Sexual dysfunction and infertility | Sieve & Sieve

The other day, I watched the play “Fertile Days”, in which the actors presented tension, worries, various anxiety states, as well as feelings of helplessness that occur in infertile couples.

They created a forum where they shared their own experiences, pains, sufferings, encouraged themselves and others. They apostrophized the bad medical treatment and the endless “wandering” of patients and doctors, in the hope that the pregnancy would come true.

Sexual activity in people can be motivated by various factors, the need for pleasure, for closeness and connection, the desire to belong to someone, the expression of power, proving one’s sexuality, etc. One of the basic and most primitive motives in human evolution is the desire to have offspring.

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The unrealized desire to have a child can lead to various reactions, which depend on individual traits, social and cultural norms, medical conditions, etc., and include frustration, anxiety, sadness, anger, anger, depression, doubt about one’s own sexuality, social devaluation and insulation. In this way, the sexual act itself is deprived of procreative powers.

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The connection between the sexual behavior and functioning of partners, on the one hand, and their fertility, on the other hand, has several dimensions:

• Sexual dysfunctions that contribute to infertility;
• Clinical conditions that cause infertility and sexual dysfunction (comorbidity);
• Sexual dysfunctions that occur during the diagnosis and treatment of infertility;

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In all these cases, sexual dysfunctions can occur separately, in both women and men, and can influence each other.

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This is so taken for granted in practice, that sometimes medical experts forget to simply ask partners if they have sex and how their sex life is. It happens that only later, during assisted reproduction and the like, they find out that the partners did not have sexual intercourse and were ashamed to admit it.

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Religious upbringing and rigid sexual socialization often lead to wrong conclusions, that sex is bad, dirty, that it pollutes the soul and the like, and thus also to the avoidance of sexual activities.

Sometimes one or both partners have no sexual desire, which leads to their distancing, lack of sexual activities, and ultimately infertility. The lack of desire in men is conditionally speaking a little more dangerous, because women are in a state without desire, excitement, or orgasm to get pregnant (through sexual intercourse) by satisfying their partner’s needs. In men, without these conditions, there is no erection, and therefore no intercourse.

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Premature ejaculation, which occurs before penetration, also prevents the path to pregnancy. This type of premature ejaculation is not so common in the general population, but it is therefore common in infertile partners and is a possible cause of infertility.

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Vaginism in women, spasm of the vaginal muscles, where intercourse is not possible, is also not common in the population, but in women who cannot have children, it is probably more common.

In rare situations, it happens that some men have difficulty ejaculating in the vagina, so the sexual act is prolonged, becomes painful, etc., or even they are totally unable to ejaculate in the vagina (inhibited orgasm).

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Some couples may have various clinical conditions that contribute to infertility and at the same time cause sexual problems and dysfunctions:

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ENDOMETRIOSIS

This disease occurs during the reproductive years, in the form of endometriosis tissue outside the uterus that can cause pain and infertility. Endometriosis lesions can cause abdominal pain during intercourse, which is characterized not as pain during penetration, but as pain that is caused by pushing the penis.

Hiperprolactinemia

Endocrine disease that leads to menstrual cycle disorder and loss of ovulation. At the same time, patients may feel reduced sexual desire (not only in women, but also in men).

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Hypothyroidism

Endocrine disorder characterized by weight gain, depressed mood and lack of energy. Amenorrhea and loss of ovulation can also occur, which contribute to infertility, and at the same time, a reduced thyroid hormone level can lead to a reduced sexual desire.

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Chronic pelvic inflammatory disorder (PID) with adhesions

Some women develop chronic lower abdominal pain as a result of previous sexually transmitted infections with pelvic inflammatory disease. This can lead to deep dyspareunia (intense pain during intercourse).

Phimosis

A condition in men where the foreskin is tight around the glans penis (men cannot pull the foreskin down), so they can feel pain and swelling during or after intercourse.

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Varikocela

A condition where the veins in the scrotum around the testicles are enlarged, and can sometimes lead to discomfort during sexual intercourse.

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Knowing that you belong to the category of infertile people can have a strong negative effect on your own value system, your own body image, and your gender identity. As a consequence, various sexual dysfunctions may appear, the clinical picture and intensity of which may vary between sexes and between individuals, depending on previous self-concepts that are largely the result of innate and sociocultural factors.

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In both sexes, typical emotional reactions include shock and uncertainty, which can lead to loss of libido, difficulty arousing both male and female partners. Some people feel angry and frustrated and blame everyone who got pregnant, and it often seems to them that everyone around them will have offspring. All this leads to a state of increased tension and even aggression, which increases stress in partner life.

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On the cognitive level, these people are faced with an unrealized desire to have a child, so some of them lose their life perspective, significance, and meaning. What will life be like without a child? Often, both partners enter a vicious cycle of repeating irrational beliefs as reasons for their infertility.

I remember one person, who sought my help because of problems with sexual desire and erection. Before that, he and his partner came for some time to doctor Bojović (where I was also often present), to treat infertility naturally. Since they failed to achieve pregnancy at that clinic, they went to Germany for in vitro fertilization. When he came to me to solve his erection problem, his wife was in a different state (the IVF attempt was successful). During the interview, I asked him various questions, including WHAT DO YOU THINK ABOUT YOUR PROBLEM and IN WHAT SITUATIONS DOES THE PROBLEM OCCUR MOST OFTEN?

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He answered me:

– Everything started from the time when the baby was supposed to be made, then going to the doctor, first to Dr. Bojović without results, and later to Germany for in vitro fertilization… I have always seen myself as an alpha male and in the beginning everything was fine , when the spermogram indicated a large number of spermatozoa… But later it turned out that they were poorly mobile, and then my image of myself as a man was broken… Then also flyers with Viagra in clinics in Germany, in case you are impotent, even more contributed to my self-confidence being shaken…From a promiscuous man, I fell to a man who is afraid to have any “outings” outside of marriage…

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I thought that it might not be necessary to change my wife, because she gained a few kilos… There was a lot of forcing around the pregnancy, everything became mechanical… And those artificial conditions where you give sperm several times, regardless of your desire… It happened to me several times. to lose my erection during intercourse, and now I’m very scared… I masturbated several times a day using porn to prove to myself that everything is fine with me…

After taking an interview and taking his sexual history, it became clear that he had secondary erectile dysfunction with decreased sexual desire. Since he lived abroad and came without his wife, we did intensive psychosexual therapy for a week (one session each day), in order to restore his security.

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He felt very good that he could openly talk about his sex life, and he also emphasized how important psychological help is to couples struggling for offspring (in the West, psychosexologists work in fertility clinics). I gave him some homework related to arousal and conditions, as well as sexual exercises to do alone and later with his wife. After some time, he told me that he got a penis, that he is now much more relaxed and that his sex life has improved.

Some people believe that infertility is a punishment they deserve for all the bad things they have done, such as, for example, the abortion they had, the separation in the past, being unfaithful, etc.

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This can change their outlook on life, but also the concept of love and sexuality. Some people begin to think differently about themselves as sexual beings on the one hand, and as men or women on the other. This sometimes conscious, and even more often unconscious process can lead to a change in sexual needs that are perceived as “strange” or “foreign”.

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In some cases, only one of the partners is for the “pillar of shame”, in the sense of being less fertile or infertile. Then it can lead to a different reaction: feelings of guilt on the part of the patient, unspoken or openly shown reproach by the non-threatened partner, overprotective behavior by the healthy partner, etc.

Partners have to find a new balance, in relation to active and passive, close and far, dominant and dependent, etc. Again, this can lead to small changes that combined can affect the sexual function of one or both partners.

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The environment in which partners live can be an additional stress factor that can affect partners and sexual dysfunction. In cultures where fertility is a highly valued characteristic of a person, infertility means shame and there is enormous pressure on the infertile couple to meet social expectations and norms. This can eventually lead to the breakup of the relationship and the separation of the partners.

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In addition to basic medical assistance, partners also need psychological help and support, most often in the form of psychosexual therapy that establishes a new balance between partners, raises self-confidence, opens new paths and develops a flexible sexual story, which in the end again includes desire, excitement and orgasm, as the basic psychological condition through which offspring are reached.