Sexual Problems in Infertility

What you should know and do!

Dr. Poosha Darbha, Ph.D

Problems with sexual desire, arousal and orgasm, sexual pain disorders can lead to infertility. This is understandable, because, for ex: a man who does not have interest in sexual activity, or one who cannot get or maintain erection through intercourse or one who cannot ejaculate semen is going to take a lot more time to conceive than his peer without these issues.  Apart from these clear cut cases, there are many sexual situations and conditions which go unnoticed, but have significant impact on the ability to bear a child. About 5% of all infertile couple report some sexual problem at the initial interview.

What are the common sexual problems that cause or exacerbate subfertility?

Here is a non-exhaustive list: 

• Problems with getting or maintaining erection (erectile dysfunction)

• Problem getting horny [diminished sexual desire (low libido), absent sexual desire (asexuality), losing interest halfway through]

• Too early ejaculation (even before penetration); delayed ejaculation; absent ejaculation; or retrograde ejaculation (semen being released into the urinary bladder instead of coming out)

• Painful ejaculation (it discourages the male from ejaculating)

• Never being able to indulge in sexual intercourse (unconsummated marriag

• Difficulty being aroused (women) – this means less or no lubrication and hurting intercourse

• Painful intercourse due to vaginal infections and conditions (women);
  due to tight foreskin, short frenulum or infection (men)

• Vaginismus (involuntary contraction of muscles around the vagina, closing the opening tightly, and making the penetration impossible – this is called vaginismus, a common cause of unconsummated marriage)        

• Infrequent or too frequent sexual intercourse

• Lack of knowledge about suitable coital positions/techniques and fertile period

• Use of artificial lubricants in intercourse, and/ or vaginal douches that may be detrimental to spermatozoa

• Psychosocial pressures: As it takes longer and longer for the couple to conceive, psychological stress builds in one or both the partners.

  • -   Distress of medical treatments, investigations and procedures

  • -   Psychological pressure from the partner, the well-meaning family members and neighbors

  • -   Social ostracizing and overt remarks play havoc on woman's in several Indian cultures

  • -   Having to perform or abstain from sex at the therapist's directions

  • -   The partner with whom factors contributing to subfertility are identified experiences more stress, lowered self-esteem and emotions like guilt, anger, resentment, helplessness. Over time they may affect sexual functioning or exacerbate the existing sexual problems.

  • -  Gradual loss of interest in sex due to mounting despair with unsuccessful treatments.

As a result, many people tend to avoid sexual intimacy during non-fertile period. As the focus is shifted from love-making to baby-making, sex becomes less enjoyable and couple may become more disconnected.

 Effects of infertility on sex:

Infertility and subfertility are distressing. Initially they cause psychological stress, tension, anxiety and emotional states like anger, resentment, inadequacy, depression, distrust in the partner and so on. In time they may progress to sexual dysfunction, marital stress, apathy etc. 

Treatment procedures impose performance anxiety and the need to do sex on demand which can lead to frequent problems with erections in men and arousal in women. One or two failures during intercourse trigger a vicious cycle of fear of failure followed by further failures. Women may tend to refuse sex on non-fertile days, leading to arguments and hostilities. These factors further complicate the subfertility problem.

Next: How you can help yourself