This chapter examines the guarantee section 92 provides for freedom of inter-State trade, commerce and intercourse. While the High Court previously interpreted section 92 as providing for two separate guarantees (one guaranteeing freedom of inter-State trade and commerce, and one guaranteeing freedom of inter-State intercourse) with different analytical frameworks, section 92 is now understood as being a composite provision having two limbs – the inter-State trade and commerce limb and the inter-State intercourse limb – with a common analytical framework for determining whether a law contravenes the provision. The guarantee of freedom of inter-State trade and commerce ensures free trade within Australia. It operates to invalidate discriminatory burdens of a protectionist kind imposed on inter-State trade and commerce. The guarantee of freedom of inter-State intercourse ensures freedom of movement from one State to another. It operates to invalidate all discriminatory burdens on inter-State intercourse. It also operates to invalidate disproportionate incidental burdens on inter-State intercourse.

In an opinion that made national news, the high court in Maryland reversed the judgment of an intermediate court and upheld the defendant’s conviction for rape. The court explicitly rejected the defendant and intermediate court’s reasoning that consent should be evaluated using a reasonable victim standard. Although the opinion in Rusk is widely cited as a turning point in recognizing sexual violence in nonstranger rape cases, there remained many elements of the opinion that have been the object of feminist criticism.

The decision of the Supreme Court of Massachusetts concerned the difficult problem of defining the quantum of intoxication abrogates a person’s ability to consent to sex. The jury convicted a police officer, who was summoned to assist a highly intoxicated person, of rape of that person. However, the high court overturned the conviction, holding that the “wholly insensible” test was too vague to support a legal conviction. Notably, the court offered no alternative to the rejected test, essentially leaving the state without any rule about the degree of intoxication or other incapacitation abrogates consent.

Spontaneous preterm birth (PTB) refers to a delivery that occurs between weeks 20 and 37 of pregnancy, due to preterm labor, preterm prelabor rupture of membranes. and short cervical length at mid-trimester. The three most common risk factors for PTB are (1) prior history of preterm delivery, (2) twin pregnancy, and (3) short cervix at mid-trimester ultrasound. Several studies have demonstrated that short cervical length is the most powerful predictor for PTB in the index pregnancy for both singleton and twin pregnancies. A short cervical length means the measured length of the cervix is shorter than expected for the current gestational age, with a cutoff value between 20 and 25 mm. Sexual intercourse by itself has not been demonstrated to be a clear risk factor for PTB. Thus, abstinence after pregnancy has been achieved has no role in strategies for prevention of PTB. Also, most sexual positions and noncoital activities (e.g. oral sex, masturbation) during late pregnancy are not clearly associated with adverse pregnancy outcomes. There is no strong evidence that sexual activity affects the risk of PTB or onset of labor in healthy individuals. Pelvic rest may be recommended in selected cases, such as patients with a very short cervix or bulging membranes.

Women and their partners frequently enquire whether sexual activity is permitted during pregnancy and its potential consequences. There is limited evidence to provide guidance on sexual activity in higher-risk pregnancies complicated by maternal disease. This chapter outlines the existing recommendations for a range of medical conditions and provides useful recommendations for patients, partners, and physicians. Sex is generally considered safe in pregnancy but may require adaptations for improved safety and pleasure. Several factors need to be taken into consideration in the context of maternal conditions, including physical discomfort and limitations, fear of injury to the individual or the fetus, as well as physical awkwardness with increasing gestation. However, abstinence is very rarely recommended in the context of maternal disease in pregnancy.

Intercourse is an integral part of human well-being and over the course of a pregnancy its frequency usually declines, at times due to discomfort and prejudice but in some cases due to medical advice. This chapter reviews the evidence for the safety of sexual activity in low- and high-risk pregnancies and establishes the validity of recommendations of abstinence in different clinical scenarios. The main concern regarding sexual intercourse is its ability to cause uterine contractions that could possibly result in premature labor or endanger a pregnancy complicated by placental pathologies. In light of the existing evidence, which is limited in amount and quality, it seems that coitus does not produce contractions powerful enough to precipitate labor, either in women who are at increased risk for preterm labor or in those who are not. Another significant concern is the possibility that sexual intercourse may trigger migration of pathogens to the cervix and cause an ascending infection and chorioamnionitis, especially in the setting of premature rupture of the membranes, and some studies indeed support this hypothesis; however, they were conducted decades ago, and their quality is low. It is clear that there is insufficient high-quality research to establish proper evidence-based guidelines for women who wish to receive medical advisement regarding sexual activity. However, when examining the existing literature and taking into consideration that coitus is part of every couple’s healthy and normal lifestyle, it seems that overall engaging in sexual activity during pregnancy is safe. In selected cases of high-risk pregnancies, recommendations should be tailored individually according to the parturient’s obstetric history.

Loss of a pregnancy is undoubtedly an awful outcome that pregnant women dread. The question of whether sexual intercourse can cause pregnancy loss is a controversial and poorly studied topic. As recently as 40 years ago, sexual intercourse was listed in textbooks as a risk factor and precipitant for pregnancy loss. Most studies on this topic have a problematic methodology; in addition, many have selection biases and comprise a small number of subjects. In this chapter we review whether sex can result in miscarriage or stillbirth and whether women should refrain from having sex in order to prevent a pregnancy loss; when sexual intercourse can be resumed after a miscarriage; whether sex should be postponed after a miscarriage; and whether patients with a previous miscarriage should avoid sex in the current pregnancy.

The first trimester of pregnancy covers a major transition period for pregnant individuals and their partners. Sexual satisfaction, including in pregnancy, is an important facet of a fulfilling relationship. The frequency of sexual activity decreases during the first trimester and is accompanied by increased sexual dysfunction, particularly once the pregnancy is identified. This may be secondary to physical factors such as fatigue and nausea and vomiting as well as a fear of miscarriage or harm to the pregnancy. Sexual activity in the first trimester has not been demonstrated to result in miscarriage, adverse obstetric outcomes, or fetal harm. Vaginal bleeding may be associated with an increased risk of miscarriage and therefore caution is advisable for vaginal intercourse in these cases. Obstetric care providers can support couples in early pregnancy by including discussions of the safety of sexual activity, expectations during pregnancy, and alternative mechanisms of intimacy as part of routine pregnancy care.

The relationship between sexual intercourse and its role in onset of spontaneous labor has been questioned for decades. Intercourse for the induction of labor is regarded by many as a “natural” method for initiating labor. Possible physiological explanations for this include prostaglandin action of sperm, oxytocin production via breast/nipple stimulation, and direct mechanical effect of sex on uterine contractions. This chapter reviews the most current literature on these theories and whether increasing the frequency of sexual intercourse hastens the onset of spontaneous labor. Limitations of the recent literature and internet/social media sources are also highlighted in detail. Other alternative and popularized “natural” methods of inducing labor, such as physical activity, acupuncture, and herbal remedies, are also analyzed. Ultimately, most robust studies reveal there is no evidence to suggest that sex at term has an effect on spontaneous onset of labor or adverse outcomes of pregnancy. Simultaneously, there are no known harmful consequences in engaging in sexual activity for those patients with low-risk pregnancies.

Sexual fantasies refer to mental imagery of sexual activity with an emotional component that absorbs the fantasizer. These images are often sexually arousing and enjoyable, but they can elicit guilt and be unwanted and intrusive. Reported frequency of sexual fantasizing is subject to large individual differences. The present chapter reviews and discusses the role of motivational tendencies underlying sexual fantasies and the relationship between sexual functioning and sexual fantasies. Men report more frequent fantasies than women, but at least part of the difference is explained by greater frequency of masturbation accompanied by fantasies for men than women. Sexual desire does not require the experience of fantasies, but fantasy frequency is robustly related to sexual desire in the reproductive years. Tendency to experience sexual fantasies is related to imagery ability, in general, but the modest correlations suggest independent processes. Unlike sexual activity that requires compromise between partners’ desires, fantasies are unconstrained by physical and social reality; as such, they provide a window into sexual motivations that guide cognitions and behavior. Predictions of sex differences in fantasy contents based on evolutionary theory have been confirmed by many studies. Women are more likely than men to fantasize about sex with the current partner, and less likely than men to fantasize about group sex, sex with strangers, extradyadic relationships, and sex with (legally) much younger partners. This is interpreted as fantasies reflecting sex-differentiated mating strategies. However, a substantial proportion of women report fantasies of group sex, sex with unknown men, and sex with men other than their current partner. This suggests that a certain degree of sperm competition has occurred in human evolutionary history, which is corroborated by the relative size of men’s testes in comparison with other primates. Generally (and against expectations), women do not fantasize more about sex with much older partners and famous people. Fantasies involving sexual aggression are very common. Men fantasize more than women about forcing someone to have sex. Some studies report that women fantasize more about being forced to have sex, but others have failed to find this sex differences. Still, more women than men report that the fantasy of being forced to have sex is among their favorites. These fantasies are typically very sexually arousing, but they may challenge evolutionary explanations and the notion of fantasies revealing motivations, as rape is reported to be traumatic and revolting by victims. Several explanations are discussed. Rape fantasies might facilitate intercourse and sexual pleasure in circumstances of psychological ambivalence, when the environment is safe. In women, evidence of a relationship between sexual fantasies and sexual satisfaction is mixed. Sexual satisfaction is unrelated to female coital fantasies and to male fantasies, in general. Many variables that may cause fantasy-related dissatisfaction are discussed; these include fantasies provoking guilt feelings, preference for arousal solely induced by sensory and emotional stimulation, fantasies being used as escapes from relationship problems and other stressors of reality, and lack of adequate sleep leading to greater fantasy-induced arousal.