Alcohol and Sex, Reproductive Wellness, and Pregnancy

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For decades, research has examined the complexities of how alcohol impacts sexuality and reproductive health.

Alcohol and Sex

Research has shown that alcohol can have an impact on certain sexual behaviors, which have been linked to increased risks of sexually transmitted infections, unplanned pregnancy and other unplanned outcomes.²

Studies show that the following behaviors occur more often when using alcohol:³

• Sexual activities at an earlier age
• Unprotected sex
• Sex with multiple partners
• Casual sex, or sex with a partner one does not know well and/or is not in a committed relationship with
• Sex while under the influence of drugs or alcohol

Research also shows that the consumption of alcohol can:²

• Increase sexual activity
• Heighten sexual arousal
• Increase the likelihood of engaging in sexual behaviors outside of your personal norm

Alcohol use can restrict and impair cognitive abilities.  This reduced ability to process information impacts judgment, which may explain why individuals participate in certain activities while under the influence that they don’t while sober.⁵

Additionally, individuals who consume alcohol are less likely to be able or willing to communicate sexual desires and negotiate sexual expectations between partners.²  This reduced ability to communicate boundaries and expectations can significantly contribute to issues of coercion and consent when either party uses alcohol, which could damage relationships or cause lasting trauma.

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Alcohol and Fertility

Research suggests that alcohol negatively impacts the reproductive systems of men and women.

Individuals assigned female at birth and who misuse alcohol have been shown to have reduced fertility and an increase in menstrual disorders.¹ One study found that heavy alcohol consumption resulted in a reduced likelihood of pregnancy of up to 13%.⁷ Heavy alcohol use can also diminish ovarian reserves, in other words, reduce the number of eggs retained in the ovaries.⁷

Alcohol misuse in individuals assigned male at birth may lead to reduced gonadotropin release, which affects testosterone production. It can also cause atrophy of the testicles, a decrease in testosterone and sperm production and lead to sexual dysfunction such as decreased libido, erectile dysfunction or ejaculatory dysfunction.⁷

Alcohol and Pregnancy

According to the National Survey on Drug Use, in 2023, 4.8% of pregnant women ages 15 to 44 in the United States reported binge drinking.  This is especially concerning because the use of alcohol while pregnant can pose a significant risk to the developing fetus. For this reason,  there is no known safe level of alcohol use while pregnant.¹

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Health effects associated with alcohol use during pregnancy include:¹

• Miscarriage
• Intrauterine growth restriction, which can result in lower birth weight
• Pre-term labor
• Stillbirth

Prenatal exposure to alcohol can disrupt normal fetal development in several ways:¹

• Gene issues
• Changes in cellular function
• Damage to the growth factor signaling that allows the fetus to develop normally
• Altered placental function (e.g., reduced oxygenation and perfusion)

Prenatal exposure to alcohol can impair the structural development of the fetus, which can present as abnormalities of the:¹

• Heart
• Liver and kidneys
• Brain
• Bones
• Head and face

In utero exposure to alcohol can potentially lead to Fetal Alcohol Spectrum Disorders (FASD). The Centers for Disease Control (CDC) and studies estimate that for every 1,000 live births, 0.2 to 7 of those births will be affected by FASD.¹   

Research suggests that approximately 1 in every 13 pregnant persons who consume alcohol while pregnant gives birth to a child with FASD.⁶ Symptoms of FASD include:¹

• Vision and/or hearing problems
• Poor coordination
• Small head size
• Abnormal facial features (e.g., smooth philtrum)
• Low body weight
• Shorter-than-average height
• Sleeping and feeding problems as an infant
• Hyperactive behavior
• Difficulty with attention
• Poor memory
• Learning disabilities
• Difficulties in school, math in particular
• Intellectual disabilities or low intelligence
• Poor judgment skills
• Poor reasoning skills
• Delays in speech and language abilities

At present, there are no cures for FASD, and the symptoms do not appear to be reversible.¹

Children who were exposed to alcohol in utero but do not meet full criteria for FASD may be diagnosed with Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE).¹

Children diagnosed with ND-PAE may exhibit symptoms of:¹

• Memory and thinking difficulties
• Problematic behaviors
• Difficulties with activities of daily living

It is also not clear how much alcohol, the frequency or pattern of consumption or in which trimester prenatal exposure to alcohol causes the most harm to the developing fetus. For this reason, the use of alcohol while pregnant is strongly discouraged.

Alcohol Use and Breastfeeding

We know that alcohol can pass through the placenta to the fetus; it can also pass through breast milk to the baby.¹ For this reason, the American Academy of Pediatrics advise mother’s to avoid alcohol while breastfeeding.  As well, the use of alcohol may also impact hormone production, which can potentially lead to a decrease in one’s ability to breastfeed.¹

Furthermore, drinking alcohol can impair a mother’s judgment and motor skills, leading to potential safety concerns for the baby.

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Resources

1. Dejong, K., Olyaei, A., & Lo, J. (2019). Alcohol use in pregnancy. Clinical Obstetrics & Gynecology, 62(1), 142-155.
2. Scott-Sheldon, L., Carey, K., Cunningham, K., Johnson, B., & Carey, M. (2015, June 15). Alcohol use predicts sexual decision-making: A systematic review and meta-analysis of the experimental literature. AIDS and Behavior, 20(S1), 19-39.
3. Egervari, G., Siciliano, C., Whiteley, E., & Ron, D. (2021, October 23). Alcohol and the brain: From genes to circuits. Trends In Neurosciences, 44(12), 1004-1015.
4. Rao, R., & Topiwala, A. (2020, February 28). Alcohol use disorders and the brain. Addiction, 115(8), 1580-1589.
5. Wang, S., Lui, J., Vega, G., Waldrop, M., & Garris, J. (2018). The moderating effect of alcohol use on protective and risky sex behaviors among college students in the Southeast United States. Journal of American College Health, 66(7), 546-552.
6. Lim, A., Van Schalkwyk, M., Maani Hessari, N., & Petticrew, M. (2019). Pregnancy, fertility, breastfeeding, and alcohol consumption: An analysis of framing and completeness of information disseminated by alcohol industry–funded organizations. Journal of Studies on Alcohol and Drugs, 80(5), 524-533.
7. Van Heertum, K. & Rossi, B. (2017, July 10). Alcohol and fertility: how much is too much? Fertility Research and Practice, 3(1).