When Sex Is No Longer Fun

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One aspect of infertility that often does not receive much attention is the effect infertility has on the sexual intimacy of the couple. Women can experience decreased sexual desire, lack of orgasm, or have pain with intercourse. Men can experience a decrease in sexual drive, inability to have an erection or premature ejaculation.  Pre-existing sexual difficulties may contribute to difficulty conceiving but the reverse is also true: difficulty in conceiving is associated with an increase in sexual difficulties. Forty-three percent of women and thirty-one percent of men who are being treated for infertility report one or more symptoms of sexual dysfunction.

For both men and women, psychological and physical factors may prevent them from achieving sexual satisfaction. Depression, anxiety and lowered self-esteem related to infertility and the other life stresses can have a negative impact on sexual function. Infertility treatments which can be intrusive can result in a diminished sexual desire. The couple’s focus on having intercourse at a prescribed time in the woman’s cycle can have the effect of diminishing the sexual experience. Both the pressure to have “sex on demand” rather than with the spontaneity of moment and the emphasis on conception rather than pleasure can result in decreased emotional satisfaction and intimacy.

Physical difficulties for women include vaginismus and pain with intercourse. Vaginismus is when the pelvic floor muscles contract such that vaginal penetration is painful. It is a non-voluntary muscle contraction and is triggered by the anticipation of pain. Vaginismus has both physical and non-physical factors. The good news is that vaginismus is highly treatable. Effective treatment approaches combine pelvic floor control exercises and self insertion of vaginal dilators. Working with a psychologist can also be helpful to identify the emotional factors that might contribute to vaginismus. An excellent website on a self-help program for vaginismus is: www.vaginisumus.com.

Pain with intercourse, not caused by vaginismus may be due to physical factors. Conditions such as endometriosis and uterine fibroids can be causes of the pain.  Surgical or medical treatment of those conditions can be successful in treating the pain. It’s important to let your physician know if you are experiencing pain, and the cause of the pain can be evaluated.

For men, the most common type of sexual problem is erectile dysfunction: when the penis does not become or stay firm. Erectile dysfunction is reported in about one-third of men. Medical conditions such as high blood pressure, diabetes, certain hormonal problems and depression can cause erectile dysfunction. Previous surgery that results in nerve injury can also be a cause. Penile erection is controlled primarily by Nitrous oxide. Nitrous oxide is the compound responsible for relaxing smooth muscles of blood vessels. When nitrous oxide is increased, it results in relaxation of the venous blood flow to the penis, which then results in engorgement and erection of the penis. Prescription medications such as Viagra and Cialis work by increasing nitrous oxide. While medications to treat ED are effective, life-style changes that can improve male sexual functioning can also be very effective. A diet low in sugar, weight loss and exercise all are associated with improved sexual function in men. Anti-oxidant vitamins may also be helpful. For an excellent self-help resource, go to: www.erectile-function.com

A first step in improving your sexual relations is being aware that your intimacy as a couple needs to be protected from the stresses of infertility. Letting your physician know that you are experiencing difficulties is also important. Resources and simple interventions can be highly effective in restoring a normal sex life for an infertile couple. Couples therapy, particularly with psychologists that specialize in sex therapy, can also be very beneficial. Sex together can be and should be fun and maintaining that aspect of your relationship is important beyond conception and having a family.

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