Sexuality During Pregnancy

Abstract

Sexuality is an important part of health and well-being. Sexual behavior modifies as pregnancy progresses, influenced by biological, psychological, and social factors.
To evaluate changes in sexual perceptions and activities during pregnancy and to determine sexual dysfunctions in that period.
Sexual perceptions (desire from the partner, feelings of attractiveness, and fear of sexual intercourse), sexual activities during pregnancy (sexual intercourse frequency, the most frequent sexual intercourse trimester, sexual activity during the birth week, type(s) of sexual intercourse, changes in sexual satisfaction and desire compared with the pre-pregnancy period, and changes in sexual intercourse frequency during each trimester compared with the pre-pregnancy period), and sexual dysfunctions.
Puerperal women were asked to anonymously complete a self-administered and structured questionnaire at the day of discharge from hospital.
One hundred and eighty-eight women, aged between 17 years and 40 years with a mean age of 28.9 years, were analyzed. The first trimester was considered the most frequent period of sexual intercourse (44.7%), followed by the second trimester (35.6%). Fifty-five percent reported a decrease of sexual activity during the third trimester. Fear of sexual intercourse was referred by 23.4% of the women questioned. Sexual satisfaction was unchanged in 48.4% of the subjects and decreased in 27.7% (P < 0.0001); sexual desire is reported to be unchanged in 38.8% and decreased in 32.5% (P = 0.196) of the population. Vaginal, oral, anal sex, and masturbation were performed by 98.3%, 38.1%, 6.6%, and 20.4% of the women, respectively.
We determined in our study that sexual satisfaction do not change in pregnancy compared with the pre-pregnancy patterns despite a decline of sexual activity during the third trimester. A discussion of expected changes in sexuality should be routinely done by the doctor in order to improve couples' perception of possible sexual modifications induced by pregnancy.

Full text

ORIGINAL RESEARCH—WOMEN’S SEXUAL HEALTH
Sexuality During Pregnancyjsm_1538 136..142
Joana Rocha Pauleta, MD,* Nuno Monteiro Pereira, MD, PhD,†and Luís Mendes Graça, MD, PhD*
*Department of Obstetrics, Gynecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal;
†Association for the Advanced Study of Human Sexuality, Lusófona University and iSex, Lisbon, Portugal
DOI: 10.1111/j.1743-6109.2009.01538.x
ABSTRACT
Introduction. Sexuality is an important part of health and well-being. Sexual behavior modifies as pregnancy
progresses, influenced by biological, psychological, and social factors.
Aim. To evaluate changes in sexual perceptions and activities during pregnancy and to determine sexual dysfunc-
tions in that period.
Main Outcome Measures. Sexual perceptions (desire from the partner, feelings of attractiveness, and fear of sexual
intercourse), sexual activities during pregnancy (sexual intercourse frequency, the most frequent sexual intercourse
trimester, sexual activity during the birth week, type(s) of sexual intercourse, changes in sexual satisfaction and desire
compared with the pre-pregnancy period, and changes in sexual intercourse frequency during each trimester
compared with the pre-pregnancy period), and sexual dysfunctions.
Methods. Puerperal women were asked to anonymously complete a self-administered and structured questionnaire
at the day of discharge from hospital.
Results. One hundred and eighty-eight women, aged between 17 years and 40 years with a mean age of 28.9 years,
were analyzed. The first trimester was considered the most frequent period of sexual intercourse (44.7%), followed
by the second trimester (35.6%). Fifty-five percent reported a decrease of sexual activity during the third trimester.
Fear of sexual intercourse was referred by 23.4% of the women questioned. Sexual satisfaction was unchanged in
48.4% of the subjects and decreased in 27.7% (P<0.0001); sexual desire is reported to be unchanged in 38.8% and
decreased in 32.5% (P=0.196) of the population. Vaginal, oral, anal sex, and masturbation were performed by
98.3%, 38.1%, 6.6%, and 20.4% of the women, respectively.
Conclusions. We determined in our study that sexual satisfaction do not change in pregnancy compared with the
pre-pregnancy patterns despite a decline of sexual activity during the third trimester. A discussion of expected
changes in sexuality should be routinely done by the doctor in order to improve couples’ perception of possible sexual
modifications induced by pregnancy. Pauleta JR, Pereira NM, and Graça LM. Sexuality during pregnancy. J Sex
Med 2010;7:136–142.
Key Words. Female Sexual Function; Sexual Perceptions; Sexual Activities; Sexual Dysfunctions; Pregnancy; Sexual
Intercourse Frequency
Introduction
Pregnancy is a special period in the life of
women that is characterized by physical, hor-
monal, and psychological changes that, in conjuga-
tion with social and cultural influences, affect
women’s sexuality and couples’ sexual relationship.
This reinforces the role of pregnancy as a stimulus
for partners to search for new ways to enhance
mutual emotional connection, intimacy, and close
physical affinity, in order to share physical sexual
pleasure and satisfy each other’s sexual needs. A
healthy sexuality during pregnancy is necessary for
the parental transition that occurs in that period [1].
Specific changes that occur in each pregnancy
trimester have significant influences on sexual
behavior. A reduction in sexual intercourse fre-
quency, desire, and satisfaction occurs in many
136
J Sex Med 2010;7:136–142 © 2009 International Society for Sexual Medicine

women as pregnancy progresses, particularly
during the third trimester, compared with pre-
pregnancy [2–11]. There are numerous physical
and psychological factors that may justify this
[12,13]. Hormonal changes (increased estrogen,
progesterone, and prolactine) cause nausea and
breast tenderness, which, in addition to fatigue,
exhaustion, and anxiety, may contribute to general
feebleness and difficulty to become aroused. As
sexual desire and arousal influence sexual satis-
faction [14] and intercourse frequency, it is
understandable that sexual practices decreased.
Moreover, self-consciousness about a growing
girth leads to a gradual change in a pregnant
woman’s self-image that influence her self-
confidence, while posing physical limitations to
perform some sexual positions. Length of inter-
course and ability to experience orgasm decrease
during the later phases of pregnancy compared
with pre-pregnancy, and dyspareunia increases
significantly throughout pregnancy [4]. Both the
women and their partners have concerns regarding
complications in the pregnancy as a result of sexual
intercourse [2–4].
Aim
The objective of this study is to evaluate the sexual
patterns (perceptions, activities, and dysfunctions)
during pregnancy and to assess changes in sexual
desire, satisfaction, and frequency compared with
the pre-pregnancy period.
Methods
Design and Data Collection
A descriptive and quantitative study was conducted
in our department between July and September
2008. The study was approved by the committee
of ethics. Women whose birth occurred in our
department were informed about the purpose of
the study and were invited to participate volunta-
rily. We gathered the data using an anonymous
written questionnaire that was given at the day of
discharge from the hospital. We performed a pilot
study on 15 puerperal women prior to the begin-
ning of the research to ensure understanding of
the questions and participation. The majority of
women refused to answer the question about the
duration of sexual intercourse and to specify oral
sex as cunnilingus or fellatio. Then, we developed
the final version of the questionnaire without these
questions and we decided to not discriminate if
oral sex was performed by man or woman. The
questionnaire was filled by each of the puerperal
women and we have assured confidentiality.
Women whose sexual partners lived away from
them, human immunodeficiency virus (HIV)
seropositive women, and women that had obstetric
conditions that imposed a long period of sexual
abstinence (placenta previa, multiple pregnancy,
cervical incompetence, and risk of premature
labor) were excluded from the study.
Details of the Questionnaire
The questionnaire included two sections. The first
section is composed by questions about socio-
demographic aspects: age, ethnic group and educa-
tion of the couple; marital status; parity; nationality,
and religion of women. The second section
included questions concerning sexual perceptions
and activities during pregnancy: feeling less sexual
desire from the sexual partner (yes or no); feeling
less attractive or sensual (yes or no); feeling fear of
sexual intercourse (yes or no); mean of sexual inter-
course frequency during the whole pregnancy
period (!1 time a month; 2–3 times a month;
1 time a week; 2–3 times a week; 4–7 times a
week); the most (more) frequent sexual intercourse
trimester(s); sexual intercourse frequency in each
trimester (first, second, and third) compared with
the pre-pregnancy period (increased, decreased,
or unchanged); sexual satisfaction and sexual
desire compared with the pre-pregnancy period
(increased, decreased, or unchanged); type(s) of
sexual intercourse performed (anal, vaginal, oral,
and masturbation—one or more choices are pos-
sible); sexual activity during the third trimester (yes
or no) and during the birth week (yes or no); sexual
dysfunctions (lower desire, dyspareunia, anor-
gasmy, difficulty in lubrication—one or more
options are possible); need to talk about sexuality
with doctors (yes or no); and next 6 months per-
spective about sexual activity (increased, decreased
or unchanged). All questions were closed ended,
except the question about feeling of fear during
sexual activity that is open ended and in which we
asked respondents to specify.
Statistical analysis was performed using the chi-
square test. Statistical significance was considered
as P<0.05.
Main Outcome Measures
The main outcome measures are sexual percep-
tions (desire from the partner, feeling less attrac-
tive or sensual, and fear of sexual intercourse) and
sexual activities during pregnancy (mean of sexual
Change of Sexual Patterns During Pregnancy 137
J Sex Med 2010;7:136–142

intercourse frequency, the most frequent sexual
intercourse trimester, type(s) of sexual intercourse
performed, sexual activity during the third trimes-
ter and during the birth week, changes of sexual
satisfaction and sexual desire compared with the
pre-pregnancy period, and changes of sexual inter-
course frequency during each trimester compared
with the pre-pregnancy period). We also analyzed
sexual dysfunctions, need to talk with doctors
about sexuality, and 6 months perspective about
changes in sexual activity.
Results
A total of 194 women were enrolled in the study.
Six women were excluded: one was HIV seroposi-
tive, one had placenta previa, one lived away from
her husband, one had a twin pregnancy with risk of
premature labor, and two women had a risk of
premature labor. One hundred and eighty-eight
women, aged between 17 years and 40 years with a
mean age of 28.9 years, were analyzed. Table 1
shows the demographic data of women and their
sexual partners. One hundred and eight women
(57.4) had their first child. Nearly all (93.6%) said
that their pregnancy was desired, but 27.1% stated
that the pregnancy was not planned. Forty-nine
patients (26.1%) had a previous abortion.
Forty-four (23.4%) women reported fear of
sexual intercourse: 18 revealed fear of “harming
the baby,” 11 of miscarriage, 4 of dyspareunia, 2 of
preterm labor, and 2 were concerned about their
partner’s worry. Seven women did not explain
their concerns regarding sexual intercourse.
Feeling less sexual desire from partners during
pregnancy compared with pre-pregnancy was
reported by 46 women (24.5%). Feeling less
attractive or sensual during the pregnancy period
was stated by 78 women (41.5%). Results are sum-
marized in Table 2.
As showed in Table 3, sexual activity decreased
significantly throughout pregnancy. The first tri-
mester was considered the most frequent period of
sexual intercourse (44.7%), followed by the second
trimester (35.6%). Table 4 lists changes in sexual
activities during pregnancy compared with the
period prior to pregnancy. Many women reported
a constancy in sexual activities during the first
and second trimesters (46.8% and 50.5%, respec-
tively), and a decrease during the third trimester
(55.3%). There were no statistical differences
between the first and second trimesters; however,
statistical differences were evident between the
second and third trimesters, and between first and
third trimesters in all analyzed parameters
(Table 5).
Table 1 Demographic characteristics
N=188
Women age (years); mean (SD) 28.9 (5.68)
Partner age (years); mean (SD) 31.4 (6.65)
Women ethnic group, N (%)
White 155 (82.5)
Black 24 (12.8)
Asian 2 (1.1)
No answer 7 (3.7)
Partner ethnic group, N (%)
White 157 (83.5)
Black 21 (11.2)
Asian 1 (0.59)
No answer 9 (4.8)
Women education, N (%)
Primary school 20 (10.6)
High school 93 (49.5)
University 60 (31.9)
Master/graduate 9 (4.8)
No answer 6 (3.2)
Partner education, N (%)
Primary school 37 (19.7)
High school 91 (48.4)
University 43 (22.9)
Master/graduate 8 (4.3)
No answer 9 (4.8)
Marital status, N (%)
Marital relation 138 (73.4)
Single 44 (23.4)
Divorced 4 (2.1)
No answer 2 (1.1)
Para, N (%)
1 108 (57.4)
2 63 (33.5)
"3 15 (8.0)
No answer 2 (1.1)
Women religion, N (%)
Christian 158 (84.0)
Muslim 3 (1.6)
Hindu 1 (0.5)
Agnostic 3 (1.6)
Other 14 (7.5)
No answer 9 (4.8)
Women nationality, N (%)
Portugal 161 (85.6)
Cape Verde 6 (3.2)
Angola 5 (2.7)
Brazil 7 (3.7)
Guine-Bissau 2 (1.0)
Albania 1 (0.5)
No answer 6 (3.2)
SD =standard deviation.
Table 2 Psychological changes and beliefs of women
during pregnancy
Yes No No answer
Fear of sexual intercourse,
N (%)
44 (23.4) 143 (76.1) 1 (0.5)
Feeling less sexual desire
from partner, N (%)
46 (24.5) 141 (75.0) 1 (0.5)
Feeling less sensual/
attractive, N (%)
78 (41.5) 107 (56.9) 3 (1.6)
138 Pauleta et al.
J Sex Med 2010;7:136–142

Sexual satisfaction was unchanged in 48.4% and
decreased in 27.7% (P<0.0001), and sexual desire
is reported to be unchanged in 38.8% and
decreased in 32.5% (P=0.196) compared with the
pre-pregnancy period.
Eighty percent of respondents reported sexual
activities during the third trimester, but 61.0% did
not engage in any type of sexual intercourse during
the birth week.
Data regarding the types of sexual activity per-
formed during pregnancy are shown in Table 6.
Seven women did not answer the question. Among
the respondents, three did not engage in vaginal
intercourse during pregnancy. However, two of
these women had oral sex and one had oral sex
and masturbation. Oral and anal intercourse were
performed by 38.1% and 6.6% of the women,
respectively.
Only 182 women answered the question about
mean sexual intercourse frequency during preg-
nancy. The results are listed in Table 7. Among the
respondents, 32.4% reported having sex once a
week, and 25.8% reported having sex two to three
times a week.
In respect to sexual dysfunctions, lower desire
was reported by 20 (10.9%) women, dyspareunia
by 18 (9.8%) women, anorgasmy by 12 (6.6%)
women, and difficulty in lubrication by 8 (4.4%)
women. One hundred and thirty-eight (75.4%)
respondents did not complain about sexual dysfunc-
tions. Five women did not answer the question.
Of 180 respondents, 160 (88.9%) said that they
do not need to talk about sexuality with their
doctors. In relation to the next 6 months after
delivery, 109 (60.6%) women stated that their
sexual activity will not change, 40 (22.2%) stated
that it will decrease, and 31 (17.2%) referred a
possible increase in their performance compared
with pre-pregnancy. Eight women did not answer
this question.
Discussion
Our findings indicate a substantial decrease in the
frequency of sexual intercourse throughout preg-
nancy. These results are consonant with other
authors [2–11,15].
The majority of women referred no change in
sexual activities in the first or second trimesters
(46.8% and 50.5%, respectively). In a meta-
analysis of 59 studies, von Sydow demonstrated
that coital frequency did not change or changed
only slightly in the first trimester and it was quite
variable in the second [16].
Although 80.1% reported engaging in sexual
intercourse during the third trimester, it was con-
sidered the most frequent trimester of sexual
Table 3 Trimester(s) in which sexual intercourse was
more frequent
N (%)
First trimester 84 (44.7)
First and second trimesters 7 (3.7)
Second trimester 67 (35.6)
Second and third trimesters 2 (1.1)
Third trimester 19 (10.1)
No answer 9 (4.8)
Table 4 Changes of sexual functions during pregnancy compared with pre-pregnancy, N (%)
Increased Decreased Unchanged No answer
Sexual activity during first trimester 33 (17.5) 54 (28.7) 88 (46.8) 13 (6.9)
Sexual activity during second trimester 37 (19.7) 40 (21.3) 95 (50.5) 16 (8.5)
Sexual activity during third trimester 19 (10.1) 104 (55.3) 49 (26.1) 16 (8.5)
Sexual satisfaction 28 (14.9) 52 (27.7) 91 (48.4) 17 (9.0)
Sexual desire 42 (22.3) 61 (32.5) 73 (38.8) 12 (6.4)
Table 5 Changes in sexual activities during pregnancy
Increased
P
Decreased
P
Unchanged
P
First vs. second trimesters 0.60 0.095 0.47
Second vs. third trimesters 0.009 0.0000 0.0000
First vs. third trimesters 0.0365 0.0000 0.0000
Table 6 Type(s) of sexual activity during pregnancy (one
or more choices)
N (%)
Anal intercourse 12 (6.6)
Vaginal intercourse 178 (98.3)
Oral intercourse 69 (38.1)
Masturbation 37 (20.4)
Table 7 Sexual intercourse frequency during pregnancy
N (%)
!1 time a month 29 (15.9)
2–3 times a month 35 (19.2)
1 time a week 59 (32.4)
2–3 times a week 47 (25.8)
4–7 times a week 12 (6.6)
Change of Sexual Patterns During Pregnancy 139
J Sex Med 2010;7:136–142

intercourse only by 10.1%. Moreover, we found
decreased sexual activities in 55.3% of the women
during this trimester compared with pre-
pregnancy. It is interesting to note that 38.9%
continued engaging in sexual intercourse during
the birth week. Coitus late in pregnancy is not
related to bacterial vaginosis [17], and does not
increase preterm labor, premature rupture of
membranes, low birthweight, or perinatal death
[18–20]. Sexual positions, such as woman on top,
side by side, or rear entry, were used more fre-
quently as pregnancy progresses [2,4,15,21].
Eryilmaz et al. pointed some reasons that may
explain the decrease of sexual frequency during
pregnancy as exhaustion, fatigue, fear of harming
the fetus, causing abortion, inducing preterm
labor, and waning of sexual desire. They also
reported a positive correlation between changes in
sexual life during pregnancy and the duration of
marriage, educational level, and parity [12].
Three women did not engage in vaginal inter-
course, however, performed other types of sexual
activities. These women did not complain about
fear of sex or sexual dysfunctions. In a Spanish
population [21], 14% of the women practiced
masturbation during pregnancy. Our results are
similar (20.4%), but very different from an Iranian
population [15] where only 6% reported this type
of sexual activity. We cannot discard the social,
cultural, and religious influences on the analysis of
this fact.
Fear of sexual intercourse was referred by
23.4% of the women. As pointed by other studies
[2,15,22], our results indicated that women often
fear that sexual intercourse might harm the fetus,
induce miscarriage, or premature birth, although
our results were less expressive. Interestingly,
some women were said to fear sexual intercourse
because of partners’ worry and because they were
afraid to have dyspareunia. Gökyildiz et al. found
that fear of intercourse was experienced through-
out pregnancy, particularly in the third trimester
[4]. Cultural factors and inadequate knowledge
influence attitudes toward and fears of intercourse.
In a study performed in Pakistan [22] and Nigeria
[23] women were convinced that sexual inter-
course during pregnancy widens the vagina and
facilitates labor, and in a study realized in Iran [15]
women pointed fear of causing rupture of the
female fetus hymen or fetal blindness. Fok et al., in
a study of 298 Chinese pregnant women, reported
that over 80% of women and their partners
worried about the adverse effects of sexual activity
on the fetus [6].
Changes in the body image developed as preg-
nancy progresses. This change has an important
influence on women’s perception of pregnancy
and sexuality. Pauls et al. reported an impairment
in body image in pregnant women, although it did
not significantly change during the pregnancy
period [11]. In our study, 41.5% of the women felt
less attractive. However, 75% did not report
diminished sexual interest from their partner.
Bogren [7] found that sexual satisfaction
declined during pregnancy, 35%, 30%, and 56%
in the first, second, and third trimesters, respec-
tively. We did not analyze this parameter over
time, although 27.7% referred a decrease in sexual
satisfaction compared with the period before preg-
nancy. In our study, sexual desire was described to
be maintained (38.8%) or declined (32.5%). Other
authors have reported a more significant decrease
in sexual desire. Shojaa et al. [15] found a reduc-
tion in 73% of the 51 women studied, and Bar-
tellas et al. [2] found a reduction in 58% of the 141
analyzed women.
Erol et al., who analyzed 589 healthy women,
demonstrated that decrease in sexual function and
sexual desire, most commonly found in the third
trimester, was not associated with lower androgen
hormone (testosterone, dehydroepiandrosterone
sulphate, free testosterone) levels [24].
Concerning sexual dysfunctions, almost one-
quarter of women reported sexual dysfunctions,
such as low desire, dyspareunia, anorgasmy, and
difficulty in lubrication; many complained of more
than one sexual dysfunction. However, only 11.1%
of women felt the necessity to discuss sexuality
with their doctors. As Bartellas et al. found, the
majority of women was not always comfortable
raising this topic with doctors [2].
Our population seems to have good expecta-
tions about their sexual lives during the first 6
months postpartum, although published data
suggest a decrease in sexual life [8–11,25–29],
especially in women who were breastfeeding [30].
In a review, Reamy and White pointed some
reasons to explain it: episiotomy discomfort,
fatigue, vaginal bleeding, discharge, dyspareunia,
decreased lubrication, fear of awakening the baby
or not hearing him/her, fear of injury, and
decreased sense of attractiveness [31]. An increase
in sexual dysfunctions during the postpartum
period compared with pre-pregnancy is also
described [26,31,32]. Mostly, dyspareunia occurs
in women with assisted (vacuum extraction or
forceps) vaginal deliveries [33,34], particularly if
they had an episiotomy, perineal lacerations
140 Pauleta et al.
J Sex Med 2010;7:136–142

[33,35], or anal sphincter lacerations [29]. There is
a positive correlation between dyspareunia and
perineal lacerations degree [33]. Despite these
results, overall sexual dysfunction of men was not
affected by their partners’ parity and mode of
delivery [36].
There are some limitations in our study. We
only assessed sexual activities among women who
participate voluntarily in the study, and many
women refused to enroll. People are not used to
talk about their sexual lives, and many taboos
persist in our population, which are evidenced by
the number of women who did not answer some
questions of the questionnaire. In the question
about the types of sexual activities, we decided not
to specify whether oral sex was performed by man
or woman, as we felt that our population was not
prepared to answer this question, based on nega-
tive feedback from the pilot study. As most sexu-
ality researchers, another limitation of our study is
the fact that the data were self-reported and we did
not confirm the information with partners. More-
over, some bias could be found as it is a retrospec-
tive study and we did not use a validated
questionnaire.
As Basson explained, many interpersonal, per-
sonal, psychological, and biological factors cause
sexual dysfunctions [37]. A lot of these factors
change inevitably during pregnancy, explaining
the rise of sexual dysfunction as pregnancy
progresses. Changes in couple relationship,
marital adjustment, developing a parental relation
or consolidating a previous one, planned/
unplanned and desired/undesired pregnancy, first
pregnancy, history of previous pregnancies or
abortions, physical and hormonal changes that can
promote low self-image, mood instability, diffi-
culty and discomfort in performing vaginal sex,
modifications on neurotransmitters’ concentra-
tions, and so on may all influence the sexual life of
the couple in pregnancy.
Doctors play an important role and should
counsel all couples during prenatal care and preg-
nancy follow up. They should inform that physi-
ological and hormonal changes may promote
fluctuations in sexual desire and satisfaction, and,
consequently, in sexual performance, as we know
that couples who are experiencing sexual problems
are more likely to discontinue sexual activity. Also,
it is essential to reassure that sex is safe in healthy
pregnancies and could be done until the end of
that period, and that it does not necessarily have to
be finished with a vaginal intercourse. This infor-
mation may decrease anxiety, and enhance couple
relationship stability and sexual satisfaction. Fur-
thermore, this attitude increases empathic confi-
dence that can contribute to the couple looking for
clinical management when and if needed.
Acknowledgments
We would like to thank all the women that participated
and other contributors who made this trial possible.
Corresponding Author: Joana Rocha Pauleta, MD,
Departamento de Obstetrícia, Ginecologia e Medicina
da Reprodução, Hospital de Santa Maria, Av. Prof.
Egas Moniz, 1649-035 Lisboa, Portugal. Tel:
00351217805078; Fax: 00351217805621; E-mail:
jrpauleta@gmail.com
Conflict of Interest: None.
Statement of Authorship
Category 1
(a) Conception and Design
Joana Rocha Pauleta
(b) Acquisition of Data
Joana Rocha Pauleta
(c) Analysis and Interpretation of Data
Joana Rocha Pauleta
Category 2
(a) Drafting the Article
Joana Rocha Pauleta
(b) Revising It for Intellectual Content
Joana Rocha Pauleta; Nuno Monteiro Pereira; Luís
Mendes Graça
Category 3
(a) Final Approval of the Completed Article
Joana Rocha Pauleta; Nuno Monteiro Pereira; Luís
Mendes Graça
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