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Contributing Factors
Infertility
may be a contributing cause of sexual dysfunction. For example, sexual
function may be affected by infertility when investigations and treatments
alter a couple’s mode of sexual relations. Alternatively, a man may
feel excessive pressure to perform, which negatively affects his erectile
or ejaculatory ability when the couple tries to conceive.
Both men and women can develop
arousal difficulties because of the associated anxiety and stress of performing.
In addition, some partners may feel their self-worth compromised by being
sought only when conception is more likely. These stresses usually diminish
the pleasurable aspect of sexual expression and focus sex solely on reproduction.
Erectile failure during sexual intercourse due to pressure to perform
may begin a vicious cycle of fear of failure, with anxiety leading to
further failures. Consequently, men may experience loss of desire and
decreased sexual activity, erectile problems, premature ejaculation, or
delayed ejaculation. Women may experience loss of desire, vaginismus,
dyspareunia, or anorgasmia.
When clients first present
with infertility, providers should investigate the possibility of retrograde
ejaculation (ejaculation into the male urinary bladder), as well as the
possibility that the client does not fully understand reproductive functioning
and is engaging in sexual activities that are not associated with pregnancy—for
example, deposit of sperm into locations other than the vagina (e.g.,
rectum).
Pregnancy stimulates tremendous
changes within women and between couples. The changes may be a combination
of hormonal and physical changes, beliefs about the roles of motherhood
and fatherhood, accepted myths or taboos about sexual activity during
pregnancy, or feeling of unattractiveness.
Fears that sex will cause
miscarriage, premature labor, or fetal damage are very common. However,
studies have shown that there is no significant increase of fetal problems,
miscarriage, or premature labor in women who continue to be sexually active
throughout pregnancy. It should be noted that during orgasm, the uterus
contracts, and some women experience painful contractions after orgasm;
however, this does not lead to premature delivery.
Sexual difficulties may also
occur after delivery as a result of episiotomy or vaginal lacerations,
discomfort, breastfeeding, fatigue, sleep deprivation, or shifted focus
from the couple’s needs to that of the infant.
When a pregnant woman is
in danger of going into premature labor, any sexual activities that would
cause uterine contractions (e.g., nipple stimulation or activities leading
to orgasm) should be avoided.
© 2007 EngenderHealth
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