from
the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
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How to Cope with Infertility
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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
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