Sexual health and it’s role in conception + beyond
When trying to conceive a baby, it’s quite common that the act of love making goes out of the window and it just becomes purely about baby making. This can have a drastic impact on a couple’s relationship both sexually and emotionally. The pressure can cause distress for both the male and female and symptoms such as erectile dysfunction can present as soon as the pressure to ‘get pregnant’ features.
Sexual health, both from a solo perspective and a couple, is something that should be thought about and supported early on in your fertility journey, no matter what that looks like. It’s also important for couples to understand that sexual troubles that develop when ‘trying to conceive’ can have consequences for sexuality during pregnancy and post-partum. As a practitioner specialising in fertility, I think it’s important that my clients are supporting their sexual health not only for the art of conception, but for sexual health and connection during pregnancy, post-partum and beyond.
Sexual health for conception
When conception doesn’t occur as planned, many couples end up in a fed-up and vicious cycle which creates poor sex and whereby poor sex diminishes the chance to conceive and can threaten the quality of intimacy in the relationship. ‘Good sex’ is a relevant factor in conception, this includes not only the quality of both male and female arousal, but also the intercourse frequency and proper timing of conception which many of us do not bring awareness to until we are actively trying to conceive.
In our current modern world, many couples are waiting until a bit later to conceive and step into parenthood. We are led to believe that after removing contraception that conception will take place within 2-3 months. For some this is the case, for many it isn’t, and this can result in a diminished self-esteem for both male and female which can directly decrease sexual desire. Wanting to conceive can often influence spontaneous intimacy and the ‘fun’ this can bring. Scheduling sexual intercourse can result in stress, less intimacy and intercourse without genuine arousal. An additional stress for some women looking to conceive later is that because they are older it will take longer. Whilst sub-fertility does not always result from ‘poor conception sex’, a vicious circle can develop between ‘poor sex’ and lower conception chance. Periods of ‘poor sex’ can spill over into pregnancy and the post-partum phase having negative influences on the relationship quality and parenthood.
Sexuality from a spiritual lens
From a spiritual and tāntrik perspective, it’s important to work with the energy of both the feminine and masculine as well as the energy that flows from the heart to the womb, particularly when it comes to honouring experiences of sexuality from a feminine perspective. A happy and fulfilling experience of sexual intercourse with the intended father of the desired child is an absolute crucial ingredient in optimising fertility. The trust and intimacy that is nourished by a positive experience of sexuality at this time is equally important in lesbian couples who are seeking to conceive, and in heterosexual couples who are using assisted reproductive technologies such as IVF.
Regardless of how the baby is conceived, the foundational relationship between the mother to be and her partner is the the ground of being into which new life is invited. This ‘ground’ is the nourishing energy that connects our heart to our womb, linking our capacity to love with our abilities to create and nurture. For all kinds of reasons, not least because of the pressure that turns spontaneous love making into a scheduled baby-making task, the loving link between anāhata (heart) and yonisthanā (womb) can be severed. This severance can cause deep wounds and a lack of trust at an emotional and psychic level that makes it difficult to conceive. Yoga practices that reconnect the energetic flow form heart to womb can help to heal such wounds and I have shared two spiritual practices that may resonate below.
Timing of intercourse
Timing of intercourse is something that should be given some thought but can often cause pressure and stress. Whilst it’s important it doesn’t add stress, optimal timing of intercourse is known to optimise chances of conception. I invite my clients to look for ovulation signs and track if that’s their thing (for some it isn’t).
For conception to occur, we need a sperm and an egg to meet. Healthy sperm can last up to 6 days in a woman’s body and the egg survives 12-24 hours after ovulation. For conception, intercourse should happen in the ‘fertile window’, which is considered to be 6 days prior until 12 hours after ovulation. Cervical mucus is often abundant, whitish and as slippery as egg white.
The optimal time for intercourse is 2 days before ovulation, when sufficient viable sperm are already available at the ovulation site. Couples who wait to have intercourse based on an ovulation test kit often miss the optimal opportunities for conception. LH strips can often given false readings depending on the quality of a woman’s cycle (they shouldn’t be used for those with PCOS in particular). Ovulation tracking 3 months prior to actually trying to conceive can be helpful to understand a woman’s typical ovulation pattern.
Frequency of intercourse
The timing of intercourse is important for conception but so is frequency of intercourse. Not only is frequent intercourse important for optimising chances of conception, but it has also been shown in research to positively impact implantation success. The research suggests that this is likely due to the immune system changes that happen by which the emerging embryo is accepted by the woman’s body, despite being a ‘foreign invader’. A males sperm contains DNA that is foreign to the female body and by having regular exposure to the male’s sperm allows the female body time to start recognising the ‘foreign invader’. Whilst ‘frequent intercourse’ is often referenced as the ideal amount of intercourse to increase chances of conception, what does that actually mean from a practical perspective?
Recent research has shown that intercourse four times a week the chance of conception is 4-5 x greater than with intercourse taking place less than once a week.
With a regular menstrual cycle, intercourse two to three times a week appears to be OK!
Frequency of Ejaculation
There is a fine balance of ejaculating too much and not ejaculating enough when it comes to sperm health. Whilst it isn’t wise to ejaculate several times a day when trying to conceive because it diminishes sperm quality, prolonged periods of abstinence until ovulation also decreases sperm quality. For couples living together, the optimal frequency for ejaculation is every 1-2 days because of the positive impact regular exposure of intra-vaginal ejaculation has on immune system ‘acceptance’ and implantation. If 1-2 days isn’t obtainable for whatever reason, research has shown that abstinence of 5 days gives the optimal quality and amount of sperm.
How about orgasm, is it essential for conception?
Both a male and female orgasm differently, with women often needing longer than men and different penetration. But does orgasm actually positively impact conception chances? Research has shown that sperm quality gets better with a higher level of male sexual arousal. A more extended pre-ejaculatory arousal period has also been shown to improve sperm concentration, which also feeds into the notion that males tapping into a female sexual energy (and not just wanting to ejaculate really quickly) has a positive impact!
How about females? Whilst orgasm for women hasn’t been shown to directly impact conception with the sperm on that given intercourse, around the ovulation period sub-endometrial smooth muscles send peristaltic waves from the cervix to the fallopian tube at the side of ovulation. When women orgasm, their oxytocin peaks, further facilitating those myometrial waves. From this perspective, an orgasm could bring the sperm from the previous evening to the site of ovulation. In addition, when females are sufficiently sexually aroused a natural lubrication is produced. Whilst lubrication is often known as just something that helps to prevent physical and mechanical irritation (which causes pain for some), it actually provides a pH and O2 that is beneficial for the sperm in that it facilities its metabolism, mobility and lifespan. Artificial lubricants often impact the vaginal microbiome in a negative manner, but if lubrication is needed it can be positive to support insertion of the penis, prevent dyspareunia and increase sexual pleasure. The pH of the vaginal microbiome is important for survival of the sperm and sexual arousal helps to support this. Some lubricants have been shown to negatively impact the sperm, which is why what you choose to lubricate is important. My recommendation of lubricant is below:
Lubrication Recommendations
Organic Jojoba Oil: Fushi, Organic Jojoba Oil
Most importantly, orgasm for both male and female often incentivise more frequently sex, which enhances conception chance.
Immunology, conception + sexual health
Recent research indicates the influence of menstrual-cycle related changes in the immune response of women that could negatively or positively impact implantation. Interestingly, relevant differences have been found between sexually active and sexually abstinent women. Microchimerism, whereby a limited number of foetal cells and fluid enters the women’s circulation has proven that the placenta does not keep a mother and foetuses’ tissues wholly separated. This immune interaction has been compared to that of those having organ transplants where we know the body tries to ‘reject’ the foreign issue. Immune tolerance is an essential part of the puzzle and sufficient maternal tolerance to foetal tissue that might cause ‘rejection’ and failed implantation can be improved by regulation and prolonged exposure to paternal antigens in the seminal fluid of the father-to-be. Interestingly research has also found that ‘women exposed to the paternal seminal fluid via absorption through the vaginal mucosa also have a lower risk for pre-eclampsia.’.
Recommendations for couples when sexual pleasure dwindles…
When getting pregnant is the only thing on your mind it’s really easy to lose sexual desire. Having sex ‘on demand’ or ‘at fixed times’ isn’t easy, life happens and at times you might just not be in the mood and that’s OK. There are some strategies listed below that you can implement as a couple that create conditions for intimacy since intimacy is important for sexual desire and enjoyable sex.
Create a nice environment, somewhere you will not be disturbed by a smartphone, TV or doorbell, keep social media out of the bedroom and try to leave your phone out of the bedroom entirely (get an old school alarm clock). This also includes making your bedroom enticing and cosy.
Create time for intimacy and this looks different for everybody, it can include household chores, working out, dancing or enjoying treatments or a lunch together.
Think back to the exciting moments when you feel in low or had good sex and take joint responsibility to strengthen your sexual relationship, indicate things that could bring you into a sexual mood.
Accept differences between being male and female. Usually, women are more sensitive to undivided attention, romance and intimacy, and men are more sensitive to variety, visual cues (from lingerie to nudity) and explicitly shown excitement.
Step out of your comfort zone, this is where a lot of arousal tends to be hiding. Depending on your limits try spicing things up by using incense, massage oil or a romantic movie, sex toys are useful for some couples but are not for everybody!
Whilst I don’t actively encourage alcohol when actively conceiving, if it helps to create relaxation and looseness and facilitate sexual ease, note this isn’t entirely dangerous for the baby before implantation as the foetus is still wholly separated from and not influenced by the mother’s circulation.
DO
Invest in sexual pleasure and sexual desire.
Try as much as possible to be at the same time parents-to-be and lovers. Give priority to sexuality and intimacy.
When using ovulation as an indicator moment, be aware that the chance to conceive is highest with intercourse on day 2 before ovulation.
Continue ejaculating regularly. Too long intervals between ejaculations will diminish the quality of the sperm. Once ejaculation every 1–3 days appears the good frequency for conceiving. So, masturbation can sometimes be helpful to keep the sperm quality optimal.
DON’T
Don’t continue sexual intercourse when it hurts. The pain usually means that you are not (or not yet) sufficiently aroused.
Don’t stop intercourse because the day of ovulation is over. Semen appears to facilitate proper implantation in the womb.
Book resources
Please see below some really great books for bringing awareness to sexual health both from a solo perspective and as a couple:
David Schnarch – Passionate Marriage
David Schnarch – Intimacy and Desire
David Schnarch – Resurrecting Sex
Nicole Daedone – Slow Sex: The art and craft of the female orgasm
Ellyn Bader and Peter Pearson – In search of the mythical mate
Robin Skynner and John Cleese – Families and how to survive them
John Gottman – The Science of Trust
John Gottman – The Seven Principles for Making Marriage Work
Spiritual sexual health practices
See attached document for spiritual health practices as mentioned in the text above.
References
Dinsmore-Tuli, U. (2014) Yoni Shakti ‘A Woman’s Guide to Power and Freedom through Yoga and Tantra’. UK: Pinter & Martin Ltd, pg. 295-301
Geuens, S. Mivsek, A. Gianotten, WL. (2024) Midwifery and Sexuality. Available at: https://link.springer.com/book/10.1007/978-3-031-18432-1 (Downloaded 12 December 2024), pg. 44-64
Hechtman, Leah (2018) ‘Baby Making vs Love Making’ Dr Leah Hechtman, 12 December. Available at: https://drleahhechtman.com/baby-making-vs-love-making/
Newberg, AB. Wintering, NA. Hriso, C. et al. (2021). ‘Alterations in Functional Connectivity Measured by Functional Magnetic Resonance Imaging and the Relationship With Heart Rate Variability in Subjects After Performing Orgasmic Meditation: An Exploratory Study’, Frontiers & Psychology, Volume 12. [Online], Available at: https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.708973/full
