Clinical Review

Sexual problems associated with infertility, pregnancy, and ageing

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7183.587 (Published 27 February 1999) Cite this as: BMJ 1999;318:587
  1. Jane Read

    Sexuality and infertility

    Infertility may interact with a couple's or individual's sexuality and sexual expression in two main ways. Sexual problems may be caused or exacerbated by the diagnosis, investigation, and management of infertility (or subfertility), or they may be a contributory factor in childlessness. Any examination of a couple's difficulty in conceiving must include overt and clear questioning about their sexual activity.


    Embedded Image

    Fertility has always been vitally important in human society, and its absence can lead to anger, panic, despair, and grief, which may have several effects on sexual activity. (Photograph shows prayers being read before a lingam, the phallic symbol of Shiva, Hindu god of fertility)

    Responses to infertility

    In response to being unable to conceive, many people feel emotions such as anger, panic, despair, and grief, and these may have several effects on sexual activity. The stress of infertility and its treatment may be a cause of sexual difficulties for both the prospective father and mother.

    Intercourse may be avoided, with patterns of behaviour established, so that one or other partner is not reminded of the fertility problem. Postcoital tests or having to provide semen samples may result in a man feeling under pressure to perform, adversely affecting his erectile or ejaculatory ability. For some men, one or two failures during intercourse begins a vicious circle of fear of failure, with anxiety leading to further failures. Partners may also develop arousal difficulties because of anxiety or distress. Some individuals feel that their partner seems to want them only when there is a chance of conception, and sexual activity can then become a battleground for issues of power and control.

    Useful questions to elicit information

    • How have your fertility problems affected your relationship, including your sexual relationship?

    • Has anything changed in your sexual relationship since you have been trying to conceive?

    • How would you describe your sexual activity?

    • How …

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