Sexuality and Reproductive System

June 23, 2023

Breast Changes

Breast changes begin early in pregnancy. Many women report tingling and a feeling of fullness. Increased sensitivity is also common. Generally, the breasts grow in preparation for lactation. Nipples and areolae darken. Colostrum may be secreted by the nipples in second half of pregnancy. Supportive bras are recommended. If colostrum leakage is problematic, the woman should be encouraged to use breast pads.

Sexual Activity

Sexual desire is normal during pregnancy. The pregnant woman can have sexual relations unless contraindicated by other conditions. Complications during pregnancy, such as premature labor, bleeding, or rupture of membranes, necessitate that sexual activity be halted. Many factors have a strong influence on the frequency and type of sexual activity, including cultural, religious, and psychological influences. Partners

must communicate their fears, concerns, and needs to each other. Many women experience a decrease in desire as a result of hormonal changes and discomfort. Change in body shape and body image may also cause concern. Discussion of various coital positions and sexual activity that does not include intercourse is appropriate. The health care provider may promote this discussion by introducing the topic during routine prenatal care. Increased vaginal secretions are common during pregnancy. Leukorrhea, an increase in vaginal mucus, results from hormonal changes. If the discharge changes in color or odor, the physician should be informed at once.

Box 25-11 Exercise Tips for Pregnant Women

• Consult your health care provider when you know or suspect you are pregnant. Discuss your medical and obstetric history, your current regimen, and the exercises you would like to continue throughout pregnancy.
• Seek help in determining an exercise routine that is well within your limit of tolerance, especially if you have not been exercising regularly.
• Consider decreasing weight-bearing exercises (jogging, running), and concentrate on non–weight-bearing activities such as swimming, cycling, or stretching. If you are a runner, you may wish to walk instead, starting in your 7th month.
• Avoid risky activities, such as surfing, mountain climbing, sky diving, and racquetball. Activities that require precise balance and coordination may be dangerous.
• Exercise regularly at least three times a week, as long as you are healthy, to improve muscle tone and increase or maintain your stamina. Sporadic exercises may put undue strain on your muscles.
• Limit activity to shorter intervals. Exercise for 10 to 15 minutes, rest for 2 to 3 minutes, then exercise for another 10 to 15 minutes.
• Decrease your exercise level as your pregnancy progresses. The normal alterations of advancing pregnancy, such as decreased cardiac reserve and increased respiratory effort, may produce physiologic stress if you exercise strenuously for a long time.
• Take your pulse every 10 to 15 minutes while you are exercising. If it is more than 140 bpm, slow down until it returns to a maximum of 90 bpm.
• Avoid becoming overheated for extended periods. It is best not to exercise for more than 35 minutes, especially in hot, humid weather. As your body temperature rises, the heat is transmitted to your fetus. Prolonged or repeated fetal temperature elevation may result in birth defects, especially during the first 3 months.
• Warm-up and stretching exercises prepare your joints for more strenuous exercise and lessen the likelihood of strain or injury to your joints.
• A cool-down period of mild activity after exercising helps bring your respiratory, heart, and metabolic rates back to normal and avoid pooling of blood in the exercise muscles.
• Rest for 10 minutes after exercising, lying on your left side. As the uterus grows, it puts pressure on a major vein carrying blood to your heart on the right side of your abdomen. Lying on your left side takes the pressure off and promotes return circulation from your extremities and muscles to your heart, increasing blood flow to your placenta and fetus.
• Drink two or three 8-oz glasses of water after you exercise to replace the body fluids you lost through perspiration. While exercising, drink water whenever you feel the need.
• Increase your caloric intake to replace the calories burned during exercise. Choose such high-protein foods as fish, cheese, eggs, or meat.
• Take your time. This is not the time to be competitive or train for activities that require long endurance.
• Wear a supportive bra. Your increased breast weight may cause changes in posture and put pressure on the ulnar nerve.
• Wear supportive shoes. As your uterus grows, your center of gravity shifts and you compensate by arching your back. These natural changes may make you feel off balance and more likely to fall.
• Stop exercising immediately if you experience shortness of breath, dizziness, numbness, tingling, abdominal pain, or vaginal bleeding, and consult your health care provider.

Vaginal Bleeding

Vaginal bleeding at any time during pregnancy should be reported to the physician at once. Sexual activity should cease until the cause of the bleeding is determined and should be resumed only when the physician determines that no danger exists.

Coping and Stress Tolerance

Pregnancy is a developmental milestone. As with other significant developmental changes, anxiety is normal. All the physical and hormonal changes of pregnancy place additional stress on the woman. The woman and her partner normally have fears. They are concerned with the ability to cope with the pregnancy, the potential pain related to labor and delivery, and the health and well-being of the baby. Mood swings and ambivalence (conflicting emotions) are common as the woman works through her fears and comes to grips with the reality of pregnancy and how it will affect her life. During the early part of the pregnancy, the sudden hormonal changes combined with fatigue, nausea, and

vomiting impact her concerns and ability to cope. As the pregnancy progresses, she will likely feel better and become increasingly able to adapt to the changes she experiences.

Women use problem-solving skills and methods of coping that worked in the past in an attempt to adjust to this new situation. Provide support as this problem solving occurs and help the woman work through her unique situation. Explain the normal physiologic changes and discomforts. Listening and allowing the woman adequate time to verbalize her fears can also help reduce anxieties.

Roles, Relationships, and Adaptation

The expectant woman has generally held several roles in her life, such as child, student, employee, and wife. Pregnancy introduces a totally new role, that of mother. The woman often looks to her own life for role models and tends to seek guidance from family and friends. Culture has much to do with how she defines her role (Box 25-12).

Dynamics also change between the woman and the baby’s father, particularly with the first pregnancy. The mother is no longer just a wife or girlfriend; she is also a mother. While she is coping with the role change to mother, he is coping with the role change to father (Box 25-13).

Self-Perception and Self-Concept

The rapid changes in body shape and size can lead to changes in self-image. Many women feel unattractive when they are pregnant. They may also feel a loss of control related to the changes taking place. They are no longer free to do as they please because all their actions may affect the growing fetus.

Cognitive and Perceptual Changes

Although sensory changes are uncommon with pregnancy, blurred vision or diplopia (double vision) may indicate problems with a hypertensive condition of pregnancy (see Chapter 28).