (32.49 ± 4.69 vs. 35.36 ± 4.36 weeks, p < 0.001) and had a higher number of clinic visits (median 3 vs. 0, p < 0.001). Most participants in both groups reported decreased sexual activity during pregnancy (65.6 vs. 64.8%, p = 0.941), with no significant differences in sexual desire, partner's perceived desire, or sexual satisfaction (very satisfied: 50.4 vs. 54.9%, p = 0.814). A substantial proportion of patients (44.7% high-risk, 42.9% low-risk, p = 0.383) expressed a desire to receive information from a physician about sexual intercourse and desire, however, only 21.4% reported receiving such counseling from their physician, and embarrassment regarding these discussions was low (16.8 vs. 18.6%). Beliefs about the safety of intercourse were mostly similar, though a higher proportion of high-risk women strongly disagreed that intercourse should be avoided in high-risk pregnancies (17.1 vs. 8.5%, p = 0.043). Obstetric outcomes demonstrated lower gestational age at birth among high-risk pregnancies (38.00 ± 2.21 vs. 39.29 ± 1.25 weeks, p < 0.001), while birthweight and mode of delivery were comparable between groups. These findings indicate similar patterns of sexual function, perceptions, and satisfaction across pregnancy risk groups but reveal a substantial gap in physician-initiated counseling. Integrating routine, proactive discussions about sexual health into prenatal care may enhance patient understanding, reassurance, and overall well-being.