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Causes of infertility

Highlights the relation between infertility and coital failure, the psychological and physical causes and describes some forms of coital failure.


Coital failure

Some infertile couples may experience difficulty in having a baby because of coital difficulty or inappropriate timing of sexual intercourse (infrequent intercourse or intercourse mainly at the beginnings and the ends of the womans menstrual cycle). Coital difficulty may also result after a sexually active couple has been labeled infertile. For some couples, sexual intercourse becomes a necessity rather than a natural love making experience. Infertility investigations itself can be very stressful to the couple.

Many men and women suffer for years without seeking advice and help. This is often because they are unaware that in most cases, treatment may help. Some do not know whom to turn to for advice and others are too embarrassed to seek help. Patient may not disclose the full extent of his or her sexual difficulties because of feeling of shame or fear of hurting his or her partner feelings.

The causes of the sexual difficulty could be physical or psychological. However, most cases will involve physical and psychological elements, although the balance may vary considerably from person to person.

Coital difficulty requires appropriate investigations and treatment. Unfortunately, talking about personal sexual matters including sexual disorders and difficulties, is often an uncomfortable experience for both doctors and patient. When the cause is predominantly psychological, normal sexual functions may be restored through psychosexual therapy. In many cases, nothing more than sex education of both partners is necessary. Some men are concerned about the size of their penis and their ability to father a child. The size of the penis is generally unimportant so long as penetration is achieved.

Treatment can improve wellbeing, social health and self-steam. Furthermore, improved sexual relationships can improve overall quality of relationship. Variuos options of treatments include lifestyle changes, treatment of coexisting medical or psychiatric disorders, discontinuation or switching medications that have an impact on sexual dysfunction, marital counselling etc.

If the cause of coital failure is predominantly physical, normal sexual activities are unlikely to be restored without some form of medical or surgical treatment.

Incidence

2-3%

Causes

Psychological causes

 

  • Emotional and financial stress and anxiety from home or work
  • Marital disharmony
  • Worry about poor sexual performance, fear of failure, fear of pregnancy
  • Depression
  • Inadequate or absent sex education
  • Sexual problems in the partner
  • Psychological trauma such as sexual abuse, rape or traumatic childbirth.

Physical causes

Male
  • Damage to the special nerves which cause erection. This could have been the result of an injury such as spinal cord injury, surgery such as prostatectomy and surgery in the bladder neck, or diseases such as multiple sclerosis.
  • Deficient blood flow to the penis e.g. blocked arteries.
  • Chronic illnesses such as kidney or liver failure.
  • Side effects of prescribed drugs e.g. certain drugs for lowering high blood pressure and antidepressant.
  • Diabetes (30 % of diabetics suffer from some form of sexual dysfunction).
  • Hormonal e.g. hyperprolactinemia or low testosterone levels.
  • Heavy smoking
  • Alcoholism and drug abuse
  • Congenital penile abnormalities such as Peyronie disease.
Female
  • Painful scar (e.g. episiotomy)
  • Infection
  • Congenital abnormalities such as a rigid and tough hymen or unusually narrow entrance.
  • Endometriosis

Presentation

Frigidity

The absence of sexual desire "libido". The psyche is the seat of libido.

Premature ejaculation

The man arrives at orgasm and ejaculates before he wishes to do so.

Nonorgasm

The inability to achieve orgasm by means of masturbation or coitus. Although, it is not necessary for the woman to have an orgasm for conception to take place, unfulfilled sexual activity may create marital tension and stress.

Delayed (retarded) ejaculation

The inability to achieve an orgasm, even though the erection is satisfactory. At times retarded ejaculation is selective (a man is able to achieve an orgasm by masturbation but not during coitus).

Erectile dysfunction (ED)

Commonly referred to as impotence, it is the inability of the man to obtain or maintain an erection satisfactory for the purpose of sexual intercourse. The true incidence is probably underestimated because of embarrassment about seeking help. The incidence rise with age. Impotence has organic and psychogenic factors

Dyspareunia

The pain experienced by the woman during intercourse. Dyspareunia could be superficial when the woman experiences pain in her vulva or vagina during penetration. Deep dyspareunia occurs when the woman experiences pain deep in her pelvis in the organs that surround the top of the vagina.

Vaginismus (vaginal spasm)

The inability of the woman to relax her vaginal muscles, preventing penetration by the male. Vaginismus is the commonest cause of dyspareunia. It can affect women who have never been pregnant before as well as women who have been pregnant before.

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