madman
Super Moderator
Abstract
Purpose Infertility represents a peculiar social burden affecting more than 15% of couples, provoking it a real threat to the general quality of life and to sexual health. The medicalization (diagnosis, therapy, and follow-up) of the lack of fertility is frequently a challenge in terms of personal and couple involvement. In particular, while Assisted Reproductive Technology (ART) has allowed many infertile couples to achieve pregnancy, the therapeutic process faced by the couple bears strong psychological stress that can affect the couple’s quality of life, relationship, and sexuality. Despite infertility affects both female and male sexual health, only recently the interest in the effects of ART on the couple’s sexuality has grown, especially for women.
Methods A literature research on sexual dysfunction in fertility care and particularly in ART settings were performed.
Results Literature largely found that intimacy and sexuality appear specifically impaired by the intrusiveness of treatments and medical prescriptions. Moreover, there is a close relationship between emotional, psychological, and sexual aspects, which can be integrated into the new concept of Inferto-Sex Syndrome (ISS) that can impair the ART treatment outcomes. Evidence demonstrates that the assessment of sexual function is necessary for couples undergoing diagnosis of infertility and ART.
Conclusion A close relationship between infertility and sexuality, both in the female and male partners, was detected. ART treatments may heavily impact the couple’s psychosexual health. A couple-centered program for the integrated management of psychological and sexual dysfunction should be considered in the context of ART programs.
Introduction
Since the first live birth resulting from in vitro fertilization (IVF) in 1978, a growing number of pregnancies derived from assisted reproductive techniques (ART) has been observed, with an impressive growth trend in the last 15 years. The use of ART has allowed many infertile couples to achieve pregnancy, but the therapeutic process is a strong psychological stress condition that can affect their quality of life as well as the couple’s relationship and sexuality.
The diagnosis of infertility is by itself a powerful stress factor, mainly for women who feel impaired their female identity often burdened with social pressure, but also for men who live with discomfort the inability to procreate, especially if the infertility is caused by a male factor [1–3]. Considering that up to 83% of infertile couples report feeling a social pressure to conceive [4], the decision to access ART increases distress of the couple, also burdened with the costs, the ethical implications, and the difficulties in managing eventual failures [1]. This stressful condition has been associated with severe anxiety and depression in both partners, with possible immunological alterations and a lower likelihood of clinical pregnancy in vitro fertilization (IVF) procedures [5].
Infertility affects both female and male sexual health, but only recently the interest in the effect of ART on the couple’s sexuality has come into a sharper focus. A recent Italian survey showed that in the Infertile Care Units the attention on sexuality was rather limited, with a strong discrepancy between the two members of the couple, with greater attention paid to male sexuality [6].
The close relationship between infertility and sexuality, both in the female and male, and the need to contextualize sexuality within the infertile couple undergoing ART treatment, may be framed in a broader dysfunctional dimension, conceptualized in the Inferto-Sex Syndrome (ISS) (Fig. 1). The utility to introduce a new taxonomic term is not merely conceptual but carries the message to consider sexual health along with the reproductive one. Too frequently, sexuality and fertility have been and are considered two different and separate fields, the former studied by the psychosexologists and the sexual physicians, the latter by the gynecologists. The ISS aims to stress the need for an integrated and shared diagnosis and therapy, considering how sexuality and fertility are, in our species, imbricated, overlapping, and strictly correlated functions.
*Finally, because of the effects of ART treatments on the couple’s psychosexual health, a couple-centered program for integrated management of psychological and sexual dysfunction in the context of ART should be assessed.
*Infertility and sexual function
*Female sexual dysfunctions and infertility
*Male sexual dysfunctions and infertility
*Sexual dysfunctions: a view of the couple
*Sexual function in couples seeking fertility treatment by ART
*Male sexuality under ART
*Female sexuality and ART treatments
*Sexuality assessment in ART protocol: an unmet need
Conclusion
Infertility constitutes a challenge for the sexual life, with SD emerging as a typical paradigm for “couple disorder”, particularly in the setting of infertility in which can be framed as the concept of ISS. The merit of this new taxonomic category could be found in identifying the peculiarity of sexual dysfunction due to infertility—such as HSDD or ED, and, vice-versa, of infertility due to sexual dysfunction—such as HSDD or vaginismus. Moreover, the ISS stresses the need of considering fertility and sexuality as a strict clinical unity, promoting the dialogue, not yet strong enough, between experts in reproductive and sexual medicine(s). In fact, either different cultural habits in the examined patient cohorts, or the lack of standardized tools for sexuality assessment in a sterility care setting, or the different comorbidities that overlap throughout the course of infertility treatment, make the real dimension of psychosexological impact of infertility difficult to assess, understand and to treat. Doctors exclusively focused on the lack of fertility itself and on the technical aspects of the diagnosis and treatment may easily lose this crucial part of the issue.
Unavoidably, psychological and sexological attitudes change through the course of the infertility diagnostic program, with different implications for the members of the couple. When the couple needs recourse to ART, additional factors may be involved such as either intrusiveness of the procedures, or perception of the disconnection between sex and reproduction, de-eroticization of the sexual intercourse, or finally, increased psychological pressure in cases ascribable to procedural failures. Women, often more involved in ART procedures regardless of the cause of infertility, are likely to be particularly affected in their psycho-sexological life side, especially if second level techniques (IVF/ICSI) are requested
Extensive evidence makes an assessment of the psycho-sexological function mandatory in couples under ART. Rewiring the couple dimension with loss of intimacy and involvement of third figures, and the mutual relationship among emotional stress, sexual function, and outcomes of ART procedures may contribute to a higher percentage of treatments’ failures or drop out of the couples. The future challenge is to support both partners, to design a couple-centered approach in the infertility treatment plan, grounded on a multidisciplinary team that guarantees comprehensive management of ISS, as all the emotional, relational, and, inevitably, sexual aspects of couples seeking parenthood.
Purpose Infertility represents a peculiar social burden affecting more than 15% of couples, provoking it a real threat to the general quality of life and to sexual health. The medicalization (diagnosis, therapy, and follow-up) of the lack of fertility is frequently a challenge in terms of personal and couple involvement. In particular, while Assisted Reproductive Technology (ART) has allowed many infertile couples to achieve pregnancy, the therapeutic process faced by the couple bears strong psychological stress that can affect the couple’s quality of life, relationship, and sexuality. Despite infertility affects both female and male sexual health, only recently the interest in the effects of ART on the couple’s sexuality has grown, especially for women.
Methods A literature research on sexual dysfunction in fertility care and particularly in ART settings were performed.
Results Literature largely found that intimacy and sexuality appear specifically impaired by the intrusiveness of treatments and medical prescriptions. Moreover, there is a close relationship between emotional, psychological, and sexual aspects, which can be integrated into the new concept of Inferto-Sex Syndrome (ISS) that can impair the ART treatment outcomes. Evidence demonstrates that the assessment of sexual function is necessary for couples undergoing diagnosis of infertility and ART.
Conclusion A close relationship between infertility and sexuality, both in the female and male partners, was detected. ART treatments may heavily impact the couple’s psychosexual health. A couple-centered program for the integrated management of psychological and sexual dysfunction should be considered in the context of ART programs.
Introduction
Since the first live birth resulting from in vitro fertilization (IVF) in 1978, a growing number of pregnancies derived from assisted reproductive techniques (ART) has been observed, with an impressive growth trend in the last 15 years. The use of ART has allowed many infertile couples to achieve pregnancy, but the therapeutic process is a strong psychological stress condition that can affect their quality of life as well as the couple’s relationship and sexuality.
The diagnosis of infertility is by itself a powerful stress factor, mainly for women who feel impaired their female identity often burdened with social pressure, but also for men who live with discomfort the inability to procreate, especially if the infertility is caused by a male factor [1–3]. Considering that up to 83% of infertile couples report feeling a social pressure to conceive [4], the decision to access ART increases distress of the couple, also burdened with the costs, the ethical implications, and the difficulties in managing eventual failures [1]. This stressful condition has been associated with severe anxiety and depression in both partners, with possible immunological alterations and a lower likelihood of clinical pregnancy in vitro fertilization (IVF) procedures [5].
Infertility affects both female and male sexual health, but only recently the interest in the effect of ART on the couple’s sexuality has come into a sharper focus. A recent Italian survey showed that in the Infertile Care Units the attention on sexuality was rather limited, with a strong discrepancy between the two members of the couple, with greater attention paid to male sexuality [6].
The close relationship between infertility and sexuality, both in the female and male, and the need to contextualize sexuality within the infertile couple undergoing ART treatment, may be framed in a broader dysfunctional dimension, conceptualized in the Inferto-Sex Syndrome (ISS) (Fig. 1). The utility to introduce a new taxonomic term is not merely conceptual but carries the message to consider sexual health along with the reproductive one. Too frequently, sexuality and fertility have been and are considered two different and separate fields, the former studied by the psychosexologists and the sexual physicians, the latter by the gynecologists. The ISS aims to stress the need for an integrated and shared diagnosis and therapy, considering how sexuality and fertility are, in our species, imbricated, overlapping, and strictly correlated functions.
*Finally, because of the effects of ART treatments on the couple’s psychosexual health, a couple-centered program for integrated management of psychological and sexual dysfunction in the context of ART should be assessed.
*Infertility and sexual function
*Female sexual dysfunctions and infertility
*Male sexual dysfunctions and infertility
*Sexual dysfunctions: a view of the couple
*Sexual function in couples seeking fertility treatment by ART
*Male sexuality under ART
*Female sexuality and ART treatments
*Sexuality assessment in ART protocol: an unmet need
Conclusion
Infertility constitutes a challenge for the sexual life, with SD emerging as a typical paradigm for “couple disorder”, particularly in the setting of infertility in which can be framed as the concept of ISS. The merit of this new taxonomic category could be found in identifying the peculiarity of sexual dysfunction due to infertility—such as HSDD or ED, and, vice-versa, of infertility due to sexual dysfunction—such as HSDD or vaginismus. Moreover, the ISS stresses the need of considering fertility and sexuality as a strict clinical unity, promoting the dialogue, not yet strong enough, between experts in reproductive and sexual medicine(s). In fact, either different cultural habits in the examined patient cohorts, or the lack of standardized tools for sexuality assessment in a sterility care setting, or the different comorbidities that overlap throughout the course of infertility treatment, make the real dimension of psychosexological impact of infertility difficult to assess, understand and to treat. Doctors exclusively focused on the lack of fertility itself and on the technical aspects of the diagnosis and treatment may easily lose this crucial part of the issue.
Unavoidably, psychological and sexological attitudes change through the course of the infertility diagnostic program, with different implications for the members of the couple. When the couple needs recourse to ART, additional factors may be involved such as either intrusiveness of the procedures, or perception of the disconnection between sex and reproduction, de-eroticization of the sexual intercourse, or finally, increased psychological pressure in cases ascribable to procedural failures. Women, often more involved in ART procedures regardless of the cause of infertility, are likely to be particularly affected in their psycho-sexological life side, especially if second level techniques (IVF/ICSI) are requested
Extensive evidence makes an assessment of the psycho-sexological function mandatory in couples under ART. Rewiring the couple dimension with loss of intimacy and involvement of third figures, and the mutual relationship among emotional stress, sexual function, and outcomes of ART procedures may contribute to a higher percentage of treatments’ failures or drop out of the couples. The future challenge is to support both partners, to design a couple-centered approach in the infertility treatment plan, grounded on a multidisciplinary team that guarantees comprehensive management of ISS, as all the emotional, relational, and, inevitably, sexual aspects of couples seeking parenthood.
