In many ways, the first trimester of pregnancy is the worst. You’re nauseous and exhausted and wildly hormonal, plus pretty anxious about all the stuff that could potentially harm your precious cargo — including having sex, because it seems like basically everything is off-limits for those nine long months.

Anxiety about pregnant sex is 100 percent normal, but thankfully your baby is safer in there than you think (yes, even when you’re getting busy with your partner).

Assuming you can muddle through the first trimester morning sickness and exhaustion long enough to actually want to have sex, here’s everything you can expect in that department in the early days of pregnancy.

If this is your biggest fear, you’re not alone. So let’s get right to the good news: In a typical pregnancy, sex is safe throughout all 9 months, including the first trimester.

Unless your healthcare provider has told you not to have sex, there’s no reason to avoid it — regardless of how far along you are. The muscles surrounding your uterus as well as the amniotic fluid inside it help protect your baby during sex, and the mucus plug at the opening of your cervix prevents germs from passing through. (And no, a penis can’t touch or damage your uterus during sex.)

There’s a higher chance of miscarriage in general during the first trimester compared with the other trimesters. Sadly, about 10 to 15 percent of pregnancies end in miscarriage, with the majority of them happening in the first 13 weeks — but it’s important to note that sex isn’t a cause.

About one half of miscarriages happen because of chromosomal abnormalities that develop during fertilization of the embryo — something that has nothing to do with anything you did. Many causes are unknown.

Per the Cleveland Clinic, miscarriages can also be caused by a variety of risk factors, including:

  • maternal infections and diseases
  • hormone issues
  • uterine abnormalities
  • use of certain medications, like Accutane
  • some lifestyle choices, like smoking and drug use
  • reproductive disorders that interfere with fertility, like endometriosis and polycystic ovarian syndrome (PCOS)

You might not feel much like having sex in the early days of pregnancy — and no one could blame you! — but you don’t need to avoid sex to limit your chances of miscarriage.

There are many reasons why you might experience light bleeding or spotting in the first trimester — and most of them don’t have anything to do with the physical act of having sex.

About 15 to 25 percent of pregnant women experience first trimester bleeding — and that statistic doesn’t come with info regarding the sexual activity of those women.

Spotting in the first few weeks can be a sign of implantation of the fertilized egg. If you’ve been wanting to get pregnant, this is a good sign! (It’s worth noting, though, that plenty of pregnant women have no implantation bleeding.)

Heavier bleeding may point to issues like placenta previa or an ectopic pregnancy. These conditions aren’t good news, but they also aren’t caused by sex.

That said, your cervix is going through some major changes. Pregnancy hormones may make it drier than usual and can even cause the blood vessels to rupture more easily. Sometimes having sex can cause enough irritation in the vagina to result in light bleeding or spotting, which will look pink, light red, or brown. It’s normal and should resolve within a day or two.

Signs that you should call your doctor? Any bleeding that:

  • lasts longer than 1 or 2 days
  • becomes dark red or heavy (requiring you to change pads frequently)
  • coincides with cramps, fever, pain, or contractions

Sex can be painful throughout pregnancy, not just in the first trimester. For the most part, it’s because of totally normal changes happening in your body. Unless you have an infection, here are a few reasons why sex in the first trimester might hurt:

  • Your vagina is dry because of hormonal changes.
  • You feel like you need to pee or feel added pressure on your bladder.
  • Your breasts and/or nipples are sore.

If sex is so painful that you’re avoiding it, talk to your doctor. There may be an underlying medical cause, or the fix may be as simple as changing positions.

There are two reasons why you might have mild cramping after sex during early pregnancy. Orgasms, which release oxytocin, and semen, which contains prostaglandins, can both cause uterine contractions and leave you with mild cramping for a few hours after sex. (If your partner stimulated your nipples during sex, that can also cause contractions.)

This is completely normal as long as the cramps are mild and resolve shortly after sex. Try to rest and call your provider if they don’t go away.

Remember when we said sex during pregnancy was totally safe unless your doctor told you not to have it? Sex during pregnancy can lead to contractions, which are temporary and harmless in low-risk pregnancies but can lead to preterm labor or other complications if you have an existing medical condition.

Be sure to check with your doctor about whether it’s safe to have sex during pregnancy if you have one of the following conditions:

History of miscarriage

The American College of Obstetricians and Gynecologists defines repeated miscarriage as having had two or more pregnancy losses. About 1 percent of women will experience repeated miscarriage, and in many cases the cause is unknown.

Remember that sex itself doesn’t cause miscarriage, though extra precautions against uterine contractions may need to be taken in high-risk pregnancies.

Multiple-birth pregnancy

If you’re pregnant with more than one baby, your doctor may put you on pelvic rest in an effort to help you go as close to full term as possible. This means nothing should be inserted into your vagina, and includes abstaining from sex as well as avoiding most vaginal exams.

Pelvic rest is not the same as bed rest. It may or may not include restrictions on having orgasms, so you should make sure you understand your doctor’s instructions. (If you need to avoid all sexual activities, there are still ways for you and your partner to be intimate!)

Incompetent cervix

No, this doesn’t mean your cervix isn’t that smart! An “incompetent” cervix means the cervix has opened too early during pregnancy.

Ideally, your cervix will begin to thin and soften right before you go into labor, so you can deliver your baby. But if the cervix opens too soon, you’re at risk for miscarriage and premature delivery.

Signs of preterm labor

Preterm labor is when labor starts between the 20th and 37th weeks of your pregnancy. It’s unlikely that this would happen in the first 12 weeks of pregnancy, but if you’re showing signs of labor before week 37, like contractions, backache, and vaginal discharge, your doctor may want you to avoid activities that could advance your labor.

Placenta previa

The placenta typically forms on the top or side of the uterus, but when it forms underneath — placing it directly over the cervix — this creates a condition called placenta previa.

If you have placenta previa, you may bleed throughout your pregnancy. You could also bleed excessively during delivery, resulting in hemorrhage.

Whether you need to see your OB-GYN depends on how long you’ve had symptoms and how severe they are. Mild bleeding, pain, and cramping after sex are all typically normal, especially if they resolve 1 or 2 days after intercourse.

Heavy bleeding, severe pain or cramping, and other signs of infection, like fever, should be reported to your doctor ASAP. And of course, if you have any concerns, call your doctor — even if they don’t fall under any of these categories.

Sex during the first trimester isn’t always comfortable or pleasant (what about pregnancy is?!), but unless you’re at risk for complications, it is safe. If you have a pregnancy-related medical condition, don’t be afraid to ask your doctor exactly what sexual activities are allowed.