Problems with sexual desire, arousal, orgasm, or sexual pain disorders can contribute directly to infertility. This is understandable because, for example, a man who experiences low interest in sexual activity, difficulty obtaining or maintaining an erection through intercourse, or an inability to ejaculate will naturally take longer to achieve conception compared to peers without these concerns.

Apart from these clear-cut situations, there are many sexual conditions that may go unnoticed yet significantly affect a couple's ability to conceive. Approximately 5% of infertile couples report a sexual problem during their initial medical consultation.

Here is a non-exhaustive list:

• Problems with getting or maintaining an erection (erectile dysfunction).
• Diminished or absent sexual desire (low libido, asexuality, or losing interest mid-intercourse).
• Ejaculatory concerns: premature ejaculation (prior to penetration), delayed ejaculation, absent ejaculation, or retrograde ejaculation (semen entering the urinary bladder instead of exiting external channels).
• Painful ejaculation, which discourages sexual activity.
• Inability to complete intercourse (unconsummated marriage).
• Difficulty with sexual arousal in women, leading to insufficient lubrication and painful intercourse.
• Painful intercourse due to vaginal infections/conditions in women, or tight foreskin, short frenulum, or infection in men.
• Vaginismus (involuntary contraction of muscles surrounding the vagina, preventing penetration — a primary cause of unconsummated marriages).
• Infrequent or excessively timed sexual intercourse.
• Lack of awareness regarding optimal timing during the fertile window or effective coital techniques.
• Use of artificial lubricants or vaginal douches during intercourse that may harm sperm motility and viability.
• Psychosocial pressures:

  As the timeline to conceive lengthens, psychological stress builds for one or both partners:

  • Stress from undergoing repeated medical investigations, procedures, and treatments.
  • Psychological pressure from partners, well-meaning family members, or social circles.
  • Social pressure and overt remarks, which can significantly affect a woman's emotional well-being.
  • The pressure of having to perform or abstain strictly on a prescribed schedule.
  • Emotional stress, lowered self-esteem, guilt, anger, or helplessness experienced by the partner in whom specific subfertility factors are identified. Over time, these feelings can worsen existing sexual concerns.
  • Gradual loss of interest in intimacy due to despair following unsuccessful treatments.

As a result, many couples begin avoiding intimacy outside the fertile window. When the primary focus shifts entirely from shared intimacy to reproduction, sexual activity becomes less enjoyable, and partners may feel emotionally disconnected.

Infertility and subfertility are inherently distressing. Initially, they generate psychological stress, tension, anxiety, and emotions such as anger, resentment, inadequacy, depression, or marital strain. Over time, these factors can evolve into persistent sexual dysfunction or apathy.

Prescribed treatment schedules can induce performance anxiety by creating a sense of “sex on demand,” frequently leading to erection issues in men or arousal difficulties in women. A single instance of difficulty during intercourse can trigger a cycle of anxiety and fear of failure. Furthermore, avoiding intimacy on non-fertile days can introduce friction into the relationship. Addressing these underlying factors is key to improving both overall well-being and fertility outcomes.