Sexual dysfunction & infertility

1. Benha University Hospital, Egypt
Aboubakr Elnashar

2. SD can be either a cause or a
consequence of infertility.
Infertility may exacerbate
already present SD.
Aboubakr Elnashar

3. Introduction
By the time a couple is seen in an infertility
clinic:
At least one year of trying, & failing, to become
pregnant.
Each unsuccessful month leaves them with a
greater sense of concern, anxiety, guilt, blame,
or anger at not becoming pregnant.
Aboubakr Elnashar

4. In the clinic:
•Investigations: Semen analysis & postcoital
test (tabulated sex).
•Recommendations. Couples are told when to
have sex & when to abstain.
•Treatments: medical or surgical.
Results:
1.The intimate sexual behavior comes under
the scrutiny & direction of the doctor.
Aboubakr Elnashar

5. 2. Conception becomes more strongly linked
to attendance at infertility clinic than
lovemaking.
3.The cause of infertility (male, tubal,
unovulatory) may be clarified or unexplained.
Recognition of the cause of infertility:
acceptance of childlessness & return to normal
sexual behavior.
Unexplained infertility: prolonged & mutual
agony
Aboubakr Elnashar

6. Aboubakr Elnashar

7. Incidence
5% of causes of infertility
Aboubakr Elnashar

8. Types
Male SD
1.Loss of desire, with a consequent decrease
in sexual activity.
2.Erectile problems.
3.Premature ejaculation- Little or no control
over ejaculatory response, & ejaculation may
occur before vaginal entry achieved.
4.Retrograde ejaculation-difficulty ejaculation
intravaginally, or at all.
Aboubakr Elnashar

9. Female SD
1.Loss of desire.
2.Vaginismus.
3.Dysparunia
4.Anorgasmia: orgasm is not essential for
conception (rape),but it improves the chances
slightly ( stimulate cervical & tubal activity &
stimulate secretions favorable for
spermatozoa, the cervix remains open for
min)
Aboubakr Elnashar

10. Diagnosis (Sexual history)
To avoid wasting time & resources.
People can undergo months or years of
invasive & expensive investigations &
treatment when simple, clear questions about
their sexual lives may elicit the cause of
infertility.
Aboubakr Elnashar

11. Screening sexual history should be a part of
any gynecological history taking.
Brachmann et al (1989) asked 2 questions:
1. Are you sexually active?
2. Do you have any sexual difficulties?
16% of non-complaining females have SD.
So the gynecologist who state that I donot see
FSD in my clinic is not looking hard enough or
avoiding the topic altogether.
Aboubakr Elnashar

12. Comprehensive sexual history:
General
•1. Do you & your husband have similar levels of sexual
interest?
2. How frequently do you have SI?
3. Are you satisfied with the current frequency of sexual
activity?
•1. Do you have difficulty becoming sexually aroused?
2. Does your husband have difficulty becoming sexually
aroused?
•Do you have problems reaching orgasm?
•Is intercourse is painful?
Aboubakr Elnashar

13. Specific analysis of the problem
1. Onset, duration, course
2. Situational or total
3. Aggravating or ameliorating factors
4. Past treatments & outcome
5. Patient own view: the cause, husband
reaction
Aboubakr Elnashar

14. Three types of SD need to be born in mind.
1.Retrograde ejaculation: 2% of diabetics
at orgasm, the ejaculate is expelled back into the
bladder. Examination of postejaculatory urine sample
for the presence of sperms.
2.Anejaculation:
Some men ejaculate with masturbation but not while
sexual intercourse
3.Non vaginal sex:
Ask about the sexual behavior. Anal sex, umbilical
sex, manual stimulation alone.
Aboubakr Elnashar

15. Aboubakr Elnashar

16. Causes
For many infertile couples,
•Lovemaking becomes baby making,
•Play becomes work.
• Couples are concerned with the procreative
aspects of intercourse, not the recreational
aspects.
Aboubakr Elnashar

17. 1. The stress of infertility:
Anger, panic, despair & grief.
2. The stress of investigations
(postcoital test, semen analysis).
Recommendations (SI in fertile period) &
Treatment.
3.Ignorance & lack of sexual education.
Aboubakr Elnashar

18. Types
In both:
1.Diminished sexual desire.
2.Decreased sexual activity during nonfertile
periods. Intercourse may be avoided, so that the
fertility problem is not reminded.
3. Arousal difficulties because of anxiety or distress.
4. Difficulty in achieving orgasm.
Aboubakr Elnashar

19. In male
1.Transitory impotence.
2.Transitory ejaculatory failure.
•For some men, one or two failures during
sexual intercourse begins a vicious circle of
fear of failure, with anxiety leading to further
failures.
Aboubakr Elnashar

20. Prevalence
•In Egypt:
No studies
Aboubakr Elnashar

21. •In Nigeria
(Audu, 2002)
Diminished desire: 78%
Dysparunia: 57%
Difficult sexual arousal: 20%
Difficulty in achieving orgasm: 20%.
These affects coital frequency & sexual
acceptance, thus complicating infertility.
There is a need to address these issues
when managing infertile couple.
Aboubakr Elnashar

22. •In India
(Jain et al, 2000)
Male:
Premature ejaculation: 66%
Erectile dysfunction: 15%
Decreased libido: 11%
Orgasmic failure: 8%
Aboubakr Elnashar

23. Female:
Dysparunia: 58%
Decreased libido: 28%
Orgasmic failure: 14%
Important observations:
Various type of misconceptions
Lack of sexual education & awareness.
Aboubakr Elnashar

24. •Long term effects of infertility on wellbeing
[psychological & sexual]
(Balen et al,1993)
A significant lower level of wellbeing
compared with women in general
A third of infertile women & a fifth of the
infertile men had serious well-being
problems.
Emotional help & counseling are important in
learning them to live with infertility.
Aboubakr Elnashar

25. Aboubakr Elnashar

26. 1.Every gynecologist should be aware of the relation
between infertility & SD.
2.SD are common in infertile couple
3.Taking sexual history before, during & after
treatment of infertility is essential.
Aboubakr Elnashar

27. 4.SD causing infertility can be successfully treated
(in two thirds of cases) saving time, efforts & money
of the investigations & treatments of infertility.
5.Educating the couple on the impact of treatment
on their sexual function & asking them to seek help
if symptoms develop.
Aboubakr Elnashar

28. Aboubakr Elnashar