Sexual dysfunction isn't an obstacle to pregnancy. Hear from an expert.
As open as we might be in seeking medical help for a failure to conceive, conversations around sexual dysfunction are equally shushed. But here’s the thing: sexual dysfunction in both men and women can impede getting pregnant naturally.
To help you understand what sexual dysfunction looks like—and the options available for those suffering from it to become parents—we spoke to Dr. Nilesh Unmesh Balkawade, who is the clinical head and fertility specialist at Oasis Fertility in Pune. He also holds a fellowship in reproductive medicine and is a Fellow at the Indian Association of Gynaec Endoscopists. Here is what he has to say about sexual dysfunction and fertility.
This is what sexual dysfunction looks like
For starters, it is important to know that sexual dysfunction can affect both men and women.
“In a woman, sexual problems can be related to anatomical faults like a partially ruptured hymen. There can also be problems caused by ovarian tract abnormalities, where the development of the tract is not proper,” explains Dr Nilesh. Certain pathological conditions like endometriosis and adenomyosis can also make having intercourse difficult for women.
Says Dr Nilesh: “In these conditions, the sexual act per se can be quite painful for women.” Psychological issues can also have a role to play here. “A childhood fear of sexual activity or trauma experienced at a younger age can cause intense spasms of the vagina during intercourse, thus causing a condition called vaginismus,” he adds.
In men, anatomical problems, as well as hormonal biochemical problems, could be the culprits behind sexual dysfunction. “Men with issues with preputial skin (which doesn’t go back), phimosis, or infections down there are likely to face problems during sexual activity,” suggests Dr Nilesh. It is also important to credit hormonal disturbances like low libido (sexual drive) and low testosterone levels as the pathological causes responsible for impaired sexual function in men.
Much like in women, certain psychological factors can be at play in men. “Many of the male sexual problems are usually psychosexual rather than anatomical,” says Dr Nilesh. “This can transmit into certain disorders like erectile dysfunction, where men face problems with erection. Men also face problems with sustaining erections and premature ejaculation, along with ejaculatory disturbances—where erection happens but there is no ejaculation,” he adds.
Seeking help for sexual dysfunction is important
“Many of the couples usually deny that they have a sexual problem. But during sexual activity if they feel that something is not right, they should consult a specialist,” says Dr Nilesh.
But whom should you and your partner go to find a solution? Well, Dr Nilesh suggests visiting a gynaecologist if the female partner suffers from sexual dysfunction. “Couples can also take the help of a urologist or an andrologist if they feel that the problem is with the man,” he adds.
“Sometimes couples also have to opt for psychosexual counselling, since a majority of the cases of sexual dysfunction are psychosexual. A combined approach is very necessary for managing such conditions,” stresses Dr Nilesh.
You can conceive even if have sexual dysfunction
There exist a multitude of treatment options for couples facing sexual dysfunction—thus helping them live a fuller marital life and become parents. Says Dr Nilesh: “Usually the treatment for sexual dysfunction is two-pronged—we treat both the sexual dysfunction problem and fertility issues.” Along with psychosexual therapy, couples with sexual dysfunction may also need to get anatomical abnormalities and/or biochemical hormonal problems fixed.
“Sometimes sexual dysfunction takes time to get corrected, but reproductive issues can be given a priority and treated side by side—so that couples can become parents,” he adds. In this regard, a fertility specialist can help.
Yes, many fertility treatments can help you welcome a baby even if you have impaired sexual function. Dr Nilesh explains a few of them here:
Self insemination: “The semen sample can be collected via masturbation in a simple syringe. And this syringe can be introduced in the vagina and the semen can be deposited. After this the woman can lie in a recumbent position for around 10 to 15 minutes,” explains Dr Nilesh. This method can be extremely helpful—especially when practised around the time of ovulation.
Intrauterine insemination or IUI: “IUI can be practised by monitoring the ovulation. This monitoring can be done with the help of hormonal or urinary LH testing, and even ultra-sonography,” he says. Around the time of ovulation, the semen is washed—removing the liquid part—and added to the media. This treated semen is then deposited into the uterus directly so that the chances of pregnancy are high.
“In patients who have sexual dysfunction, we suggest multiple IUIs—since a single cycle won’t be sufficient. We usually recommend a minimum of three to four IUI cycles—though up to 10 cycles are also okay so that the treatment can be continued for a period of six to 10 months,” explains Dr Nilesh.
In-vitro fertilisation or IVF: If after IUI a couple hasn’t been able to conceive, they are usually asked to go in for IVF which is a more advanced treatment. “In IVF the embryo is prepared outside the body and is transferred directly into the womb,” says Dr Nilesh.
“If couples have some other associated infertility problems, along with sexual dysfunction, then IVF can work very well,” he adds.
Intracytoplasmic sperm injection or ICSI: ICSI is an advanced form of IVF where the is injected directly into the egg under high-powered magnification. “ICSI is usually recommended to those patients who along with sexual dysfunction have issues with sperm count and low egg count,” explains Dr Nilesh.
Struggling with sexual dysfunction? Don’t ignore this advice by Dr Nilesh
“Don’t be disheartened if you want to conceive and have sexual dysfunction,” says Dr Nilesh. “Don’t go just for a medical line of management—psychosexual counselling is an important aspect of treating sexual dysfunction,” he adds.
Stressing that doctors also need to handle such cases more sensitively, he says: “Doctors should also understand this could be originating from a personal front for the couples or stemming from the extreme pressure that families might be putting on them to get pregnant. All this needs to be kept in mind while treating sexual dysfunction and infertility,” he concludes.