Clinical Review ABC of sexual health

Sexual problems associated with infertility, pregnancy, and ageing

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7465.559 (Published 02 September 2004) Cite this as: BMJ 2004;329:559
  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.

    Responses to infertility

    In response to being unable to conceive, many people feel emotions such as anger, panic, despair, and grief, and these may affect sexual activity. The stress of infertility and its treatment may also cause sexual difficulties for both men and women.

    Intercourse may be avoided, with patterns of behaviour established so that one or other partner is not reminded of the fertility problem. Post-coital tests or repeated need to provide semen samples may result in a man feeling under pressure to perform, which can adversely affect his erectile or ejaculatory ability. For some men, one or two failures during intercourse begin 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 people feel that their partner wants them only when there is a chance of conception, and sexual activity can then become a battleground for issues of power and control.

    Such stresses conspire to alienate couples from the recreational aspects of sexual expression and focus them, often obsessively, on the procreative aspect of sexual intercourse.


    Embedded Image

    Prayers being read before a lingham, the phallic symbol of Shiva, Hindu god of fertility. Fertility has always been vitally important in human society, and emotional reactions to infertility may affect sexual activity

    Sexual problems that result in infertility

    Childlessness may be the result of an existing sexual dysfunction. One study of infertile couples found that 5% had a history of sexual problems.

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