Couvade syndrome

Couvade syndrome also called sympathetic pregnancy, refers to the various physical symptoms of varying intensity and severity experienced in expectant fathers ¹⁾, for which there is no explanation during the period of the transition to parenthood ²⁾. Couvade syndrome is the common but poorly understood phenomenon whereby the expectant father experiences somatic symptoms during the pregnancy for which there is no recognized physiological basis ³⁾. Couvade syndrome symptoms commonly include indigestion, increased or decreased appetite, weight gain, diarrhea or constipation, headache, and toothache. Onset is usually during the third gestational month with a secondary rise in the late third trimester. Symptoms generally resolve with childbirth. Couvade syndrome has been seen as an expression of somatized anxiety, pseudo-sibling rivalry, identification with the fetus, ambivalence about fatherhood, a statement of paternity, or parturition envy. It is likely that the dynamics of couvade may vary between individuals and may be multidetermined ⁴⁾.

Couvade syndrome is not listed as a diagnostic category in the American Diagnostic and Statistical Manual of Mental Disorders or the World Health Organization’s (WHO) International Classification of Diseases. In addition, Couvade syndrome is not described or discussed in many medical textbooks, although a few handbooks in family practice mention it as a condition of unknown cause.

Couvade syndrome is best examined from the anthropological perspective. The term “couvade” (from the French “couver,” meaning to brood, to hatch) was first used by the anthropologist Edward Burnett Tylor in 1865 to describe the child expectancy habits that he had observed among smaller scale communities ⁵⁾. Couvade syndrome is used to describe a man’s empathic responses to his wife’s pregnancy ⁶⁾.

Based on the data analysis, the prevalence of Couvade syndrome among the participants in a study was very high compared to elsewhere. For example, the prevalence of Couvade syndrome in the UK has been estimated between 11% and 50%, although it should be noted that all the data are some decades old ⁷⁾. In Australia, the proportion of expectant fathers presenting symptoms of Couvade syndrome is 31%, in the United States it is between 25 and 52%, and in Sweden it is 20% ⁸⁾, while in Thailand an estimated 61% of expectant fathers are reported to have Couvade syndrome ⁹⁾. In Poland, 72% of expectant fathers experience at least one of the signs of Couvade syndrome during their wife’s pregnancy ¹⁰⁾. However, in some international studies ¹¹⁾, the presence of only two symptoms is deemed sufficient to denote the presence of Couvade syndrome.

Most diagnoses are made by the exclusion of physical causes and the condition is self-limiting because it tends to resolve after childbirth ¹²⁾. In a study published in 1983, it was concluded that men’s symptoms are a reflection of their level of attachment to the unborn child and involvement in the pregnancy ¹³⁾. Men who have prepared for their parental role, for example by making antenatal visits, report a higher susceptibility to being afflicted by Couvade syndrome ¹⁴⁾. According to attachment theory, the man’s closeness to the fetus gives rise to the Couvade syndrome ¹⁵⁾.

Couvade syndrome causes

Couvade syndrome cause is unknown. Couvade syndrome (sympathetic pregnancy) is an involuntary disorder whereby an expectant father experiences physiological and/or psychological symptoms for which there is no explanation during the period of the transition to parenthood ¹⁶⁾. Couvade syndrome is distinguished from other syndromes by its time course, commencing in the first trimester, temporarily disappears in the second trimester, and emerges again with greater severity in the third trimester and the fact that it is not caused by illness or injury ¹⁷⁾. In a study published in 1983, it was concluded that men’s symptoms are a reflection of their level of attachment to the unborn child and involvement in the pregnancy ¹⁸⁾. Men who have prepared for their parental role, for example by making antenatal visits, report a higher susceptibility to being afflicted by Couvade syndrome ¹⁹⁾. According to attachment theory, the man’s closeness to the fetus gives rise to the Couvade syndrome ²⁰⁾.

Several investigators have reported that the Couvade syndrome is related to various psychosocial factors such as anxiety in expectant fathers; empathy to total identification with the expectant mother as a somatic expression of anxiety; ambivalence about fatherhood and symbolic representation of deeper conflicts; the view of the fetus as a rival for the mother’s attention and a regressive manifestation of the narcissistic injury of losing his position as a “favorite;” paternity issues; roots of fatherliness that develops secondarily to motherliness from the biological dependence on the mother to the biological sexuality as sources of fatherhood; sexuality and gender identity issues as an activation of a passive femininity; parturition envy as the male’s envy of the female’s ability to bear and give birth to children; defense against aggressive impulses as a self-inflicted punishment for his feelings of aggression toward the unborn child; all mostly psychodynamic in nature ²¹⁾.

There is evidence suggesting that these shifts in behavior in males are mediated by physiological changes similar to those seen in pregnant females that induce parental care. Increases of prolactin and decreases of testosterone are associated with paternal behavior. Also, estradiol levels in men peak in the late prenatal period while cortisol levels increase immediately before birth in both men and women with up to a 75% increase from baseline ²²⁾.

Couvade syndrome symptoms are most likely the result of men’s desire to participate, to be more a part of the pregnancy, which will, after all, transform their life ²³⁾. While their wife is pregnant, they are preparing for their new role as a father. Overall, research findings could be explained by both the emotional contagion within couples and the general eagerness of fathers to have children as soon as they get married. Although expectant fathers are expected to be actively involved in their wife’s pregnancy, they receive little guidance on how to do so. In a previous study, Mrayan et al. ²⁴⁾ reported that the major goal behind getting married is to have children and create a family. Some decades ago, Weaver and Cranley ²⁵⁾ found a positive association between paternal–fetal attachment and the incidence of physical symptoms resembling pregnancy in the expectant father.

Couvade syndrome symptoms

Couvade syndrome fathers complained of leg cramps (55.8%), increased appetite (55.8%), stomach distention (49.2%), nausea and abdominal pain, weight gain (45.2%), loss of concentration (44.2%) and lack of motivation (42.7%). The least experienced signs, but which were still significant, were sleeping less than usual (35.2%), feeling frustrated (28.7%), and for some sleeping more than usual (23.1%). It has been suggested that these symptoms mimic the pregnant woman’s nocturnal restlessness as pregnancy progresses ²⁶⁾. Usually, couples share a bedroom and a bed, which also may explain men’s vulnerability to sharing their wife’s sleep disturbances during pregnancy. All these reported signs are also very common and considered normal physiological changes in pregnancy ²⁷⁾. These findings are consistent with those reported by Ganapathy ²⁸⁾ who investigated the frequency of Couvade syndrome symptoms among first-time expectant fathers in India. His results revealed that the most commonly reported physical symptoms are related to gastrointestinal disturbances such as changes in appetite, constipation, flatulence, indigestion, nausea, diarrhea, and abdominal pain ²⁹⁾. Another notable result from a study was that toothache was one of the symptoms commonly experienced by the men during their wife’s pregnancy (43%). Steel ³⁰⁾ states that if a patient presents with unexplained toothache and has a pregnant partner, particularly if other unexplained symptoms are also present, perhaps the possibility of Couvade syndrome should be considered. Many years ago, Trethowan ³¹⁾ identified that more toothache is recorded among expectant fathers compared to a matched control.

Table 1. Frequency of physical symptoms of Couvade syndrome among married males

Table 2. Frequency of psychological symptoms of Couvade syndrome among married males.

Couvade syndrome treatment

Couvade syndrome is normal for the expectant fathers to experience some discomforts during their wife’s pregnancy and it is not considered an illness. Expectant fathers need to know that Couvade syndrome is not a rare or unusual occurrence. In addition, health-care providers need to start monitoring the health status of expectant fathers, and armed with a better understanding of the variety of responses normally experienced by expectant fathers during their wife’s pregnancy, health-care providers will be better able to provide them with the necessary support and education to help them through this transitional period.