Fertility and Sexual Problems

As fertility treatment continues sexual problems frequently arise. Often people who are experiencing infertility have sexual intercourse at times when one or both members of the couple are clearly not in the mood. Sex on demand is unromantic and often mechanical. Sex becomes something one must do to achieve the end goal, which is pregnancy. Both men and women, therefore, may develop sexual problems.One such problem is dyspareunia, which is genital pain that is associated with sexual intercourse, usually occurring during, but also possibly occurring before or after intercourse. Symptoms range from discomfort to sharp pain, and cause distress and interpersonal difficulty.At least one episode of male erectile difficulty has been reported in approximately 90% of men who are in fertility treatment. Erectile problems can infrequently or regularly occur.Hypoactive sexual desire, also known as inhibited sexual desire, may occur early, late, and/or intermittently throughout fertility treatment. One or both partners may begin to look at their sex life as a total failure, because it never leads to conception. Situational depression and anxiety are common reactions to infertility and individuals do not feel particularly sexy or attractive when their emotional state is negatively affected.Both men and women misread their partner's lack of sexual interest, and begin to feel ambivalent toward sex. Each may feel unattractive to his or her partner or may feel sexually inadequate. If either had a poor body image prior to being diagnosed with infertility, the likelihood that this will become more pronounced is high. This, in turn, may lead to a rigid or routine approach to sex that may cause additional problems for the couple.Guilt is another emotional reaction to infertility. The person with the physical problem leading to infertility may feel guilty that he or she is unable to provide his or her partner with a child. Guilt may also occur when one no longer desires sexual activity, even though it is the rule rather than the exception. There are many ways to stop the downward spiral, but more often than not, physicians and nurses do not inquire whether sexual problems are occurring during fertility treatment. You may need to be proactive and take responsibility for having this discussion with your doctor. A good source for referrals to mental health professionals who deal with sexual problems is the AASECT website: www.aasect.org where you can find a certified sexual therapist.
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3/29/09
by Judith E. Horowitz, Ph.D.