infertility and sex
How does the experience of infertility impact our sex lives?
One in Four Couples
The World Health Organization estimates that one in every four couples in developing nations has been affected by infertility, an estimated 48.5 million people worldwide (Mascarenhas et al., 2012). While this number is based on the commonly used biomedical definition of infertility, “1 year of regular, unprotected heterosexual intercourse without conception” (Shreffler et al., 2018), infertility refers to so much more. Folx who engage in fertility treatment at home, in complementary and alternative practices, or in a medical setting using Assisted Reproductive Technology (IUI, IVF, and more) are a diverse group of people. Queer couples and families, those pursuing parenthood without a partner or partners, and many others depend on medical infertility interventions to help start a family.
Infertility and Sexual Satisfaction
A simple web search will result in a wealth of information about the process of commonly administered Assisted Reproductive Technology like IVF (In Vitro Fertilization) but less about how this process feels emotionally, affects relationships, and even less about how this affects a person’s sex life. Sex is intertwined with fertility, and sexuality is an important part of well-being. Healthy sexuality looks very different for each one of us, and the baseline for every person is unique. We do know that the experience of infertility does seem to lead to a decrease in sexual functioning and satisfaction, regardless of baseline. When a person loses connection to their sexuality, it can lead to some painful emotions, and potentially a loss of pleasure in life.
When sexual functioning and satisfaction is studied, data is often gathered around the following experiences for a person: arousal, desire, lubrication, orgasm, satisfaction with sexual experience, presence of pain, sexual self-esteem, relationship satisfaction, frequency and type of sexual contacts, external and internal shame, frequency of intercourse, and frequency of masturbation. This list is not exhaustive, but these are some ways that we can try to understand how a person is feeling sexually, and how they perceive their sexuality. When studies refer to sexual difficulty or dysfunction, this often means that study participants are rating some of the above areas as challenging, or not where they would want them to be.
Studies show that the experience of infertility is linked to an increase in stress, grief, anxiety, and depression in women (Zayed & El-Hadidy, 2020). Sex educator and researcher Emily Nagoski explains that stress and negative emotions, including anxiety and depression, can contribute significantly to sexual inhibition (Nagoski, 2015), which can change the arousal and desire process. Simply put, when we feel stressed, down, or preoccupied, we are just not in the mood. This is normal. Infertility also often brings complicated feelings around shame and identity. For many people, difficulty becoming pregnant is a surprise. This can impact self-esteem and the way a person perceives their abilities. In the same way that painful emotions can lead to difficulty accessing desire and arousal, so too can shame and a blow to self-worth.
The longer folx experience infertility, the higher the rates of sexual difficulty (Gabr et al. 2017). Additionally, women who are experiencing secondary infertility (those who have had one child but are having a challenge getting pregnant a second time) are also at a higher risk of sexual difficulty (Keskin et al., 2011). Assisted Reproductive Technology is an amazing way to help build families, however, the medicalization of infertility might miss some opportunities for common sense compassion. One only has to look to the common phrase “geriatric pregnancy”, a reference to those over the age of 35 hoping to conceive, to recognize some of the internal and external shame that might be associated with the medical model of treating infertility.
How to Reconnect with Sexuality and Pleasure
So what do we do now that we know that infertility can lead to a decrease in sexual functioning and satisfaction? If you have experienced infertility, it’s so important to understand that you are not broken. And if you have experienced infertility yourself, you are not alone! It is normal for stress to impact the connection we have with our sexuality, and it is common for difficult medical experiences to lead to a disconnect with our physical, somatic selves.
Introducing compassion, love, and kindness to our bodies and ourselves when coping with infertility is crucial. Working with an understanding of just how stressful and anxiety-provoking this process can be will allow us to take care of our needs, and to be patient and gentle when recovering from Assisted Reproductive Technology or additional infertility interventions. For some people, this process may even be traumatic. Knowing that research demonstrates that the experience of infertility can absolutely affect sexuality allows for a much less judgmental understanding of why we might be noticing some changes in our sex lives.
Set aside extra time for connection with your own sexuality or the sexual connection within your relationship. When things are tough, it is normal to need some extra time to release stressors, ease into our bodies, and relax into intimacy with others. Ask yourself what might help with that connection and relaxation - what are some ways that you might help yourself feel turned on? What are some ways that you might help yourself demonstrate compassion to your body? How might this work in your relationship?
Define, or perhaps redefine, pleasure in your intimate life. What feels good to you in your current moment? Too often we get stuck in very limited definitions of what sexual pleasure looks like. Especially when working towards pregnancy, the definition of sex can be very specific and purpose-driven. Expand this definition of sex and pleasure to include a diversity of types of connection, touch, and affection.
Thinking of you!
References
Boerma, T., Flaxman, S.R., Mascarenhas, M. N., Stevens, G. A., Vanderpoel, S. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. (2012). Plos Medicine. 9(12):e1001356. DOI: 10.1371/journal.pmed.1001356.
Greil, A. L. McQuillan, J., Shreffler, K. M. (2018) Responding to Infertility: Lessons From a Growing Body of Research and Suggested Guidelines for Practice. Family relations, 66(4), 644–658. https://doi.org/10.1111/fare.12281
El-Hadidy, M.A., and Zayed, A. A. (2020). Sexual satisfaction and self-esteem in women with primary infertility. Middle East Fertility Society Journal, 25:13. https://doi.org/10.1186/s43043-020-00024-5
Abdallaha, A. A., Belal, D. S., Dieba, A. S., Faridb, E. Z., Gabra, A. A., Omrana, E. F., Kotba, M. M. (2017). Prevalence of sexual dysfunction in infertile versus fertile couples. European Journal of Obstetrics & Gynecology and Reproductive Biology, 38-43. http://dx.doi.org/10.1016/j.ejogrb.2017.08.025
Baser, I., Coksuer, H., Ercan, C.M., Gungor, S., Karasahin, K.E., Keskin, U. Differences in prevalence of sexual dysfunction between primary and secondary infertile women. (2011). Fertility and Sterility Vol. 96, No. 5, 1213-1217. http://doi:10.1016/j.fertnstert.2011.08.007
Nagoski, E. (2015). Come As You Are : the Surprising New Science That Will Transform Your Sex Life. New York :Simon & Schuster Paperbacks.