It has been assumed that sexual activity during pregnancy would lead to an increased risk for miscarriage and other complications of pregnancy. Various studies showed no association of sexual behavior and pregnancy complications in single pregnancies. The aim of our study was to evaluate changes in sexual activity in women with twin pregnancies and whether a higher frequency of sexual intercourse was associated with an increased risk for pregnancy complications. We report on 50 women with twin pregnancies who answered a questionnaire on sexual behavior during pregnancy. At the time of delivery, patients were aged 31.0 ± 4.8 years. All women reported to have had sexual intercourse during pregnancy. In contrast to the first trimester in the vast majority of patients (41/50, 82.0%) the coital frequency decreased in the last month of pregnancy. Patients who had become pregnant after in-vitro fertilization were significantly less likely to have regular sexual intercourse than patients after spontaneous conception during early pregnancy (p = .002). No statistical significances were found when the rates of preterm delivery before the 37th gestational week were compared to the frequencies of sexual intercourse during early pregnancy and during late pregnancy (p >.05). In conclusion, our study demonstrates a decrease in frequency of sexual intercourse from early to late pregnancy in the specific collective of women with twin pregnancies, especially in women after in-vitro fertilization. There was no association between sexual activity and preterm delivery.