Sexual Problems in Infertility What you should know—and what you can do

Infertility can put unexpected pressure on sex and intimacy. Understanding this connection can help couples protect their relationship while trying to conceive.

When a couple has difficulty conceiving, most people naturally focus on medical causes: sperm count, ovulation, hormones, blocked tubes and so on.

But there is another side that is often overlooked—sex itself.

Problems with sexual desire, arousal, erections, ejaculation or painful intercourse can make conception difficult. A man who cannot get or maintain an erection, for example, may find it difficult to have intercourse at the right time. A man who cannot ejaculate, or a woman who finds intercourse painful or impossible, may face a similar difficulty.

And there is another complication: the stress of infertility can itself create sexual problems.

So the relationship goes both ways.

Sexual problems that can interfere with conception

Some are obvious, while others may not be recognised as fertility-related at first.

These include:

Erectile difficulties – difficulty getting or maintaining an erection sufficient for intercourse.
Low sexual desire – reduced interest in sex or losing interest during intimacy.
Ejaculation problems – including premature, delayed, absent or retrograde ejaculation.
Painful ejaculation – which can make a man reluctant to have sex.
Painful intercourse – for example, because of vaginal conditions, infections or other causes.
Difficulty with penetration – including vaginismus, where the muscles around the vagina tighten involuntarily and make penetration difficult or impossible.
Difficulty with arousal or lubrication – which can make intercourse uncomfortable or painful.
Difficulty completing intercourse – sometimes described as an unconsummated relationship or marriage.
Sex that is too infrequent – simply because the couple has little opportunity for intercourse during the fertile window.
Uncertainty about timing – some couples are unsure when intercourse is most likely to result in pregnancy.

These problems don't necessarily mean that either partner is medically infertile. Sometimes they simply make it difficult for a couple to have comfortable, regular intercourse when pregnancy is possible.

When sex becomes a scheduled task

This is one of the most common problems I see.

Initially, sex may be spontaneous, affectionate and enjoyable. Once a couple starts trying for a baby, however, everything can change.

"Today is the right day."

"We have to do it tonight."

"Did we miss the fertile window?"

"What if we don't have sex today?"

Suddenly, something that was once about pleasure and closeness becomes another item on the fertility timetable.

For some men, this pressure can make getting an erection difficult. For some women, it can make arousal difficult or increase discomfort. And once one disappointing experience happens, anxiety about repeating it can make the next attempt even harder.

Sex on demand is not always easy sex.

The emotional burden of infertility

As months go by without a pregnancy, the emotional pressure can become enormous.

There may be:

repeated investigations and treatments
pressure from family or friends
insensitive questions about when the couple will have a baby
guilt or self-blame
worry about disappointing the partner
embarrassment about being the partner with a fertility problem
fear about the future
disappointment after unsuccessful treatment
loss of confidence and self-esteem

All of this can affect sexual desire and enjoyment.

A man may think, "I am the reason we can't have a baby."

A woman may think, "My body is failing me."

Such thoughts can gradually enter the bedroom too.

When infertility starts affecting the relationship

Another common pattern is for couples to stop having sex except around the fertile period.

There may be little or no intimacy during the rest of the month because both partners become focused on the next opportunity to conceive.

Over time, sex can begin to feel like a medical procedure rather than an expression of affection.

The couple may also start talking almost exclusively about fertility—appointments, reports, medications, ovulation, sperm counts and treatment plans.

Without realising it, the relationship can become centred around having a baby rather than being a couple.

This is not anyone's fault. Infertility can consume enormous emotional energy.

But it is important to notice when it starts happening.

Don't let infertility take away your intimacy

Pregnancy may be the reason you are having sex more often, but it doesn't have to be the only reason.

Continue to hug, kiss, cuddle, touch and enjoy each other's company. Have dates. Watch a film together. Go for a walk. Cook together. Laugh together.

And, when possible, have sex because you want to—not only because an app, calendar or doctor says that today is the right day.

Your relationship deserves attention even while you are trying to build a family.

What can you do?

Don't blame yourself—or your partner

Infertility is a couple's problem, even when a specific fertility factor is found in one partner.

Blaming each other rarely helps. It can increase guilt, resentment and sexual difficulties.

Try to approach the situation as "us against the problem", rather than one person being responsible for it.

Talk openly about sex

If you are having difficulty with erections, ejaculation, desire, arousal or painful intercourse, talk about it.

Don't pretend everything is fine when it isn't.

And don't be embarrassed to tell your doctor. Sexual problems are common, and many are treatable.

Don't make every sexual encounter a fertility exercise

If possible, preserve some spontaneity.

Affection doesn't always have to lead to intercourse, and intercourse doesn't always have to be about getting pregnant.

Keeping some room for pleasure and closeness can protect your relationship during what may otherwise be a very stressful period.

Support each other

If your partner is upset after another unsuccessful cycle or treatment, sometimes what they need most is not advice but reassurance.

A simple "We'll get through this together" can mean a lot.

Try to spend time together that has nothing to do with fertility.

Keep living your life

Continue with your hobbies, friendships, exercise, work and other interests.

Infertility may be an important part of your life for a period of time, but it does not have to become your entire life.

Get help when you need it

You don't have to wait until a sexual problem becomes severe.

If anxiety, low desire, erection difficulties, painful intercourse or other sexual concerns are continuing, speak to your doctor or a qualified sexual-health professional.

Counselling or sex therapy can also be helpful when stress, anxiety, relationship difficulties or performance pressure are contributing to the problem.

Remember: you are not alone

Infertility can make a couple feel isolated, especially when everyone around them seems to be having children easily.

But many couples go through exactly the same emotional and sexual difficulties.

Most importantly, don't allow the struggle to conceive to make you lose the intimacy you already have.

A baby may be what you are hoping for, but your relationship is what you are living every day.

Look after both.