Journey of Desire: Sexuality and the infertile woman

by Susan Wilson, BScN, MBA
Summer 2007

 

Throughout history, female sexuality has either been celebrated or suppressed. Celebration of female sexuality was evident with the fertility goddesses of ancient civilizations, the Kama Sutra, and for those of us who remember, the glorious sexual revolution of the nineteen sixties! In turn, suppression has occurred by forced modesty and chastity. Chastity belts used as early as the 15^th century literally had fathers and husbands holding the key to a women’s virtue. Another classic example of sexual suppression was the attitude towards female sexuality evident during the Victorian era when Queen Victoria’s advice to her daughters before marriage was to “close their eyes and think of England” during lovemaking.

 

Female sexuality is influenced by many factors: culture, religion, and personal ethics certainly play a role. A woman’s body image and self-esteem are critical factors which influence her sexuality. Her personal history also contributes to her attitudes towards her sexual self, including relationships, sexual orientation and physical handicaps. There is much scientific literature regarding female sexuality in relation to various cancers, hysterectomy, urinary incontinence and menopause. However, there is very little scientific literature regarding infertility.

Female sexual dysfunction, with symptoms of loss of desire for sexual activity, negative sexual feelings, difficulty having orgasms, vaginal dryness and pain during intercourse is well documented. Some women experiencing infertility and its treatment will be all too familiar with these symptoms. So, what about the influence of infertility on a woman’s sexuality? Women are more powerfully socialized to the expectation of having babies than men so failure to conceive can often produce feelings of failure. In fact, some women report that infertility causes them to feel like “less of a woman” in terms of their sexuality. Consequently, failure to conceive can destroy self-esteem and self-worth.

 

Female sexuality is particularly affected when trying to get pregnant, during investigation and diagnosis, during infertility treatment and also during menopause. When trying to conceive, sex becomes an activity with a purpose rather than for pleasure. Engaging in sexual activity may feel pointless when it is unlikely to produce a pregnancy. Some couples “give up” their sexual relationship and rely on fertility treatments alone to conceive.

 

During investigation and diagnosis a woman may feel that sex is only a reminder of what was once pleasurable becoming degraded and public. Even submitting a basal body temperature chart into the doctor’s office is a very public declaration of having sex. With infertility treatment there is a more intense invasion of sexuality and the sexual relationship. Proceeding through various treatments often makes the woman feel that she is losing control, and if treatment fails, these are even more barriers to becoming pregnant. This can further intensify decreasing self esteem and influence a woman’s sexuality. The advent of menopause for women dealing with infertility may make women feel that they are relinquishing genetic motherhood particularly for those who have yet been unable to conceive.

 

While this may sound sad and discouraging there are ways of counteracting the negative effects of infertility on female sexuality. There is research to show that there are many benefits to sexual well being. Psychologically, sexual activity can produce heightened emotional awareness through the release of oxytocin. Semen itself has properties that can enhance female mood and create calm and happy feelings. Physical benefits include increased immunity, and the possibility of reducing pain caused by headaches and arthritis.

 

These significant benefits should prompt healthcare professionals to be sensitive to the needs of women experiencing infertility and its affect on their sexuality. Unfortunately, this can be overlooked in all the maze of testing and treatment. But there is an increasing awareness among healthcare professionals to listen for verbal cues and to use gentle probing questions to determine if a woman is experiencing sexual difficulties. Medical intervention may be helpful for symptoms experienced during fertility treatment, such as vaginal dryness (caused by oral fertility drugs) or painful intercourse. Psychological intervention is beneficial as well when a woman is experiencing loss of desire, negative thoughts or feelings during sex or difficulty attaining orgasm.

           

If you are a woman whose sexuality has suffered from the experience of infertility, what can you do? Open communication is a key factor between women and their healthcare professionals to resolve sexuality issues. Connecting with a psychological counselor or psychologist who specializes in infertility can be invaluable. Community resources include the Infertility Awareness Association of Canada (IAAC) and the Society of Obstetricians and Gynecologists of Canada (SOGC) who have an excellent website with information for patients regarding sexuality (www.sogc.org ).

 

If the experience of infertility has negatively influenced the sexual relationship between you and your partner, how can you renew intimacy? Again, communication is a critical first step in the sexual healing process. By going back to what attracted you to your partner when you first met and reintroducing the dating phase in your relationship romance often ensues. A beneficial approach to renewing intimacy can be to avoid any sexual encounters for the first few “dates”. Then, gradually progressing with sexual activity for the next several encounters but refraining from intercourse until both partners are feeling sexually comfortable.

 

An increasingly popular approach to sexual well being is Tantric sex derived from an ancient Indian spiritual philosophy that sensual joy is to be celebrated, but is not the end purpose of sexual activity. Tantric sex is described as a journey of body, mind and soul. One tenet of Tantric sex is that a woman love her body. This is important for women who are experiencing infertility and feel that their body has “let them down” or feel disassociated from their own body as a result of infertility investigations and treatments.

 

For women who are feeling their sexuality has suffered as a result of infertility there are two things they should know. First, you are not alone. Many women are also experiencing the same difficulties. Second, there is help available, and by connecting with the right resources you can restart you own journey of desire.

 

Susan Wilson, BScN, MBA has been in reproductive health for over 30 years. Currently, she is the Program Director of the UBC Centre for Reproductive Health where she has been a member since 1995. She has been actively involved in the promotion of public education regarding infertility and particularly enjoys speaking to high school and university students. She is an ardent proponent of the Hope Fertility Fund and “hopes” to have the fund assist many more people in their quest for a family.

 

Batataglia, A.R., Graziano M.R., and Scafidi, M.G., (1993) Experimental research into the changes in the way sexuality is experienced by the infertile woman. Acta Europia Fertilatis, 14 (1), 67 – 73.

 

Lee, T., Sun, G.,, Chao, S., (2001). The effect of infertility diagnosis on the distress, marital and sexual satisfaction between husbands and wives in Taiwan. Human Reproduction 16 (8), 1762 – 1767.

 

Monga, M. Alexandrescu, B. et al (2004). Impact of infertility on quality of life, marital adjustment & sexual function. Urology 63 (1), 126 – 130.

 

Moser, C. (2006). Demystifying alternative sexual behaviors. Sexuality, Reproduction & Menopause. 4 (2), 86 – 88.

 

Read, J. (1999). ABC of sexual health: sexual problems associated with infertility, pregnancy, and ageing.  British Medical Journal 318 (7183), 587 – 589.