The condition of infertility is considered as a strong personal stress as it inevitably has an impact on both functioning and sexual health.
In the event that the couple presents difficulties related to their fertility, the experience of sexual intimacy risks being experienced in an altered way by both partners. If focused exclusively on procreation, the couple’s sex life can become methodical and predictable to the point of losing the value of communication, intimacy and sharing.
In the case of male infertility , men tend to live less virile while, in the case of female infertility, women live less feminine and incomplete. Common feelings related to infertility, such as anger, guilt, despair, depression, shame, and anxiety can interfere with the feelings of warmth, affection, and emotional sharing that are natural prerequisites for a satisfying sexual encounter.
The relationship between sexual activity and infertility is very complex. Indeed, while sexual dysfunction can cause infertility, psychological difficulties can also prevent normal sexual activity.
In some cases, infertility highlights sexual or couple problems that have already existed for a long time and existed before the diagnosis of infertility; in other cases, sexual difficulties for infertile couples are the result of planned sex, the pressure to perform on demand, the psychological presence of medical staff, and the reproductive performance pressure experienced by the infertile couple.
In still other cases, sexual dysfunctions could be a symptom of relationship problems in the couple and in these cases the use of medically assisted procreation (MAP) techniques could represent the “shortcut” that leads to reproduction and parenting without having to deal with relational problems and sexual relations existing in the couple relationship.
It is equally important to consider that relying on MAP treatments can foster a split between sexuality and reproduction , sharpening the emotional, affective and sexual distancing between partners and, therefore, it is important to help the couple to keep these two aspects together and not giving up their intimate relational dimension.
In female experience, reproduction and sexuality are often more intrinsically intertwined than they are for men.
Only recently the attention of the literature has focused on the incidence and type of sexual dysfunctions in infertile couples, on the impact that infertility can have on the sexual life of women and men and on the impact that specific diagnoses of infertility and related treatments may have on the sexual life of individual partners and couples.
The causes of sexual dysfunction in infertile couples can be divided into:
- psychosexual problems disguised as cases of infertility;
• incidental discoveries of psychosexual disorders in cases of infertility;
• infertility causing psychosexual problems.
Common sexual dysfunctions in infertile couples resulting from the stress of medical treatment include problems such as loss of desire and anorgasmia .
In fact, medical treatment seems to increase feelings of loss of control, intimacy and self – esteem and leads to a decrease in desire to the point of compromising sexual response and activity.
Therefore, a multidisciplinary approach that also considers the relational and sexual aspects of the infertile couple appears very important in the context of infertility counseling, differentiating the problems related to the treatment from those deriving from pre-existing difficulties in the couple relationship.
It is also essential to carefully evaluate together with the couple the advantages and disadvantages of the medical protocol in terms of potential resolution or possible exacerbation of sexual difficulties .
The evaluation of these implications guides the diagnosis and identification of an adequate therapeutic approach. Infertile couples can benefit from the availability of psychological support before, during and after their diagnostic-therapeutic path.
Sexological intervention is particularly useful and effective in those cases in which the couple’s sexual difficulties have become a primary source of individual and couple stress.
However, it is desirable to leave ample and free space for the discussion on sexuality even for those couples in which sexuality does not seem to be a clinical topic of central importance; in fact, minimizing this space can strengthen in couples the impression that sexuality must be separated from any form of intervention aimed at their fertility.