Sexual Dysfunction and Infertility

What is sexual dysfunction and how is it a cause of infertility?

Sexual dysfunction is an issue that prevents an individual from enjoying or wanting to have sex, which is most often related to sexual desire, arousal, orgasm or pain during intercourse. Any of these conditions can prevent effective resolution of sexual activity that might result in conception.

Sexual dysfunction is common and can occur in people of all ages, affecting as many as 30% of men and 40% of women, according to the American Society for Reproductive Medicine. It is even more common for couples dealing with infertility, as treatments such as in vitro fertilization (IVF) can bring on psychological and physical demands that trigger dysfunction.

Many factors can influence sexual dysfunction, including:

• Stress.
• History of sexual trauma.
• Psychological issues.
• Diabetes.
• Hormonal factors.
• Certain medications.
• Vascular factors (issues affecting blood vessels).

Causes and symptoms

The causes for sexual dysfunction can vary depending on the type of disorder category (see section on types below) but they all stem from physical and psychological factors. Issues with sexual function can result from physical causes including medical conditions such as cardiovascular disease, diabetes, kidney failure, liver failure, cancer and cancer treatment, and hormonal imbalances. Additionally, some medications such as antidepressants can have side effects that negatively affect sexual function.

Psychological issues such as stress, anxiety, depression, feelings of sexual inadequacy, marital or relationship problems and body image issues also contribute to sexual dysfunction. For couples undergoing infertility treatment the pressure of planned intimacy can cause the man or woman to avoid sex during non-infertile times and can lead to a loss of affection, leaving couples feeling tension or disconnected. In addition, timed intercourse can negatively impact sexual function by placing “pressure” on the patient or partner, and this can effect both erection and ejaculation in the male patient.

Symptoms

Symptoms in men include:

• Inability to achieve or maintain an erection for intercourse.
• Difficulty ejaculating (premature ejaculation, absent or delayed).

Symptoms in women include:

• Vaginal dryness or an absence of lubrication during sex.
• Inability to achieve an orgasm.

Symptoms in men and women include:

• A lack of sexual desire.
• Pain during intercourse.
• Difficulty becoming aroused.

Types of sexual dysfunction such as anorgasmia, erectile dysfunction, HSDD & dyspareunia

Some examples of female sexual dysfunction include difficulty reaching orgasm, loss of interest in sex, pain during intercourse and absent or decreased sexual thoughts and fantasies. Male sexual dysfunction includes erectile dysfunction, premature ejaculation, low testosterone and painful erections. The types of sexual dysfunction follow.

Desire disorders like hypoactive sexual desire disorder (HSDD)

Stress and relationship issues can affect an individual’s sexual desire and performance in both men and women. Hormonal changes can also be a factor in low libido for both genders. Increasing age, depression, anxiety, pregnancy and certain medications can also contribute to a decreased sexual desire.

Hypoactive sexual desire disorder (HSDD) comprises mental and physical sexual dysfunction in which women experience a lack of desire to have sex for at least six months, causing them significant emotional distress. It occurs in up to a third of adult women in the United States, and it also occurs in men to a lesser degree. Symptoms of HSDD are lack of spontaneous sexual fantasy thoughts, inability to remain interest during sex, decreased response to stimulation and reduced desire to initiate sex.

Arousal disorders like erectile dysfunction

The inability to achieve sexual stimulation is referred to as an arousal disorder. For men, erectile dysfunction (ED), which is when the penis cannot get or stay erect through ejaculation during intercourse, is the most prominent form of arousal disorder in men. According to a study, 52% of men experience some form of ED and that complete ED increases from about 5% to 15% between ages 40 and 70.

A woman can still desire to have sex but has trouble becoming aroused to engage in sex or difficulty maintaining arousal to complete intercourse effectively for conception. Women can experience vaginal dryness, decreased swelling of the clitoris and diminished vaginal lubrication. Men and women affected by arousal disorders may tend to avoid sexual contact with their partner.

Orgasm disorders such as anorgasmia

Orgasmic disorders occur when a man or woman experiences a delay or absence of orgasm after sexual stimulation, known as anorgasmia. These symptoms can be present even with arousal and continuous stimulation. Anorgasmia causes personal distress that can affect both a man’s or a woman’s desire to have sex due to dissatisfaction with sex.

Anorgasmia is more common in women and is thought to occur in about 8% of men. In men, an orgasm occurs when the man ejaculates sperm, though not all men ejaculate during orgasm. The role of orgasm in women isn’t well understood, but anorgasmia can lead to a woman’s disinterest in having sex.

Pain disorders like dyspareunia

Dyspareunia, or female pain during sex, is vaginal, pelvic or vulvar pain that gets worse before, during or after sexual intercourse. As many as 10% to 20% of U.S. women have it, though may women likely do not report it.

Dyspareunia can cause some women to avoid having intercourse timed to ovulation, which affects their ability to conceive. It can have an effect on the male partner who doesn’t want to cause pain and can result in problems with his sexual performance. Women more commonly experience lesser pain disorders with sexual arousal or stimulation caused by vaginal muscles tightening or insufficient lubrication.

Men also experience pain during sex, which can cause problems related to conception similar to those in women. Pain during sex in men can stem from deformities in the penis, foreskin problems, sexually transmitted diseases, skin disorders and other issues.

Female sexual dysfunction & male sexual dysfunction

According to a JAMA study, sexual dysfunction is more common among women (43%) than men (31%). However, it can affect any age and is more prevalent in those over 40 because it’s usually related to aging or a decline in physical health.

Women and men with a low quality of physical and emotional health are more likely to experience sexual dysfunction. Negative experiences in sexual relationships and overall well-being are also related to the condition.

For couples undergoing fertility treatment, the pressure to have planned sex and perform on demand, lengthy and sometimes painful tests, and anxiety can affect sexual performance.

Treatment for sexual dysfunction

Treatment usually involves more than one approach because symptoms of sexual dysfunction are often related.

Medications for men may help improve sexual function by expanding blood flow to the penis such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn) and avanafil (Stendra). For women, medications such as estrogen and testosterone can be used, but there is no medicine equivalent to Viagra available. Men and women with hormone deficiencies may benefit from hormone shots, pills or creams.

Therapy or psychological support can help to address mental health issues, sexual trauma and poor body image. Sex therapy with a trained professional, who can help individuals and couples resolve sexual issues while also providing relationship therapy, can be helpful. Behavior treatments through different techniques can help provide an understanding into harmful behaviors in the relationship. There are also other techniques aimed toward self-stimulation for treatment of problems with arousal and/or orgasm.

Devices and mechanical aids such as vacuum devices or mechanical and penile implants can help men with ED to achieve erections. Women do have a vacuum device approved for use but it can be expensive. For women who experience narrowing of the vagina or dyspareunia in which there’s pain in the pelvic or genital area during intercourse, dilators can be helpful by increasing the vaginal tissue elasticity and promoting successful penetration and intercourse.

Communication and keeping an open dialogue among partners are key to treating sexual dysfunction. Couples discussing their needs and concerns with each other while being willing to reach out and ask for help can put themselves on a path to a healthier sex life.

Sexual dysfunction can affect anyone, and this is notably true for couples undergoing treatment for infertility. It’s important for these couples to be aware that some type of sexual dysfunction is common and for them to actively accept support when it is needed to maintain the intimacy during this challenging time.