Part of my work has involved counselling with couples who are undergoing assisted reproduction such as IVF, donor sperm insemination, and donor egg and embryo use.
From this work I have noticed some key things about sex and reproduction:
- Sex can be unproductive;
- Reproduction can be unsexy; and
- Reproductive treatment can be downright sexually demoralizing.
And these things play out in different ways for different people:
Some couples present for IVF due to a sexual difficulty that is impacting their ability to conceive.
Meanwhile, others find that their previously enjoyable sex life has been taken over by a range of reproductive stresses such as timed sex, increased pressure to “perform”, medications and hormones, and the roller coaster of emotions experienced during infertility and assisted reproduction.
Lastly, after spending so much time focusing on reproduction, couples who finish treatment can come out the other end feeling unsure how to redefine sex as just sex again.
Common sexual difficulties that can interfere with efforts to conceive
There are a range of sexual issues that can create conception difficulties:
Difficulties gaining/maintaining erections – This is very common, and erectile difficulties can unfortunately be exacerbated by the pressure to perform whilst trying to conceive.
Pain during sexual activity – Many people suffer from pelvic pain conditions that limit their ability to engage in intercourse without substantial pain. These conditions include vaginismus, vulvodynia, vulvar vestibulitis and pudendal neuralgia. Other types of pain may also impact sex, such as chronic back pain or migraines.
Difficulties ejaculating during intercourse – While more attention is given to rapid ejaculation, delayed or inhibited ejaculation occurs when someone is unable to consistently (or ever) ejaculate during intercourse.
Rapid ejaculation – Some people with rapid ejaculation are unable to make it to vaginal penetration, and therefore sperm is not making it to the right place for reproductive purposes.
Lack of sexual knowledge – Very poor sex education, misinformation about anatomy and sex, and limited knowledge on reproduction can lead to non-reproductive sex. Examples include a lack of knowledge about ovulation or mistaking the anus for the vagina.
Common sexual problems that may arise during infertility and assisted reproduction
Performance anxiety – Couples can find that the pressure to sexually perform, such as during timed sex or when taking fertility drugs, can give rise to a range of sexual difficulties such as erectile issues, painful sex, difficulties achieving arousal and orgasm, and rapid or delayed ejaculation.
Reduced sexual enjoyment and satisfaction – With an increased focus on sex for reproduction, couples may find that they put less effort into sex being pleasurable and fun, and that sex therefore becomes routine, mechanical and unsatisfying.
Decreased sexual desire/interest – With repeated attempts at timed sex and treatment cycles, sex itself often becomes a symbol for failure and disappointment. Pair this with decreased sexual satisfaction, and it is very understandable that both people can lose their appetite for regular sexual intimacy.
Avoidance of intimacy and sexual contact – During this time of stress and emotional ups and downs, one or both partners may choose to avoid sexual contact altogether. When people try to avoid sexual contact, it is not uncommon for them to also avoid all forms of physical affection in case it may lead to sex.
Conflict around sex and intimacy – Changes in a couple’s sexual routine can lead to feelings of rejection, confusion and guilt. While good communication around this can be very helpful if broached sensitively, these changes can often be a source of conflict and friction.
Strategies for managing sexual difficulties during infertility and assisted reproduction
Here are some suggestions for couples struggling with sexual intimacy during this difficult time:
- Communicate together about what aspects of your intimate life are going well, and what areas are becoming difficult or unsatisfying. Talking about sex may be awkward at first, but communication really is a key factor in a sustainable sex life that can navigate life’s challenges.
- Focus on nurturing your relationship as a whole – for example, have regular date-nights, give each other compliments, show physical affection, surprise each other with small gifts, do extra chores and reminisce about positive memories together.
- Make time for sexual and non-sexual intimacy. Non-sexual intimacy may include hand holding, cuddles, massages, back rubs and kissing that does not lead to sexual activity. To read more about the getting this balance right, go here.
- Set certain times when you both try to take the focus away from sexual performance and reproduction, and refocus on sexual connection, intimacy, pleasure and fun.
- Eat well, exercise and get a decent amount of sleep.
- Take a brief vacation from sex – some couples need a time out from focusing on sex. Instead they could spend a few weeks investing in shared leisure, emotional intimacy and affection. For most couples who value sex in their relationship, it is important to keep a time limit on this vacation from sex, and then to start working on their sex life in other ways.
- Reflect on the things that used to make your sex life more enjoyable (eg. more variety, longer foreplay, different positions) and talk about how you can bring those things back into the bedroom.
- Engage in relaxation activities to reduce overall stress.
- Bring variety back into sex – in particular, engage in sexual activities other than intercourse to help break the association between sex and failure. This could include erotic massages, oral sex, handjobs/fingering, anal play and masturbating together.
Dr. Alice Hucker