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from the book How to Have a
Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
Previous page: How
to Cope with Infertility
Next page: Support Groups-Self-Help
is the Best Help
Table of Contents
How does infertility affect your sexuality ?
Which are the times when sexuality is particularly affected ?
How does infertility affect your sexuality ? Infertility brings about many changes in a couple's
relationship. It may bond you closer together in unspoken sadness
and hope - and allow mutual support and understanding which leads
to a sharing never before experienced. Or it may bring out feelings
of resentment, of guilt, and of despair. As the initial months of
investigations turn into frustrating years it is not surprising
that sex quickly loses many of its associations with pleasure and
becomes instead an activity with a purpose.
Failure to conceive certainly destroys self esteem,
self worth and sexuality. All these negative feelings are reflected
in the bedroom, which is, after all, where all the 'problems' started.
The psychological effect of a diagnosis of infertility
on sexuality has largely to do with the self image. Fertility is
one very basic expression of sexuality. The man with six sons in
many cultures has more status than a man who has borne none - he
is considered to be more potent, more virile.
The emotional response to a diagnosis of infertility
is a grief reaction. It involves many losses: those of potential
children and the family planned and dreamed about, genetic continuity,
the experience of conception, pregnancy and birth, the gift of grandchildren
to one's own parents, the central meaning of one's life plan and
marriage, and the procreative potential in sexual relations. It
is common for a woman to feel "less of a woman" and a
man "less of a man", at least for a time, when faced with
infertility. Many men describe feeling a "dud", "sexual
failure" and many other expressions relating to feeling emasculated.
Women, too, often feel their sexuality threatened
when faced with the possibility of not becoming pregnant. Women
are probably more powerfully socialised into the expectation that
they will reproduce than are men. When this is thwarted, there is
often the feeling of having failed as a "proper woman",
as shown in this statement:
"I saw the blood (of the menstrual period)
today. I feel weak and tearful. All the strength I'd thought I'd
acquired just seems to have drained away. The discomfort serves
as a reminder of my failure. For many women menstruation is a sign
of femininity and potential for motherhood. All it signifies to
me is my failure".
And another comment about sexual attractiveness:
"I have always been told I was pretty.
I like the way I look, and I feel confident in social situations.
After my pelvic surgery, the doctor told me he had never seen a
worse mess of adhesions in his life. He said it looked like a little
kid had been let loose with a pot of glue and stuck everything all
together. I am ugly on the inside and pretty on the outside. I would
gladly have the reverse if it would make me a baby."
Which are the times when sexuality is particularly affected ?
There are significant periods which impinge on
feelings about sexuality of the couple faced with infertility. These
are:
- Trying to get pregnant
- Investigation and diagnosis
- Treatment
- Menopause
1. Trying to get pregnant
The usual advice for a couple trying to start a family is to have
unprotected sexual intercourse for at least twelve months before
having fertility investigations. This waiting period can be nerve-wracking
! Doubts about one's fertility almost always result in a heightened
awareness of signs of fertility that surround us. Pregnant friends,
noisy children in markets, media coverage of new reproductive technologies,
hints from eager parents wanting grandchildren - all these can begin
to erode the sexual self-confidence of the couple wishing to have
children. Inevitably, sexual intercourse is timed for the fertile
time of the woman's cycle. Spontaneity goes out the window as the
sexual life of a couple comes to be associated month after month
with procreating and the failure to conceive. Men often come to
feel like a stud bull, and women may feel it is pointless to engage
in sexual activity when it is unlikely to result in pregnancy.
2. Investigation and diagnosis
Those not faced with infertility would be staggered by the number,
complexity, and invasiveness of medical procedures that a couple
with a fertility problem go through in their search for an answer
to why pregnancy is not occurring. As one patient put it - "
It's like donating your body to science while you're still alive!"
A basic procedure is the Basal Body Temperature
Chart. Although useful from a medical point of view, it is also
the surrendering of some very personal information about oneself,
as shown by this quote:
"There is no inner recess of me left unexplored,
unprobed, unmolested. It occurs to me when I have sex, what used
to be beautiful and very private is now degraded and very public.
I bring my chart to the doctor like a child bringing a report card.
Tell me, did I pass ? Did I ovulate ? Did I have sex at all the
right times as you instructed me?"
The Temperature chart becomes a way of ruling
one's life - and ruining one's sex life. It is also a public declaration
of making love. With the desire for a child becoming increasingly
frustrated, life can become an endless maze of temperature changes,
ovulation calculations, timing of sex and the disappointing signs
of one's menstrual onset. Anxiety, depression and fighting over
sex can often be traced to this source. "Ordinarily my husband
was the instigator of sex. During my fertile time, I felt I had
to seduce him. What quite often happened was that we'd end up fighting
instead of making love."
"It was pretty hard to feel an urge to
make love when your wife is expecting a command performance."
It is not just the physical charting but the mental
charting (which may continue indefinitely) that is a source of stress,
even if the partner is not aware of what is happening.
"One of the things that freaked me out
about charting my temperature was the accompanying need for the
X's. I guess that is what brought home to me that we had stopped
making love as frequently as we had used to."
"The ultimate moment for me was when I
found myself 'cheating' on the charts. I put in a few more X's here
and there to make things look good...then I said to myself, "
Good heavens - has it come to this ?"
"At first it was quite exciting - I felt
as if I was actually doing something. We would both look at the
chart and go for, say, six X's in a row - in fact our frequency
of intercourse increased I'm sure. By now we've gone through the
stage of 'saving up sperm' and have hit the stage of almost total
abstinence. I put in an occasional X so that the nurse doesn't get
the impression that there's something wrong with our marriage."
Providing a sample for semen analysis can also
be stressful:
"I looked around desperately for something
to turn me on - there was nothing - not even soap. After 15 minutes
I gave up - literally sore as hell."
Most men feel their masculinity is 'on the line'
when having this done, sometimes to the extent of being unable to
produce the specimen. It is not uncommon for the man to become impotent
for a short time while he is undergoing such procedures.
"The first time it happened I thought
- here it is - middle age. I'll never get it up again."
While post-coital tests are painless and physically
unobtrusive, many find them very difficult because they intrude
so much on your relationship. There's the need to comply with a
specific time, the rush to the surgery or clinic to keep the appointment,
the embarrassment and real fear of 'failure' if all does not proceed
as had been 'instructed'.
"They told us to make love first thing
in the morning and then come in. Well, what if you don't feel like
it ? We're dreadful in the morning. We put the alarm on at 6 o'clock
and we had the kettle on to make coffee...making love was the last
thing we felt like doing...he hated it and I hated making him do
it."
The power play dynamics in the doctor-patient
relationship takes on a new dimension when fertility is being investigated.
Couples are desperate to find an answer to their difficulties and
hence are compliant and rarely let the clinician know they are under
stress ("not coping"). They must expose the most intimate
aspects of their lives - their sexual relationship and their desire
to have children.
"There's a coyness about the way doctors
handle sex. It's as if infertility has nothing to do with sex, yet
it's everything to do with it. I never know whether I want them
to assume that I don't have problems, or whether I want them to
ask me if I do have any difficulties."
3. Treatment
A couple's decision to commence a treatment programme, such as IVF
or Donor Insemination signifies hope and excitement that they can
overcome infertility and produce children like everyone else. However,
like the investigative period, it again signals a further, if not
more intense, invasion of their sexuality and sexual relationship.
Once accepted on to an IVF programme, most women
are confronted at each attempt with the barriers to becoming pregnant,
to become mothers, and thereby expressing a major aspect of "femaleness".
The low pregnancy rate - about 35% per treatment cycle - means most
will leave the programme with a reconfirmed sense of failure, at
least for a short time, and certainly if they have had little emotional
support.
The use of donor sperm to cause a pregnancy, as
in a donor insemination programme where the male partner is infertile,
brings home to the man his inability to reproduce. Some of the feelings
of inadequacy may have been worked through during the period following
diagnosis, but it is not uncommon for these feelings to be rearoused
when the programme actually begins. At most infertility clinics,
the men are encouraged to be present while their wives are being
inseminated. Some even do the insemination themselves (a painless
and simple medical procedure). This encourages bonding between the
couple at this time, and especially gives value to the participation
of the husband in the act of the conception of their child.
During IVF treatment, after the embryo transfer
, most doctors will advise patients not to have intercourse. However,
this does not mean that you cannot have sex ! Sex does not always
mean putting a penis in the vagina – and you can use your imagination
to give each other sexual pleasure in other ways – for example,
by mutual masturbation.
With nearly all forms of infertility treatment,
rarely is the infertility cured, and clearly not where donor egg
or sperm is used. For example, women with blocked fallopian tubes
who become pregnant on an IVF programme, still face further IVF
attempts if they wish to become pregnant again. A feeling of defectiveness
may remain despite pregnancy and a live birth.
4. Menopause
Menopause is a time when all women are confronted by their sexual
identity, simply because the physical signs of being a woman are
changing forever. It is a difficult time of adjustment for many
women, and for those with infertility it means saying goodbye, yet
again, to motherhood.
It is useful to ventilate feelings of frustration,
anger, and feeling "taken over", as your sexuality gets
trampled upon throughout the course of investigation and treatment.
This will restore a sense of personal worth. Remember that it is
normal, expected and almost inevitable that your sex life will take
a beating for a time.
It is useful at this stage to join a support group
or talk to a counsellor - who can help you to separate sex from
reproduction - perhaps by throwing away the BBT chart for
a while, or taking a break in the middle of a treatment programme
to have a romantic holiday.
Next page: Myths
and Misconceptions
Previous page:
How to Cope with Infertility
Table of Contents
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