What's Love Got To Do With It?

When Problems With Fertility Affect Couple Intimacy & Sexual Functioning

by Leanna Zozula, Ph.D.

Winter 2008

Ever since Tara was a girl, she dreamt of getting married and having a family. When she married her husband, Trevor, they had discussed children and both agreed that they wanted two, maybe even three, if they could afford it. Tara and Trevor waited about two years before starting their family, to give themselves enough “couple time” before the disruption and sacrifice of having kids. After several months of trying, they wondered whether something might be wrong.

That was four years ago. Since then, they have undergone three unsuccessful IUI procedures, two IVF cycles and a miscarriage. Like so many couples, they never dreamed they would have problems with fertility. After all, Tara watches her weight, eats healthy and does not smoke. Trevor is physically active. They are the typical couple in many ways except that they are unable to conceive.

They are one of the about 15% of Canadian couples who experience problems with fertility.

Emotional Roller Coaster Ride Can Affect Intimacy

The standard medical definition of infertility is the inability to conceive while a couple is having regular, unprotected sex for 12 consecutive months. Infertility could also be defined as a chronic, unpredictable and uncontrollable stressor that can take its toll on a couple’s ability to cope and quality of life.

Many use the metaphor of an emotional roller coaster ride to describe how individuals cope with their infertility. This metaphor also describes the emotional ups and downs that come with anticipation of a pregnancy test result and devastation if the result is negative. Further, even if success is achieved and the woman becomes pregnant, a new series of worries and concerns emerge over whether everything about the pregnancy is fine and whether the baby is healthy.

These intense and wildly shifting emotions can wreak havoc on the expression of love in the bedroom. This, in turn, can often interfere with the goal of baby-making. In couples that do get pregnant, there is a fear that sex could somehow harm the developing fetus.

Infertility Testing

Whenever a couple turns to medical testing in the search for a cause for their fertility problems, there are four possible scenarios: 1) problems with fertility are detected in the man; 2) problems with fertility are detected in the woman; 3) problems with fertility are detected in both the man and woman; 4) the diagnosis is unexplained infertility, where no known medical reason could be found given the technology available.

When Tara and Trevor underwent infertility testing several years ago, Trevor was found to have a low sperm count. Tara’s tests were found to be normal.

Effects of Infertility on Intimacy and Sexual Functioning

Receiving a diagnosis of infertility can affect how individuals perceive themselves sexually. This can negatively impact lovemaking on many levels. Studies have demonstrated that problems with fertility can lead one or both partners to experience decreases in sexual desire, frequency of intercourse, foreplay, arousal and orgasm.

Not only can lovemaking be negatively impacted, but some infertile couples also suffer from various sexual dysfunctions. Sexual dysfunctions can include impotence, premature ejaculation and a lack of (rather than just a decrease in) desire to have sex. In many cases, the sexual dysfunction first appears after a diagnosis of infertility.

Other ways that infertility can negatively affect intimacy and sexual functioning include:

scheduling of intercourse takes the spontaneity out of sex
a decrease in self-esteem due to an infertility diagnosis interferes with a desire to engage in sex
viewing sex as a chore or a clinical act reduces the pleasurable aspects of lovemaking
allowing sex to become a method to inseminate makes us forget it is an expression of love
the sexual act serves as a reminder of infertility, especially if medical procedures are incorporated into the process (monitoring body temperature, for example)
technical questions about the sexual act asked by medical staff feel like invasions of privacy
feeling alienated from fertile couples or having a sense of social stigma discourages some couples from even trying to conceive
the feeling of loss of control and direction over their destiny leaves some individuals feeling hopeless

Trevor’s diagnosis of a low sperm count made Trevor feel less masculine, and this in turn decreased his desire to have sex with Tara. Tara felt rejected and unloved by Trevor.

A Crash Course to Boost Intimacy

After years of fertility treatments, Tara no longer felt special and loved by her husband and Trevor was basically uninterested in having sex with Tara. The couple decided to consult with a psychologist specialized in helping couples with fertility problems. Their goals for therapy were to reawaken their romance and to reconnect sexually. The technique of Sensate Focus was explained to them.

Sensate Focus aims to build intimacy and desire while removing the pressure to perform sexually. The goal is to explore and pleasure your partner, and rekindle intimacy with each other. Specifics of the technique are discussed in the psychologist’s office and questions are answered. Then the couple goes home to practice what they have learned. The first few sexual encounters involve pleasuring one another without engaging in intercourse. The ban on intercourse helps to reduce anxiety and to alleviate the pressure to perform, or try to make a baby. Creativity is encouraged, and all senses can be used.

Eventually, the goal of the Sensate Focus exercise is to engage in sexual intercourse where both partners feel aroused, both partners orgasm and the sexual experience is pleasurable for both. The goal was for Tara and Trevor to enjoy sex and feel closer to one another, and the couple was pleased to find out that conception is more likely if the woman orgasms.

How a Psychologist can Help

Therapy with a psychologist specializing in infertility issues can help with many of the challenges an infertile couple faces. These include

decisions on when to start or stop treatment
what treatment options or alternatives are right for you
coping with the stress of medical procedures, waiting and setbacks
marital difficulties
reducing stress, anxiety and depression
problems with intimacy
sexual dysfunction

Tara and Trevor are still hoping to conceive their own child. After consulting with a professional, they now have a realistic plan with a timeline. They also have a backup plan if the current fertility treatment fails. Both feel less stressed overall. Tara better understands Trevor’s way of coping with their infertility, and Trevor now knows what to say to lift Tara’s spirits. Trevor initiates sex more often and has learned different ways to express his love for Tara. And while they wait to have a child of their own, they have never felt closer to each other.

Recommended Readings

For Each Other: Sharing Sexual Intimacy by Lonnie Barbach, Garden City, NY, 1983.

Conquering Infertility by Alice Domar & Alice Lesch Kelly, New York, 2002.

The New Male Sexuality, Revised Edition by Bernie Zilbergeld, New York, 1999.

Dr. Leanna Zozula is Clinical Director of PsyMontreal, and a licensed clinical psychologist specializing in infertility and other reproductive mental health issues, such as perinatal mood disorders. For more information, you can contact her at 514-337-2473, extension ,3 or visit the clinic’s website at www.PsyMontreal.com

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