The Ceremony is a highly ritualised sexual act that high-ranking men (such as Commanders or Angels), their Wives and Handmaids undergo to conceive children. Given that Handmaids have little to no choice in taking part, it could be viewed as ritualised rape.
Prior to the Ceremony, the household gathers together for a reading of the Bible and prayer, lead by the patriarch of the house. During the Ceremony itself, everyone remains mostly clothed. It is designed to be as clinical and non-sensual as possible, as the purpose of the Ceremony is not sexual pleasure or intimacy, but the conceiving of children. The Wife and Handmaid must lie on their backs on the edge of a bed, with the Handmaid lying between the Wife's legs, her head against her abdomen, and her arms raised above her head to hold hands with the Wife whilst the man involved has intercourse with the Handmaid. This is to symbolise that they are "of one flesh" and alluding to the Bibical story of Rachel, Jacob and their handmaid Billah, who bore children for the barren Rachel "upon [Rachel's] knees". The man is not permitted to touch the Handmaid in any other way; Offred mentions that when Commander Fred tries to touch her face, it is considered improper. The nature of the Ceremony is very awkward and humiliating for all involved.
Afterwards, the Handmaid is meant to rest on the bed, with her feet propped up on a pillow to "increase the chances" of conceiving, whilst the Wife uses it as a time to reflect and pray in silence (although in the novel, a humiliated and frustrated Serena Joy orders Offred to "Get up and get out" instead as soon as the Commander has left). The Ceremony is intended to be the only time that the man of the household may have sexual contact with a Handmaid and, presumably his Wife, as well, though some men, such as Commander Fred, break this rule. The Ceremony is also the only sexual contact Handmaids are permitted as well; sexual relations at any other time, or with anyone other than the man they are assigned to, is considered 'fraternizing' and is sinful. Presumably, the same applies to Wives as well.
- It is unknown if lower-ranking men and their wives are also required to observe sexual relations as strictly or have some kind of ritual they must adhere to.
- It is unclear how the correct method of the Ceremony is enforced, as the only participants are the patriarch of the household, his Wife and their Handmaid. Therefore, it stands to reason that, should they be so inclined, they could potentially flout the regulations imposed by the Ceremony without anyone's knowledge, though, like many practices in the Republic of Gilead, it is possible that fear of God and damnation serves to ensure self-policing in regards to the Ceremony.