When Sex Becomes a Chore

When "Amy" and her husband decided to start trying to have a baby three years ago, the sex was fantastic. They did it three to six times a week, and a year later, she became pregnant but promptly miscarried. The couple continued to make love just as frequently over the next couple of years, but Amy didn't get pregnant again. During sex, she couldn't stop thinking about her infertility, and over time, she felt disconnected from her husband. "We normally like to tease each other, switch positions and cuddle before and after," says Amy (not her real name), 28, a teacher from Milwaukee. "There was far less of that."Anyone who has had trouble getting or staying pregnant knows that infertility is hard on relationships; however, a new study from Stanford University has documented the extent to which it hurts women's sex lives. Forty percent of infertile women suffered from sexual problems that caused them distress, compared with 25 percent of a control group of healthy women. They experienced low desire and had trouble becoming aroused. They engaged in sexual intercourse or masturbated less frequently. The research is important because it highlights a problem few women talk about. Also, the data make a clear case for fertility doctors to collect couples' sexual histories and refer them to counseling, especially given the growing awareness of how patients' emotional health affects their chances of treatment success, explains Janet Takefman, psychologist and chair of the mental health professional interest group of the American Society for Reproductive Medicine. Advertisement

In the Stanford study, published last month in Fertility and Sterility, researchers surveyed 119 women with an average age of 36 and found that infertile women were less happy with their sex lives, compared with a group of 99 healthy women. However, the infertile women had similar levels of sexual satisfaction as the healthy women before being diagnosed. Infertility is defined as the inability to become pregnant after one year of regular intercourse if a woman is younger than 35 and six months if she is older. Since fewer than half of the women had received IVF treatment, it was unclear whether hormone shots depressed their libidos, though the researchers believe the cause was mostly psychological. Women with infertility suffer from depression, anxiety, and low self-esteem, and their distress is compounded with each unsuccessful treatment attempt. In the Stanford study group, the average length of infertility was 3.4 years. Ronny Diamond, a therapist based in New York and the co-author of Couple Therapy for Infertility, says that women's sexual desire is further dampened if they feel unattractive or unfeminine because they can't conceive. "Sex, rather than being a place where you can escape the world, becomes a reminder of what you can't do. You can't make a baby," she says. As a result, women are less likely to feel close to their partners. Worse, they might feel they're disappointing them.When sex is so fraught with failure, it quickly becomes a casualty. When it does occur, it may be the on-demand variety that feels like a chore for both men and women. "When the woman calls her husband at work and says 'I'm ovulating. Come home. We've got to do it now,' it ruins people's ideas of romantic conception," says Diamond. There's little room for foreplay, and men may have trouble performing under so much pressure. Alice Domar, a psychologist who developed a popular mind-body program for infertility patients (which DoubleX previously wrote about), advises patients to protect the pleasure of sex by designating one bed for baby-making sex and another for fun sex. Or they can try to strive for "mindful love-making" and focus on their partners' touch and smell rather than think about the purpose of the act. Domar even counseled one couple to have their doctor inject the husband's sperm into the wife's vagina to make the functional distinction clear. "Making love can just be about making love now," she says. Although medical intervention can be an added source of stress for couples—fueling arguments over how much money to spend for treatments and whether to use donor eggs or sperm—one DoubleX reader says it helped her sex life by relieving her of her baby-making duty. "The doctor is essentially barging in the reproductive cockpit and taking over," writes "Shayla" (also not her real name), a 30-year-old artist from San Diego, who has tried unsuccessfully to become pregnant for more than two years. "Since sex no longer serves a practical purpose, i.e. getting the woman pregnant (that's handled in the lab), it is all of a sudden just for pleasure again. That can be really, really nice after months of pressure-filled and timed intercourse."The question remains, however, whether couples' sex lives bounce back once a couple gets past infertility, whether by conceiving, deciding to adopt, or making peace with not having children. There is some good news on that front: A 10-year follow-up of couples who completed IVF treatments—successfully or unsuccessfully—rated their sexual satisfaction as being adequate or somewhat better than adequate. Although one-third of childless women in this study reported that infertility had a negative impact on their marriages, Takefman notes that infertile couples have a lower divorce rate and can recover from sexual stress. "You're fighting a crisis together and learning how to cope quickly with something traumatic," she says. "If you survive that, you'll be in good standing for the rest of your marriage."Amy says her sexual bond with her husband returned once they decided to register with an adoption agency and she stopped following her ovulation cycles. She and her husband currently are waiting placement. "I can snuggle with him, and we can play around without having to worry about when and where he ejaculates," she says. "My period stops being the center of my life."Become a fan of DoubleX on Facebook. Follow us on Twitter.
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Sarah Elizabeth Richards is a journalist who frequently writes about health and science and the author of Motherhood, Rescheduled: Five Quests to Stop the Biological Clock a narrative nonfiction book that chronicles the lives of women who attempt to preserve their fertility by freezing their eggs (forthcoming in 2012). Photograph of a couple in bed by Digital Vision/Getty Creative Images.