/. Psychosom. Obstet. Gynecol.

15 (1994) 125-131

The couvade syndrome

S. Masoni, A. M a i o , G. Trimarchi, C. de P u n z i o and P. Fioretti

Department o f Gynecology and Obstetrics, University of Pisa, Pisa, Italy

Key words: COUVADE,

PREGNANCY
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ABSTRACT is no single word meaning the condition of being

a father-to-be, whereas by tradition women
The couvade syndrome can be considered to be the
receive all the attention during pregnancy.
psychosomatic equivalent of primitive rituals of initi-
Although scientific literature fails to deal with
ation into paternity. Various symptoms have been
issues somehow linking males with pregnancy,
described in the husbands of pregnant women with an
man, pregnancy and birth are connected events
incidence from 11 % to 65%. The most common o f
in mythology, primitive rituals and the imagin-
these are: variations in appetite, nausea, insomnia and
ation of modern
weight gain. Seventy-three couples with the women
Anthropology uses the term couvade to
in the last month of pregnancy were given a
define the different ritual behaviors fathers-to-be
For personal use only.

questionnaire; as a reference group, 73 men without

pregnant wives or children under 1 year of age were
taken. A n emotional involvement connected with
pregnancy was reported in 91.78% of the men. This
involvement was expressed as changes in sexual habits
in 87.67% of cases,fear and anxiety in 36.98% and
curiosity in 47.94%. W i t h the exception o f nausea,
physical symptoms were lessfrequent in the men with
pregnant wives than in those without pregnant wives.
These data cannot conjirm the existence of the couvade
syndrome with its own physical symptoms but we
think that some male experiences, which constitute a
peculiar imaginary and behavioral reality of thefather-
to-be, do exist.
INTRODUCTION
Paternity, according to G. Delaisi de Parseval,
among the territories studied by human sciences,
is still a dark continent, a little known zone,
particularly when attention is focused on that
strange binomial father-pregnancy . T o confirm
this, in the principal European languages, there
must follow in various societies in order to be
initiated into paternity. In this connection, Frazer
describes a prenatal or pseudomaternal form and
a postnatal or dietetic form of couvade4. In the
former, the father-to-be goes to bed and is
assumed to act out the labor pains, whereas his
pregnant wife goes on working till childbirth; in
the latter, the husband follows a strict diet and
child-protecting behavior4.Such rituals have been
repeatedly described in South America, Africa
and Asia6.
O n the basis of anthropological evidence,
many authors have pointed out a psychosomatic
equivalent in the experiences of the man of
modern Western civilization, which arise with
his wifes pregnancy.
Some authors9*have stressed the presence of
somatic problems in husbands with pregnant
wives, but the first accurate description was made
by Trethowan and Colon. The most common
symptoms were decreased appetite, toothache,
nausea, vomiting, colic pains, diarrhea, constip-
ation, insomnia, depression, irritability and

Correspondence to: Dr Stefan0 Masoni, Department of Gynecology and Obstetrics, University of Pisa, 67, Via Rorna,
56100 Pisa, Italy

125
 Couvade syndrome
weight gain, especially near the end of the
pregnancy". The incidence of the couvade syn-
drome ranges from 11%" to 20-25%l3.l4 to
65%'*.
Bogren reports an incidence of 19.5% assum-
ing as the defining criterion the presence of at
least two unrelated symptoms, which were absent
before pregnancy and disappeared after deliv-
e r ~ ' ~The
. highest incidence is in the third
trimester of pregnancy, especially during the last
month".'5.
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Other authors have found a higher incidence
in older men, in those more attached to their
own mother", in anxious men, in Blacks, in
the working class, in those experiencing an
unplanned pregnancy", and in those with a better
paternal-role preparation".
Without referring to a change in personality,
somatic trouble could be explained as a normal
defensive mechanism, a way to vent the birth-
related, unconscious, conflictual, ambivalent ten-
sion upon the body. Childbirth reproposes to the
husband a set of problems such as unresolved
mother dependence, paternal conflicts, old fra-
For personal use only.
ternal jealousy and the loss of an exclusive
relationship with his own wife and the consequent
condition of a third party left out. These factors
can all take part in the development of the
couvade syndrome".
It seems that modern man, without any social
role which stems from following a set of cere-
monials and prohibitions, searches for an indi-
vidual ritual to accede to the status of paternity.
Couvade is not the negation of paternity but
its fulfilment, 'a complex creative will acting in
unison with the pregnant woman'*'.
METHODS
Eight whole classes of Respiratory Autogenous
Training courses in our Department were ran-
domly chosen for this study. The classes had four
different trainers and a total of 73 couples. All
the women were in the last month of pregnancy.
The social parameters of the study group are
shown in Table 1.
In order to constitute a reference group, 73
men were selected from our acquaintances and
the patients' escorts at the Clinic. Men without
pregnant wives or children under 1 year of age,
whose age, number of children and educational
126
Masoni et al.
levels were comparable to those of the study
group were chosen.
Both the study group partners and the refer-
ence group men were given a multiple choice
questionnaire to fill in individually. The que-
stionnaire could also be filled in at home, but
couples were explicitly requested to do it separ-
ately. The questionnaire investigated sexual life
variations and the presence of 37 symptoms
during pregnancy. For each symptom a score
from 0 (absent) to 3 (severe) was used. Symptoms
were grouped into seven classes:
Gastrointestinal symptoms (loss or increase
of appetite, toothache, nausea, vomiting,
diarrhea, constipation, abdominal pain);
Weight variations (loss or gain);
Cardiac symptoms (feeling of chest pressure,
tachycardia);
Dermatological symptoms (hair falling,
itching, other dermatological symptoms);
Sleep disorders (insomnia, increased need
for sleep);
Psychic symptoms (feeling of well-being,
muscular tension, fatigue, irritability, anx-
iety, anguish, concentration difficulties,
affective lability, restlessness, sensitivity to
criticism, pessimism, feeling of inferiority,
phobias, impairment of initiative, attacks of
fear, feeling of unreality); and
Other symptoms (epistaxis, pollakiuria,
headache, other pains).
The results were analyzed by the t-test (Tables 2
and 3) and the t-paired test (Tables 4 and 5).
RESULTS
Pregnancy was desired by both partners in
72.60% of couples. Two couples stated that their
pregnancy was not desired; 91.78% of husbands
and 95.89% of wives stated that pregnancy was
emotionally very demanding (Table 2). Feelings
of curiosity about the pregnancy were reported
by 41.09% of wives and 47.94% of husbands;
78.08% of women and 75.34% of men were
happy about it, whereas fear and anxiety were
expressed by 49.31 % of the women and 36.98%
of the men. The differences between men and
J. Psychosom. Obstet. Gynecol.
 Couvade syndrome Masoni et al.

Table 1 Social parameters in study group and in reference group

Study group Study group Reference group
women men men
Average age (years) 29.53 f 3.36 31.81 f 3.10 31.56 f 4.42
Primary school (%) 1.36 2.73 2.73
Secondary school (%) 12.32 12.32 12.32
High school (%) 57.53 49.31 49.31
Degree (%) 28.76 35.61 35.61
Living together (years) 3.63 2.45 3.63 f 2.45 3.89 3.26
With children (%)
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15.06 15.06 15.06

Table 2 Feelings expressed towards pregnancy Table 3 Sexual habit changes in exDectant couoles
Women Men
(/) (%I
Unpleasantness 2.73 2.73 Sexual habit changes 86.3 87.67
Involvement 95.89 91.78
Frequency
Curiosity 41.09 47.94
decreased 68.49 69.86
Happiness 78.08 75.34
increased 6.84 4.1
Fear 49.31 36.98
unchanged 24.65 26.02
Baby as immediately real 19.17 20.54
Attraction
women were not significant (p > 0.05) (Table decreased 16.43 15.06
For personal use only.

increased 16.43 10.95

2)* unchanged 67.12 73.97
The feeling of the baby as a real entity started
at an average of 12.07 f 8.54 gestation weeks for Gentleness
men and 12.33 f 8.01 weeks for women, but 15 decreased 2.73 2.73
men and 14 women declared they had that feeling increased 54.79 50.68
unchanged 42.46 46.57
as soon as they found out they were expecting a
baby (Table 2). Fear of indelicacy* 24.65 45.2
Sexual habit changes during pregnancy were Fear of hurting* 24.65 46.57
-
revealed by 86.30% of wives and 87.67% of
husbands (Table 3). Attraction was mostly * p < 0.01; all others p > 0.05
unchanged and gentleness increased in about half
of the cases, but the frequency decreased for trimester), psychic symptoms (all through the
68.49% of women and 69.86% of men. Fears of pregnancy) and the total (all through the preg-
indelicacy and of hurting the baby were present nancy) (Table 4).
in almost half of the men, with a significant The most common symptoms in the men of
difference in comparison with the women (Table the study group were sleep disorders and psychic
3)* symptoms, especially anxiety and restlessness
Regarding the above-mentioned symptoms, (Table 4). Gastrointestinal symptoms (Class 1)
all of them had higher scores in the womens decreased as pregnancy advanced, while cardiac
group, except for restlessness (all through the symptoms (Class 3), dermatological symptoms
pregnancy), insomnia (first trimester), weight (Class 4), sleep disorders (Class S), other symp-
loss (second trimester), sensitivity to criticism toms (Class 7) and in particular psychic symptoms
(third trimester) and headache (second and third (Class 6) increased. Weight variations were more
trimester). Womens scores were significantly severe in the second trimester, but they decreased
higher for gastrointestinal symptoms (all through in the third trimester. The only significant vari-
the pregnancy), dermatological symptoms ations were for psychic symptoms (in the third
(second and third trimester), sleep disorders (third trimester compared to the first, p = 0.02, and

J. Psychosom. Obstet. Gynecol. 127

 Couvade syndrome Masoni et al.

Table 4 Study group symptom score per sex and pregnancy trimester
1st Trimester 2nd Trimester 3rd Trimester
Symptoms Men Women Men Women Men Women
Loss of appetite 1 31 0 5 0 8
Increase of appetite 6 50 5 54 6 42
Toothache 0 6 0 8 1 15
Nausea 8 96 4 21 2 16
Vomiting 1 44 0 15 0 10
Diarrhea 0 2 1 3 0 7
Constipation 3 32 2 33 2 33
Abdominal pain 4 8 2 10 1 18
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subtotal 23 269* * 14 149** 12 149****

Weight loss 0 10 4 1 1 1
Weight gain 9 41 8 74 5 65
subtotal 9 51 12 75 6 66
Feeling of chest pressure 0 11 1 15 7 33
Tachycardia 0 15 4 13 6 22
subtotal 0 26 5 28 13 55
Hair falling 3 11 3 13 3 8
Itching 2 5 2 8 6 11
Other dermatological symptoms 0 2 0 7 0 4
subtotal 5 18 5 28** 9 23***
Insomnia 8 6 15 16 17 52
For personal use only.

Increased need for sleep 13 89 9 33 19 50

subtotal 21 95 24 49 36 102*
Feeling of well-being 1 16 3 31 0 32
Muscular tension 3 8 2 13 9 16
Fatigue 5 26 6 17 11 91
Irritability 7 23 9 29 14 28
Anxiety 18 27 11 13 22 43
Anguish 0 14 0 6 0 20
Concentration difficulties 2 15 3 15 3 19
Affective lability 0 7 0 6 0 9
Restlessness 9 8 7 3 18 16
Sensitivity to criticism 6 7 3 4 14 11
Pessimism 2 9 0 11 0 11
Feeling of inferiority 0 0 0 6 0 4
Phobias 0 5 0 2 0 8
Impairment of initiative 0 0 0 2 0 11
Attacks of fear 0 7 4 5 1 9
Feeling of unreality 2 9 2 6 2 6
subtotal 55 181**** 50 169* * * * 94 334* * * *
Epistaxis 1 5 4 7 1 9
Po11akiuria 2 53 2 52 3 90
Headache 5 6 5 4 7 5
Other pains 1 16 1 22 3 16
subtotal 9 80 12 85 14 120
Total score 122 720* * * * 122 583* *** 184 849* ** *
* p = 0.04; **p = 0.02; ***P = 0.01; ****p c 0.01

128 J. Psychosom. Obstet. Gynecol.

 Couvade syndrome
compared to the second, p = 0.04) and for the
total (same variation with p = 0.01 and p = 0.02
respectively) (Table 4).
The most common symptoms in women were
gastrointestinal, pollakiuria and psychic symp-
toms, especially fatigue (Table 4).Gastrointestinal
symptoms decreased as pregnancy advanced,
while cardiac symptoms and others (Class 7)
increased. Weight variations and dermatological
symptoms reached their highest scores in the
second trimester, unlike psychic symptoms.
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Insomnia increased considerably as pregnancy
advanced, while the need for sleep was felt
especially in the first trimester. Significant vari-
ations were present for psychic symptoms (in the
third trimester compared to the first, p = 0.03
and compared to the second p = 0.04) and for
the total (in the third trimester compared to the
second p = 0.01) (Table 4).
Reference group men had higher symptom
scores than the study group men except for
nausea in the first two trimesters; the differences
were not significant with the exception of gastro-
intestinal symptoms (all through the pregnancy),
For personal use only.
psychic symptoms (all through the pregnancy)
and the total (all through the pregnancy) (Table 5).
DISCUSSION
The data show that an emotional involvement
connected with pregnancy was present in various
forms in 91.78% of the men. This involvement,
which was confirmed by the finding of changes
in sexual habits in 87.67% of cases, was mostly
connected with feelings of curiosity in men,
while fear was the prevalent feeling in women:
fear and psychic symptoms had high scores in
women especially in the first and third trimesters
which correspond to the assumption of the new
roles of pregnant woman and mother, and they
revealed a relative stillness in the central phase of
pregnancy, whereas in men these items had the
same trend, but much lower scores.
Besides curiosity, men seem to have a feeling
of respect for the new being, but they imagine
it rather than feel it. They are afraid of not being
gentle and of hurting the baby in the mothers
womb; they are more restless than their partners,
but substantially they suffer from fewer troubles
J. Psychosom. Obstet. Gynecol.
Masoni et al.
than non-expectant men, because they may be
more interested in feeling their baby than their
own body. The only exception, which might
be the only physical symptom of the couvade
syndrome in our research, was represented by
nausea, which in the first and in the second
trimesters had a higher score in study group men
than in the reference group, but it did not reach
any statistical significance.
However, nausea itself is the item with the
highest score in the womens group and therefore
the most frequently and clearly observed by the
father-to-be.
Even if these data cannot confirm the existence
of the couvade syndrome with its own physical
symptoms, we think that some male experiences,
which constitute a peculiar imaginary and
behavioral reality of the father-to-be, do exist.
Also for the father-to-be, pregnancy is a dynamic
moment, when he needs to cope with an imposed
set of changes in the individual and in the couple.
It seems that modern man feels a stronger and
stronger need to retrieve lost female values and to
reach the creativity archetype through pregnancy
and delivery. This is an evolving reality, a slow,
gradual and often unexpressed process with many
difficulties.
For many men, pregnancy and baby care are
no more an exclusive female heritage and they
naturally tend to maintain a separation from
them to uphold the traditional roles of man and
father.
The Italian context is still unable to cope with
the new requests of the individual and of the
couple: childbirth preparatory courses are scanty
and husbands rarely enter the delivery room. We
think that male pregnancy experiences should be
more attentively studied as a physiological issue;
gynecologists should be prepared to understand
not only pregnant womens troubles, but also
those of expectant couples.
ACKNOWLEDGEMENTS
The authors wish to thank Dr Sergio Vaglini,
physicist of the Faculty of Engineering, Univers-
ity of Pisa, for his invaluable support in the
statistical analysis.
129
 Couvade syndrome Masoni et al.

Table 5 Study group men vs. reference group men scores

1st 2nd 3rd Reference
Symptoms Trimester Trimester Trimester group
Loss of appetite 1 0 0 1
Increase of appetite 6 5 6 29
Toothache 0 0 1 16
Nausea 8 4 2 3
Vomiting 1 0 0 3
Diarrhea 0 1 0 14
Constipation 3 2 2 12
Abdominal pain 4 2 1 16
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subtotal 23* 14** 12** 94

Weight loss 0 4 1 13
Weight gain 9 8 5 31
subtotal 9 12 6 44
Feeling of chest pressure 0 1 7 14
Tachycardia 0 4 6 27
subtotal 0 5 13 41
Hair falling 3 3 3 29
Itching 2 2 6 21
Other dermatological symptoms 0 0 0 3
subtotal 5 5 9 53
Insomnia 8 15 17 39
For personal use only.

Increased need for sleep 13 9 19 57

subtotal 21 24 36 96
Feeling of well-being 1 3 0 45
Muscular tension 3 2 9 27
Fatigue 5 6 11 44
Irritability 7 9 14 71
Anxiety 18 11 22 50
Anguish 0 0 0 24
Concentration difficulties 2 3 3 35
Affective lability 0 0 0 19
Restlessness 9 7 18 47
Sensitivity to criticism 6 3 14 35
Pessimism 2 0 0 26
Feeling of inferiority 0 0 0 10
Phobias 0 0 0 10
Impairment of initiative 0 0 0 13
Attacks of fear 0 4 1 7
Feeling of unreality 2 2 2 2
subtotal 55*** 50*** 94** * 465
Epistaxis 1 4 1 10
Po11akiuria 2 2 3 15
Headache 5 5 7 44
Other pains 1 1 3 3
subtotal 9 12 14 72
Total score 122*** 122*** 184*** 865
* p = 0.03; **p = 0.01; ***p < 0.01

130 J. Psychosom. Obstet. Gynecol.

 Couvade syndrome
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