What most OB-GYNs aren't telling their patients about sex during their third trimester.
Going down on pregnant pussy is, oftentimes, a matter of convenience more than anything else. By the time a woman reaches the third trimester, a lot of sex positions become physically impossible due to belly size so it can be easier to forgo all penetrative options altogether and simply resort to oral sex.
Oral sex, specifically in the third trimester, though, could yield some serious consequences. The situation is dire enough that some STI experts are recommending that, during the third trimester, all oral sex is avoided completely, whether you're in a monogamous relationship or not. It sounds messed up and discriminatory that pregnant folks need to be on high-alert to STIs during this time, but blame it on a compromised immune system.
"The biggest risk is when a woman contracts herpes in the third trimester," says Terri Warren, a nurse practitioner with a track record of herpes specialization and author of The Good News About The Bad News: Herpes: Everything You Need to Know. "If you get herpes in your third trimester, there's a 50 percent chance your baby will get it at delivery. In the third trimester, you're immunocompromised—that's just a fact of pregnancy—your immune system can't build an immune response the way you normally would. You're shedding more because you have brand new infection, so that combination... and the fact that you have just a very short time before you deliver—all of that's a perfect storm."
Warren's implications about a storm of potential complications includes an increased likelihood of cesarean delivery. In the case of infection at birth, it can even lead to infant death. So why aren't more OBs talking about it?
"I think we wind up with sort of Virgin Mary events around pregnant women," says Peter Leone, professor of medicine at the University of North Carolina's School of Medicine. "Somehow, people have sex and become pregnant but once they become pregnant...we can't discuss sex." And that lack of discussion and awareness is dangerous, he says.
Leone, an STI brainiac of sorts, says that most pregnant women aren't receiving all the information they should be around safer sex practices during gestation, asserting that it's likely due to the sexual stigmatization that pregnant women are no longer sexually active beings. He also notes that though patients might not test positive for herpes at the beginning of a pregnancy, their partners are a different story—and they might even contract it outside the relationship at some point after conception. Since, Leone says, genital herpes is often contracted via oral sex (meaning you can pass on the virus to any genitals you put in your mouth), late in pregnancy cunnilingus could lead to severe complications since the first outbreak usually debuts when the host's immune response is compromised (such as during pregnancy).
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Of course, those aforementioned negative outcomes are some seriously worst-of-the-worst case scenarios. Before you decide to abstain from going down altogether, it's good to know that these potential outcomes are not inevitable; with proper testing, treatment, action, and education, they can be, for the most part, avoided.
But therein lies the problem—many patients don't end up receiving information they need throughout gestation. Warren agrees, citing an experience from her past, when she toured the country performing lectures, often about herpes.
"I was talking about the possibility of [herpes] testing in pregnancy," she tells me. "And this physician got so angry with me for raising that, that he was just yelling and said 'why would you ruin a perfectly wonderful pregnancy by telling someone they had a lifelong sexually transmitted infection?' And my response was 'why would ruin a perfectly good baby when you could stop it from happening?'"
And while the word "ruin" sounds harsh, Warren isn't talking about marring an infant's reputation with a hyper-stigmatized STI; she's talking about the fact that a herpes infection at birth can cause neurological damage and even death. When adults contract herpes, our immune systems can typically handle the virus well enough that the only side effect is a pretty intense first-time breakout (typically, the first is the worst). For newborns, that first outbreak can turn out to be, in Leone's words, "devastating."
Warren says her suggestion to appropriately test, educate, and support pregnant patients was met with great upset out of fear of disappointing patients, and that she doesn't find the response to fit the central goal of care providers. "We're not supposed to base what we do on whether it's bad news or not, that's not our job," she says.
According to these experts, here's how pregnant women can most effectively avoid contracting herpes during the latter end of their pregnancy: Ask questions, get tested each trimester, have any sexual partners (no shame in your game) tested each trimester, and avoid oral sex with every partner—monogamous or otherwise—at least for the final three months (I know, sorry). No matter your STI status, this is a good guideline, since, according to Warren, 30 percent of HSV1 goes undetected by traditional antibody tests. So, even with routine testing, you might not know for sure.
For those who do end up acquiring herpes during the third trimester, Leone wants them to understand that while the plan may have changed, their integrity hasn't. "[They need to know] they're not bad people," he says, urging women to know their diagnosis, get on suppressive therapy, and make sure not to allow any invasive procedures.
"If you've acquired it late in pregnancy, meaning the third trimester, then no forceps delivery, no fetal scalp monitoring, no premature rupture of the membrane to induce labor and delivery, and that person should have an exam done at the time of labor and delivery," Leone says. If there's an outbreak then the baby needs to be delivered by C-section, not by vaginal delivery, he adds. "It's a different way of approaching things, but you don't wan to increase the risk."
Assess your situation, talk to your care provider, ask as many questions as you need to ask, and figure out how to make sex work for you during those especially full-bodied, rounded out days of late pregnancy. Herpes is generally manageable, including during pregnancy. It just might mean skipping getting head for three months.
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