Infertility, Intimacy and “Homework Fatigue”

The inability to conceive can take a couple on an emotional roller-coaster ride. In addition, infertility has also been shown to be a risk factor for female sexual dysfunction.

A case-control study was conducted with 119 infertile woman and 99 healthy female controls without infertility between the ages of 18 and 45.  It was found that the group of infertile women had a lower score in desire, arousal and a lower frequency of sexual encounters. It followed that their satisfaction was also lower. Why does this happen?

When the goal is pregnancy, there is only a 24 hour window of opportunity each cycle.  That is, the egg is viable for 24 hours while the sperm is viable for 72 hours.  Sex on demand eliminates any spontaneity.  The focus of sex becomes conception, rather than pleasure. All this can lead to pressure to perform and conceive which may lead to less satisfaction.

Infertility can also affect a woman’s sense of herself and her sexual identity.  Males accordingly may be affected and become depressed, experience performance anxiety, premature ejaculation and erectile dysfunction.

Now add in the effects of certain fertility medications. Although the effects are short lived, these drugs may have to be used repeatedly. They suppress ovulation for IVF cycles and can cause decreased libido along with vaginal dryness and pain.  Drugs like Clomiphene (Clomid) are used to induce ovulation but can cause nausea, breast tenderness, hot flashes and mood swings.  This is certainly not a great way to “bring sexy back!”

What to do?  Talk with your doctor.  There may be alternatives to certain medications. Talk with your partner. Just being aware of possible concerns may help.  If necessary, seek the counsel of a therapist who is knowledgeable about sexual issues.  When lovemaking has to be an assignment, remember how pleasurable impromptu sex can be, that it isn’t always going to be about procreation.

Keep your eyes on the prize and realize that you can turn that roller coaster ride into the tunnel of love!

Menopause, Painful Sex and a New Solution

Menopause.  What is the first thing that comes to mind when you hear that word?  Chances are good you think of hot flashes.  Certainly, hot flashes are part of the mid-life change and for some women, they can be quite bothersome.  However, there is another condition associated with menopause that can be even more bothersome and quite painful.  It is vulvovaginal atrophy, which causes burning, itching and at times, bleeding.  Unfortunately, many women are too embarrassed to discuss this matter with their health care providers.  Ladies, let’s turn this around. There is no need to suffer!

Painful sex in and around the time of menopause is often due to the natural decline of estrogen, which makes vaginal tissue thinner, drier and less elastic.  The result?  For many women, sex becomes uncomfortable and sometimes impossible.  Insufficient lubrication can cause tearing of vaginal tissues during intercourse.  Anxiety and frustration may also take its toll and cause future arousal difficulties or a halt to sex altogether. It is estimated that 20%-45% of middle-aged and older women are affected by these symptoms.

Prescription remedies are available in the form of vaginal estrogen rings, tablets and topical creams.  The estrogen used in these products is low dosage and a much lower risk than estrogen pills used in hormonal replacement therapy. There is a low rate of absorption into the bloodstream. For those who prefer a nonhormonal alternative, an over the counter lubricant like K-Y Jelly, or moisturizer such as Replens, can be helpful.

Recently, the FDA approved Osphena, the first nonhormonal pill, taken once a day to treat moderate to severe sexual pain.  This drug mimics estrogen on some tissues and is in a class of medications called selective estrogen receptor modulators, or SERMS.  In the vagina and uterus, it acts like estrogen and can relieve sexual discomfort

Yes, there are side effects with Osphena as with all medications.  They include vaginal discharge, blood clots and stroke.  It is always important to check with your doctor, be honest, ask questions and weigh the risks.  For those who want a non-estrogen alternative and prefer swallowing a pill over the messiness of applying a cream, Osphena may the right answer for you.

It is always important to talk with your doctor and get regular checkups. Remember, good health starts with you.  A comfortable and happy sexual relationship is part of the total package!