“Doctor, I just don’t understand what’s happening to me,” Bob said as we began our first counseling meeting. “I love my wife, we have really pulled together with this infertility thing and I think we are closer than ever. We are determined to do what it takes to create a family, no matter what. But for some reason, I just don’t seem to be as interested in or even as capable of sex as I was before. Is there something wrong with me? What am I going to do?”

Bob had been given a preliminary diagnosis of male factor infertility problem just a couple of months ago. He had been referred to me for routine counseling by his reproductive endocrinologist. Like so many men, he found the news upsetting and disruptive to his life in many ways. In particular, he felt that his masculinity was on the line. Feeling like less than a “real” man when it came to his reproductive capacity didn’t do much for his sexual desire. At times his erectile ability seemed to elude him. He was experiencing something that some, but not all, men do. Some research indicates that as few as 15% of couples experience any sort of sexual dysfunction as a result of their fertility problems. Their sexual problems are about equally divided between male and female problems.

The ability to impregnate a partner gets linked with sexual ability for many of us. We begin to think that this important aspect of sex is its only aspect. A man can be susceptible to thinking that he is “useless” to a partner unless he can make her pregnant. Worry about this inability and what his wife will think of him as a man can make sexual intimacy less than appealing. If the worry continues for a long time he may be so consumed that his erection, previously never a problem, now is unreliable. This performance anxiety can lead to additional “failure” experiences and an avoidance of sex at all. Or a man can become depressed about his infertility. One of the normal signals of depression is a diminished or missing desire for sexual activity. Finally, the process of diagnosis involves procedures that necessarily are sexual in nature, such as producing a semen specimen. What was formerly private behavior now seems like a very public event. It is anything but sexy.

 However, sex is more than intercourse for reproduction. Sex in all its various components can also be a source of relationship enhancement and playful intimacy. Couples also use their sexual relationships as a source of stress release. Tender moments that involve physical attention, whether they culminate in orgasm or not, can have a beneficial reduction of tension that results from infertility diagnoses and their treatment.

Just how does a man avoid these potential pitfalls? What could I offer Bob as a means of holding onto the pleasure of his sexual relationship with his wife while they worked out a plan for dealing with their infertility? The most important piece of information I provided him was the idea that he was not abnormal. The very thought that what he was feeling was experienced similarly by others in his shoes seemed to set him at ease. After all, most of us like to know that we are responding normally to our circumstances.

Bob and I talked about how uncomfortable it was to produce a specimen in the doctor’s office, feeling that the staff knew what he was doing. We discussed steps he could take to make the process less public and more comfortable for him. If he was distracted by noise outside the room I suggested he take an mp3 player with headphones to screen out the mental interruptions. If he lived close enough to the clinic perhaps the doctor would allow him to produce a specimen at home and bring it in. We discussed just how likely it was that the staff was focusing on what he was doing rather than the myriad other tasks they must attend to in a busy office.

I made the following suggestions to Bob in order to keep the sexual part of his relationship from suffering while he and his wife underwent treatment:

1. Plan sexual encounters that are unrelated to any treatment you are receiving. Infertility treatment can sometimes feel like “sex on demand.” Make the time to be sexual without any treatment related requirements.

2. Be sure to allow time for non-intercourse sexual pleasuring. Too often a couple can get forget that sex involves more than intercourse leading to orgasm. Physical contact that is sexual in nature can focus on other sexually satisfying behavior.

3. Remember to be sexually playful as you were early in your relationship. Sex needn’t always be serious to be enjoyable.

4. Take your time with sex. Sex that is rushed can feel like a job rather than a joy.

5. Remember to be creative and inventive in your sexual behavior. If you feel like you are stuck in a rut reading erotic literature or watching a steamy movie can shake things up a bit.

6. Talk to your partner about how you feel. Communication is one of the most important aspects of a good sexual relationship.

7. Keep in mind that the most important sex organ is your brain second only to your skin. When your thoughts are clear you will enjoy sex more. Skin touch can be extremely erotic and need not be focused on the genitals.

I told Bob that he had already taken an important step by having the courage to discuss the problem with me. Too often men can suffer in silence, uncomfortable with the notion of talking with a stranger or even their partners. Bob’s willingness to confer with a third party gave him a distinct advantage to improving the sexual aspect of his relationship while he underwent treatment.

Author: Bill Petok Ph.D.

Bill Petok earned his doctorate from the University of Maryland in 1978. Before entering full time independent practice, he worked as a psychologist in the public sector in both Baltimore and Anne Arundel County. His postdoctoral training includes a year at the Family Therapy Institute of Washington, D.C. and an externship at Sheppard & Enoch Pratt Hospital in the Sexual Dysfunctions Clinic. His practice focuses on the problems that individuals, couples and families experience in daily life, including anxiety, depression, stress, marital and family relationships. He also has several areas of special expertise: Sex Therapy and Counseling for Fertility Problems.