Sexual Dysfunction and Infertility
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You probably don't realize how many people have problems having sex. But sexual dysfunction is common: 43% of women and 31% of men report having at least one symptom. When a couple has an infertility issue, problems with their sexual relationship may become more pronounced because of the need to "perform" at specific times. Therefore, sexual activity may become an activity restricted for procreation rather than recreation. Because of this, sexual problems can arise.
What is sexual dysfunction?
Doctors divide normal sexual function into 3 phases: desire (you want to have sex), arousal (your body undergoes the physical changes that allow you to have sex), and orgasm. Sexual dysfunction occurs when your health, your relationship, or your ideas about sex cause problems in any of these phases. This is true for men and women. Pain during sex can also cause sexual dysfunction, especially for women.
Sexual dysfunction in men. The most common type of sexual problem in men is erectile dysfunction, which is when your penis does not become or stay firm. Many medical conditions can cause erectile dysfunction: high blood pressure, diabetes, blood vessel diseases, surgery that affects your bladder or genitals, nerve disease or injury, hormonal problems, depression. Certain medications can also cause erectile dysfunction.
Another common sexual dysfunction in men is ejaculatory dysfunction, which occurs when a man does not release semen during orgasm.
Sexual dysfunction in women. Women with sexual dysfunction may have low sexual desire, difficulty becoming aroused, or difficulty reaching orgasm. These disorders may be caused by many different physical or psychological problems.
Women may feel pain during sex, which is called dyspareunia. Many things can cause dyspareunia, including diseases such as endometriosis or those that affect a woman's external genitals. Some women have a pain disorder called vaginismus, a condition in which the muscles around the vagina spasm and cause the vagina to close.
How do doctors diagnose and treat sexual dysfunction?
Your doctor will do a physical exam and ask you questions about your medical and sexual history. Important chemicals in your body, called hormones, affect your interest in and ability to have sex. Your doctor may measure your hormone levels, to make sure that they are not too high or too low. Your doctor will ask you what medications you are taking, because some medications cause problems having sex.
Once your doctor knows what is causing your sexual dysfunction, you may need treatment. Medications or surgery treat physical or medical problems. If the problem is psychological or it has to do with your relationship, your doctor may suggest that you and your partner talk to a sex therapist.
Sexual dysfunction and infertility
Sexual dysfunction may cause problems getting pregnant (infertility). But trying to get pregnant may also cause sexual dysfunction!
A cause of infertility. If you are trying to get pregnant, you have to have sex at the right time. The right time for sexual activity is when the egg is released from the ovary (ovulation). Determining the time of ovulation by your partner's menstrual history or by the use of a urine test that becomes positive when the hormone that triggers the egg to be released can be detected. If you cannot or do not have sex near that time, the woman is less likely to get pregnant. If you only have sex once in a while because of low sexual desire or pain during sex, you may miss that important time for pregnancy. Men who have erectile dysfunction or ejaculatory dysfunction will not be able to get their partner pregnant.
A consequence of infertility. Infertility treatments can be stressful, intrusive, and emotionally demanding. As part of your infertility treatments, you and your partner may need to have sex at certain times, even if you do not feel like it. Some of the medications that you need to take as part of your treatment may make it harder to have sex.
All of these things can be bad for a couple's sexual relationship and may lead to sexual dysfunction. Because of the stress caused by the need for a male to "ejaculate on demand," some men may have erectile dysfunction. Both partners may have less sexual desire. Because these problems are related to your infertility treatment, you definitely should talk to your fertility doctor about them.
For sexual dysfunction and infertility
The American Society for Reproductive Medicine & Mental Health Professional Special Interest Group: www.asrm.org
For a list of local certified sex therapists
The American Association of Sex Educators, Counselors, and
For information and support groups
The American Fertility Association: www.theafa.org; 888-917-3777 RESOLVE, Inc: www.resolved.org; 888-623-0744