Health
PT Health Watch: Sex during pregnancy is usually safe, but some risks remain
Pregnancy often comes with questions about what women can and cannot safely do, particularly when it comes to sexual activity.
For some couples, pregnancy may create fears that sex could harm the baby or trigger complications. Others may assume that once a woman becomes pregnant, all forms of sexual activity should stop.
But medical guidance suggests that pregnancy itself is not a reason to stop having sex.
The American College of Obstetricians and Gynaecologists (ACOG) says most sexual activity is safe for women with healthy pregnancies, noting that the amniotic sac and strong muscles of the uterus protect the developing baby.
However, that reassurance does not apply to every pregnancy. Certain complications can make sexual activity unsafe or require a woman to avoid it on the advice of her healthcare provider.
To provide more insight into sexual activity during pregnancy and the precautions women should take, PREMIUM TIMES spoke with Halimat Jimoh, a nurse and midwife, who explained the circumstances that can make sex unsafe, the risks of STIs and why some precautions are necessary even during oral sex.
When sex may not be advisable
Ms Jimoh explained that in an uncomplicated pregnancy, the developing baby is protected inside the uterus by the uterus, amniotic fluid and cervix.
However, she said certain pregnancy complications can change the advice given to a woman.
These may include unexplained vaginal bleeding, placenta previa or other placental problems, leaking of amniotic fluid, some cervical conditions and concerns about preterm labour.
She said this means pregnancy should not be viewed as a blanket reason to stop having sex. Rather, a woman’s individual pregnancy and any complications she may have should determine what is considered safe.
“Pregnancy itself is not a reason to stop having sex; it is certain pregnancy complications or medical concerns that may make avoiding sex necessary,” she explained.
Oral sex is generally safe, but not risk-free
While vaginal intercourse is often the focus of discussions about sex during pregnancy, oral sex is another form of sexual activity that couples may have questions about.
Ms Jimoh said oral sex is generally considered safe during an uncomplicated pregnancy, but certain precautions are necessary.
One of them is that a partner should not blow air directly into the vagina.
Although extremely rare, forcing air into the vagina has been associated with air embolism, a potentially life-threatening condition in which an air bubble enters a blood vessel and interferes with blood flow.
More importantly, oral sex does not eliminate the risk of sexually transmitted infections.
The National Health Service (NHS) states that infections, including herpes, gonorrhoea, syphilis, chlamydia, HIV and hepatitis, can be transmitted through oral sex. The risk can increase when either partner has sores or cuts around the mouth, genitals or anus.
This means that the absence of vaginal penetration does not automatically make oral sex risk-free.
And for pregnant women, an STI acquired through sexual contact can have implications beyond the mother.
Pregnancy does not protect women from STIs
According to Ms Jimoh, pregnancy does not protect a woman from contracting an STI.
An infection acquired during pregnancy can affect the mother and, depending on the infection, may also affect the developing baby.
Syphilis is one example.
The World Health Organisation (WHO) estimates that about eight million adults aged 15 to 49 acquired syphilis in 2022.
The organisation says untreated, late-treated or inadequately treated syphilis during pregnancy can result in adverse birth outcomes in an estimated 50 to 80 per cent of cases, depending on the stage of the infection.
The infection can pass from a pregnant woman to her baby through the placenta and may result in stillbirth, neonatal death, premature birth, low birth weight or congenital syphilis.
WHO also stresses that early testing and treatment during pregnancy can prevent these outcomes.
Ms Jimoh said pregnant women should therefore not wait until after delivery before seeking care for a suspected STI.
“Many STIs can be treated or effectively managed, and early testing, diagnosis and appropriate treatment during pregnancy can help protect both the mother and baby,” she said.
Herpes requires particular attention
Among the infections requiring particular attention during pregnancy is genital herpes, particularly because of the risk of transmission to the baby around the time of delivery.
Ms Jimoh explained that genital herpes can be transmitted from a mother to her baby during childbirth.
The risk is particularly concerning when a woman develops genital herpes for the first time towards the end of pregnancy, as she may not yet have developed sufficient antibodies to help protect the baby.
The Centres for Disease Control and Prevention (CDC) estimates that the risk of transmitting herpes to a newborn is between 30 and 50 per cent when a woman acquires genital herpes near the time of delivery.
This compares with a risk of less than one per cent among women with recurrent herpes or those who acquired the infection during the first half of pregnancy.
The CDC recommends that pregnant women with genital herpes inform their healthcare providers. Antiviral medication may be prescribed towards the end of pregnancy to reduce the likelihood of an outbreak around delivery, while a caesarean delivery may be recommended when genital lesions or symptoms are present at the onset of labour.
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But herpes is not always accompanied by visible symptoms.
Ms Jimoh noted that the infection can sometimes be transmitted even when there are no obvious sores or other symptoms.
She, therefore, advised pregnant women and their partners not to dismiss unexplained sores, blisters or lesions around the mouth or genitals.
This is particularly relevant to oral sex because oral herpes, commonly associated with cold sores, can be transmitted through oral sexual contact.
When should sexual activity be avoided?
The presence of sores is not the only reason a pregnant woman may need to pause sexual activity.
According to Ms Jimoh, women experiencing unexplained vaginal bleeding, leaking of amniotic fluid, known or suspected STI exposure, unexplained sores or lesions, unusual discharge, pain or fever should seek medical advice.
Women who have already been advised to avoid sex because of a pregnancy complication should also not assume that oral sex is automatically safe.
Instead, Ms Jimoh said they should ask their healthcare provider which forms of sexual activity are appropriate for their specific condition.
Vaginal bleeding during pregnancy, in particular, should not simply be dismissed as a normal consequence of sex.
For pregnant women, regular antenatal care, early testing where necessary and prompt medical attention when unusual symptoms occur can help identify and manage potential risks early.
The message, Ms Jimoh stressed, is therefore not that pregnant women must stop being sexually active, but that they should understand their individual circumstances and seek professional advice whenever complications, warning signs or concerns about infection arise.
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Health
FG inaugurates committees for 67th National Council on Health, demands result-oriented recommendations
The Federal Ministry of Health and Social Welfare has inaugurated sub-committees ahead of the 67th Regular National Council on Health (NCH), urging members to ensure that their recommendations are evidence-based, practical and focused on improving healthcare delivery in Nigeria.
The ministry said this on Thursday during the inaugural meeting of the sub-committees in Abuja.
The 67th NCH is scheduled to hold from 16 to 20 November in Lafia, Nasarawa State.
The council, which will bring together key stakeholders across the federal and state health sectors, will be held under the theme, “From Commitment to Results: Delivering Quality and Equitable Healthcare for All Nigerians.”
Representing the Permanent Secretary of the ministry, Kachollom Daju, at the meeting, the Director of Health Planning, Research and Statistics, John Ovuoraye, described the NCH as a critical platform for policy dialogue, coordination and decision-making in Nigeria’s health sector.
Daju said the Technical Committee and its subcommittees play an important role in preparing recommendations for the council’s consideration.
“The quality of the work produced by these sub-committees will have a direct bearing on the effectiveness of the recommendations that will be presented to the National Council on Health,” she said.
She urged members to carry out their responsibilities with diligence, integrity, professionalism and objectivity.
Daju also called for an open-minded approach to the assignments and constructive engagement between the Federal Ministry of Health and Social Welfare and the Nasarawa State Local Organising Committee.
According to her, members’ participation reflects a shared commitment to strengthening Nigeria’s health system and improving Nigerians’ health and well-being.
Nasarawa promises collaboration
The Nasarawa State Commissioner for Health, Shekwonugaza Gwamna, represented by the Permanent Secretary of the state Ministry of Health, Ibrahim Hassan, welcomed participants to the meeting.
Mr Hassan reaffirmed the state’s readiness to work with the Federal Ministry of Health and Social Welfare to ensure a successful 67th NCH.
He said the inaugural meeting provided an opportunity for the state’s Local Organising Committee to present the progress made so far, receive guidance from the federal ministry and strengthen preparations for the council.
He thanked members for their commitment and wished them productive deliberations as preparations for the event continue.
Key areas of preparation
The meeting considered several issues relating to preparations for the council, including the formal inauguration of the sub-committees and clarification of the roles and responsibilities of their chairmen and members.
Members also reviewed and worked towards finalising the logo for the 67th NCH, as well as the format and timely submission of memoranda by states.
READ ALSO: PT Health Watch: Why parents should not overlook children’s vision problems
The meeting was attended physically by officials of the Federal Ministry of Health and Social Welfare, while members of the Nasarawa State Local Organising Committee participated virtually.
The 67th NCH is expected to deliberate on major health priorities and develop actionable recommendations to improve the quality, equity, and responsiveness of healthcare delivery across Nigeria.
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The Democratic Republic of the Congo (DRC) has received an initial allocation of 70,000 doses of the Ervebo Ebola vaccine to support the response to the ongoing Bundibugyo virus disease outbreak.
The World Health Organisation (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) disclosed this in a joint statement on Thursday.
The allocation followed a request by the DRC government last week for vaccines from the global Ebola virus disease vaccine stockpile managed by the International Coordinating Group on Vaccine Provision (ICG).
Of the 70,000 doses, 20,000 will be used in a Phase III clinical trial to assess whether Ervebo can protect against Bundibugyo virus, while the remaining 50,000 doses will be administered to frontline and health workers in line with recommendations by the WHO Strategic Advisory Group of Experts on Immunisation (SAGE).
Why the vaccine is being tested
The decision to use part of the allocation in a clinical trial reflects the uncertainty surrounding the effectiveness of Ervebo against Bundibugyo virus.
Ervebo is a licensed vaccine recommended for use during outbreaks caused by the Zaire species of Ebola virus. The current outbreak in the DRC, however, is caused by Bundibugyo virus, a different species of the Ebola virus.
WHO said it is not yet known whether Ervebo can protect humans against Bundibugyo virus, although early laboratory and animal studies suggest that it may provide some protection.
The Phase III trial is therefore expected to generate evidence on whether the vaccine can offer protection against the virus and help guide future decisions on its use during similar outbreaks.
WHO said people offered the vaccine, whether as part of the trial or outside it, must be informed about the potential risks, benefits and limitations of using Ervebo against Bundibugyo virus and must provide informed consent.
Outbreak spread
According to the latest WHO disease outbreak update, 4,665 confirmed cases and 2,184 deaths had been reported as of 12 August.
The outbreak has expanded from the Mongbwalu health zone in Ituri Province to 54 health zones across six provinces: Ituri, North Kivu, South Kivu, Haut-Uélé, Tshopo and Bas-Uélé.
WHO described the outbreak as being in a phase of intense transmission and said it was the largest Ebola outbreak ever reported in the DRC.
The outbreak was declared on 15 May and has been driven by factors including population movement, insecurity, artisanal mining activities and cross-border travel involving Uganda and South Sudan.
The scale of the outbreak has consequently increased pressure on health authorities and researchers to deploy available interventions while developing tools specifically suited to the Bundibugyo virus.
Vaccine development
In July, PREMIUM TIMES reported that the first human clinical trial of an experimental Bundibugyo Ebola vaccine had begun at the University of Oxford.
The Phase I trial, known as BD-Ebov, is assessing the safety of the experimental ChAdOx1 BDBV vaccine and its ability to stimulate immune responses in healthy adults.
The vaccine was developed by the University of Oxford’s Oxford Vaccine Group and Pandemic Sciences Institute in collaboration with the Serum Institute of India and the Coalition for Epidemic Preparedness Innovations (CEPI).
Unlike Ervebo, which is licensed for use against Zaire ebolavirus, ChAdOx1 BDBV was specifically designed to target Bundibugyo virus.
The development of a vaccine specifically targeting the virus is considered important because there is currently no approved vaccine specifically for Bundibugyo virus.
The use of Ervebo in the current outbreak could therefore serve a dual purpose; providing protection to health workers who are at high risk of exposure while generating evidence on whether an existing Ebola vaccine can provide protection against another species of the virus.
WHO’s technical advisory group on candidate vaccine prioritisation recently recommended that Ervebo be included in a randomised clinical trial during the ongoing DRC outbreak following a review of emerging evidence on its potential cross-protection against Bundibugyo virus.
Community response
Beyond the vaccines, WHO and Africa CDC said the success of the response would also depend on the involvement of communities affected by the outbreak.
The two organisations welcomed the allocation of the vaccines and supported the DRC’s focus on a community-led approach, which they said would give communities a central role in the response.
Such an approach, they said, would help protect affected populations, save lives and contain transmission while ensuring that people receiving the vaccine understand its potential benefits and limitations.
The ICG partners are WHO, the International Federation of Red Cross and Red Crescent Societies, Médecins Sans Frontières (MSF) and United Nations Children’s Fund (UNICEF), while Gavi, the Vaccine Alliance, provides funding for the global vaccine stockpile.
WHO and Africa CDC said they remained committed to supporting the DRC government to end the outbreak while generating scientific evidence that could strengthen preparedness for future outbreaks.
READ ALSO: DRC Ebola outbreak becomes second-largest on record – WHO
Nigeria’s preparedness
The continued spread of the virus has also raised concerns beyond the DRC because of the potential for cross-border transmission.
Nigeria has subsequently heightened its preparedness, with the Nigeria Centre for Disease Control and Prevention (NCDC) activating its Emergency Operations Centre, strengthening surveillance at points of entry and increasing monitoring across states.
The federal government also identified 21 states and the Federal Capital Territory as being at high risk of Ebola infection following a dynamic risk assessment.
State governments were urged to strengthen surveillance, isolation capacity and infection prevention and control measures.
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