Why Does Sex Feel Different During Infertility?
Infertility can have profound emotional, relational, and sexual impacts beyond the biological hurdle of conceiving. These impacts can be a significant stressor to a couple’s sexual wellbeing.
If you prefer to listen rather than read, this podcast answers the question, why does sex feel different during infertility?
Sexual activity with its focus on conceiving, the medicalisation of fertility, can transform sex into a place of anxiety rather than intimacy. This can diminish sexual pleasure, arousal, and desire, leading to confusion and even conflict. I also want to acknowledge that for many couples’ infertility can hold deep grief. Grief around the gap of expectation of baby plans and the reality of infertility, the grief of treatment itself, and grief around the possible loss of future hopes.
What Is Infertility?
Infertility is when after engaging in regular, unprotected sexual intercourse for a year, a couple has not conceived naturally. Primary infertility is when the couple has never conceived, and secondary infertility is when the couple has had a successful pregnancy previously.
While fertility treatments have advanced and offer genuine hope for pregnancy, they also are medically intrusive, introduce strict schedules, and can be emotionally and mentally draining.
Infertility is not just a problem with one person, it is a “couple disorder” in how it affects the relationship. In this way, it is essential that infertility is approached with integrated, holistic support.
Inferto-Sex Syndrome (ISS) is a framework that explores the intricate relationship between infertility and sexual dysfunction from a couple’s lens. For example, infertility can give rise to erectile dysfunction due to the pressured nature of sex in infertility, but like-wise infertility can occur because of a pre-existing sexual dysfunction such as vaginismus where penetration of the vagina is impossible or extremely difficult.
How Can Infertility Affect Sexual Intimacy?
How can sex become pressured or goal-oriented?
The desired goal of baby-making and the understandable emotional load of this can take full priority in sex. Sex becomes pressured with regular testing for pregnancy to check if the goal has been achieved, pressured due to scheduling (“sex by the clock”) with ovulation, and pressured during sex to achieve ejaculation to meet the goal of baby-making.
How can infertility affect desire?
Due to the immense pressure of the goal of baby-making, and especially when this becomes the only focus during sex, sex loses pleasure. Pleasure, sex’s recreational and erotic value, a sense of connection, sensuality; these are essential ingredients that facilitate desire. Desire is the anticipation of sexual pleasure, or the response to sexual pleasure. If pleasure is diminished, sexual desire disappears. Couples may begin to feel that sex is another chore, and worse, feel resentment towards sex. It can also be immensely difficult for many couples to desire to engage sexually in the presence of the grief of infertility.
How can infertility affect arousal and pleasure?
Arousal is the mental and physical excitement and readiness for sex, that feeling of being turned on mentally and physically. In male bodies this leads to erection, and in female bodies the swelling of the vulva and vaginal lubrication. Arousal is a pleasurable sensation in itself, and as arousal increases, pleasure increases. Pressure interferes with arousability for most individuals, as it creates a significant mental block for arousal. When arousal is impacted, pleasure diminishes. Infertility frequently leads to erectile dysfunction or premature ejaculation in male bodies due to the immense pressure of performance. For female bodies, there may be the experience of painful sex due to stress, hormonal treatments, the overall medicalisation that diminishes physical arousal and pleasure.
How can infertility affect emotional intimacy?
Due to the immense stress, overall communication can be disrupted and lead to disconnection. In this context of overall disconnection, couple’s may find that conflict becomes heightened and more difficult to navigate. Amplifying this, couples may feel that their private lives have been invaded by intrusive medical appointments and treatments.
How Infertility Can Affect Identity and Self-Worth
Infertility can come as a shock to many couples. There can be profound loss of identity, that comes with inaccurately equating femininity or masculinity to the ability to conceive. There can be the sense of only being reproductive parts rather than a whole person, such as the feeling of being just a “sperm donor” rather than a partner.
How Couples Can Become Stuck in Cycles
Sexual burnout driven by emotional and physical exhaustion can occur. Rather than looking forward to sexual intimacy, couples begin to dread it. This can fuel avoidance of sexual activity, which leads to more disconnection, fuels more stress and relationship dissatisfaction, which then amplifies the avoidance of sexual activity, and so on…the cycle perpetuates.
Practical Steps You Can Try Now
Touch regularly and sensually, outside of the bedroom. This re-introduces eroticisation and pleasure to touch, without any pressure for intercourse. It also maintains and builds connection both physically and emotionally, which is critical to support each other in a stressful time.
Focus on pleasurable sensation during sexual activity. Notice being in your head, rather than being in your body. Being in your head during sex means being distracted by thoughts, worry, pressure. Being in your body is about being open to the raw sensations and pleasure of physical touch, not analysing it, or thinking about it, but experiencing it.
Improve communication and general connection. Have you noticed that all you talk about is baby-making and lost perspective on yourself and who your partner is beyond their genitals? Create time to enjoy each other’s company, dedicate quality time where baby-talk is kept separate. When it comes to the stress of infertility create a supportive environment for each other to hear and empathise with each other.
When to Seek Support for Sexual Intimacy
If sexual intimacy is causing distress
If sexual dysfunction is present such as erectile dysfunction, vaginismus, or severe losses in desire
When grief is impacting daily functioning, amplifying relational or sexual distress
If self-identity and worth has significantly diminished
Sexual dysfunction, relational and sexual distress can interfere with fertility treatments. Therefore it is essential to not only approach the issue from a biological and medical lens, but also from a mental, emotional, relational, and behavioural lens.
Can Sex Therapy Can Help During Infertility?
Sex therapy can support couples in understanding and navigating the emotional, relational, and sexual impacts of infertility. While fertility treatment often focuses heavily on the biological and medical aspects of conception, sex therapy creates space to address the psychological, relational, and sexual strain that can develop alongside infertility.
In therapy, we explore:
the pressure and performance anxiety surrounding sex,
the impact of infertility on desire, arousal, and pleasure,
feelings of grief, inadequacy, or body betrayal,
communication and emotional disconnection,
and ways to rebuild intimacy outside of baby-making.
Rather than viewing sexual difficulties as another “failure,” sex therapy helps couples move away from pressure and back toward connection, sensuality, teamwork, and emotional support.
I offer online sex therapy across Australia, supporting individuals and couples navigating infertility, sexual dysfunction, relationship stress, and intimacy concerns.
Final Thoughts
Infertility affects far more than reproduction. It can deeply impact how couples experience intimacy, desire, pleasure, and connection with each other.
When sex becomes heavily associated with pressure, schedules, performance, and disappointment, it is understandable that sexual intimacy can begin to feel different. This does not mean the relationship is broken, nor does it mean intimacy cannot be rebuilt.
Approaching infertility through a holistic lens that includes emotional, relational, and sexual wellbeing alongside medical care allows couples to better support both themselves and each other through an incredibly difficult season.
Even within grief and uncertainty, intimacy, pleasure, and connection can still be nurtured.
Written by Justine
References
Piva I, Lo Monte G, Graziano A, Marci R. A literature review on the relationship between infertility and sexual dysfunction: Does fun end with baby making? The European Journal of Contraception and Reproductive Health Care. 2014;19(4):231-237
Luca G, Parrettini S, Sansone A, Calafiore R, Jannini EA. The Inferto-Sex Syndrome (ISS): sexual dysfunction in fertility care setting and assisted reproduction. Journal of Endocrinological Investigation. 2021;44:2071-2102
Brotto L, Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, et al. Psychological and interpersonal dimensions of sexual function and dysfunction. The Journal of Sexual Medicine. 2016;13(4):538-571
