Sexual Dysfunction and Infertility

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

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

Some people find it challenging or embarrassing to talk about sexual dysfunction. However, it's extremely common, affecting as many as 30% of men and 40% of women. It's even more prevalent for couples with infertility, as treatments like in vitro fertilization (IVF) can come with psychological and physical demands that trigger dysfunction. Sexual dysfunction is nothing to be ashamed of, and an experienced fertility team can help patients effectively navigate it so they can grow their families. 

What factors influence sexual 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 of sexual dysfunction

Sexual dysfunction stems from various physical and psychological factors. Physical causes include 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 either partner to avoid sex during non-infertile times. This can lead to a loss of affection, leaving couples feeling tense or disconnected. Additionally, the pressures of timed intercourse can negatively impact both erection and ejaculation in the male patient.

Symptoms

Symptoms of sexual dysfunction in men include:

• Inability to achieve or maintain an erection for intercourse.

• Difficulty ejaculating (premature ejaculation, absent or delayed)

Symptoms of sexual dysfunction in women include:

• Vaginal dryness or an absence of lubrication during sex

• Inability to achieve an orgasm

Symptoms of sexual dysfunction in both men and women include:

• A lack of sexual desire

• Pain during intercourse

• Difficulty becoming aroused

Types of sexual dysfunction 

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 examples include erectile dysfunction, premature ejaculation, low testosterone, and painful erections. DIfferent types of sexual dysfunction include:

Desire disorders 

Stress and relationship issues can affect an individual’s sexual desire and performance. Hormonal changes can also cause low libido in both partners. 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 can also occur in men. Symptoms of HSDD are lack of spontaneous sexual fantasy thoughts, inability to remain interested during sex, decreased response to stimulation, and reduced desire to initiate sex.

Arousal disorders 

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. According to a study, 52% of men experience some form of ED and complete ED increases from about 5% to 15% between ages 40 and 70.

A woman can still desire to have sex but have 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 

Orgasm 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 partners’ desire to have sex.

Anorgasmia is more common in women than 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 

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 many 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 also have an effect on the male partner who doesn’t want to cause pain, resulting  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 and male sexual dysfunction

According to a JAMA study, sexual dysfunction is more common among women (43%) than men (31%). However, it can affect any one at any age and is more prevalent in those over 40 because of 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, as symptoms of sexual dysfunction are often related.

Medications for men, such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn) and avanafil (Stendra), may help improve sexual function by expanding blood flow to the penis. 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 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 beneficial. Behavior treatments can also help provide an understanding into harmful behaviors in the relationship. There are additional techniques aimed toward self-stimulation for treatment of problems with arousal or orgasm.

Devices and mechanical aids, such as vacuum devices or mechanical and penile implants, can help men with ED 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 increase the vaginal tissue elasticity, promoting successful penetration and intercourse.

Communication is key for treating sexual dysfunction. Couples who discuss their needs and concerns with each other and ask for help can put themselves on a path to a healthier sex life.