Psychological aspects of men's sexual health in the context of infertility

The cycle of sexual response includes physical and psychological reactions that occur during sexual activities, regardless of the type of sexual activity. Most often, the cycle is explained as a linear alternation of four phases: stage of sexual desire, then excitement, phase orgasm and finally resolution phase. The desire phase denotes the psychological function of motivation and interest in sexual activity, thinking and fantasizing about sex. In the arousal phase (which can follow without the desire phase, with physical stimulation of the genitals or other erogenous zones), the most visible change in the entire cycle occurs: the erection of the penis. In addition to erection, during this phase the testicles (testicles) rise, as well as other changes in the body.The orgasm phase includes ejaculation and orgasm. Ejaculation means the ejection of semen, and orgasm is a psychological experience of great pleasure. Most often, these two events take place simultaneously, but it is also possible for them to be separated or for one to be missing. Finally, in the dissolution phase, the body returns to its pre-arousal state. In men, a refractory period occurs after orgasm, or a period in which he cannot ejaculate again.

At each of these stages, difficulties may arise. If they last long enough and cause personal suffering or interpersonal tension, we are talking about sexual disorders. Sexual disorders related to the sexual response cycle are reduced sexual desire, erectile dysfunction, premature ejaculation, delayed ejaculation, etc.

Men's sexual health is closely related to infertility in two ways.Infertility can be caused by sexual disorders, but it itself also contributes to the appearance of sexual disorders. In some men, the problem of infertility is caused by a sexual problem or as it is called coital infertility caused by erectile dysfunction or ejaculation disorder (either premature or delayed). In those whose infertility is not caused by a sexual problem, various sexual problems can occur as a result of coping with infertility and infertility treatment, from reduced sexual desire, erectile dysfunction to problems with ejaculation and orgasm.

So far, research has been much more focused on researching sexual dysfunctions in women struggling with infertility than in men.Nevertheless, those carried out show that in the general population about 25% deal with sexual disorders, while on the samples of men with infertility information is obtained about a significantly higher percentage. 48-56% of them also have a sexual disorder and are predominantly significantly less satisfied with their sexual life.

Infertility leaves its mark on different aspects of a couple's life. It causes feelings of shame, guilt, sadness, anxiety, and if it lasts for a long time, it represents one of the most stressful periods of life. Sexual relations cease to be spontaneous and lose their erotic value precisely because it is exclusively and closely related to conception, which is so longed for and pleasure is difficult to achieve. Precisely because sexual arousal is lacking or difficult to achieve, it is not uncommon for men who are infertile themselves or are in a partnership in which infertility is present to develop sexual dysfunction. Furthermore, the infertility treatment itself also dictates the frequency and time of sexual relations, and thus regulated and controlled intimate relations by infertility specialists are often symbolically perceived as if doctors are also present during sex.Problems arise due to the emotional state that accompanies the knowledge of infertility and forced and dictated sexual relations during infertility treatment.

In infertile men, hypoactive sexual desire and lack of sexual satisfaction are the most common types of sexual dysfunction. Research shows percentages between 8.9% and 68.7%. Erectile dysfunction has a prevalence of one in six infertile men, and ejaculation disorder has a prevalence of one in ten infertile men.

Disorder of reduced (hypoactive) sexual desire

Lack of sexual desire or motivation for sex is one of the rarer disorders that occur in men. It is estimated that at least 10% of men have this disorder, and in the Croatian sample it was found that approx 4% of men experienced a lack of sexual desire and motivation.Reduced sexual desire in men is defined as a state of reduced or absent motivation for sexual activities, disappearance or significant reduction in the appearance of sexual thoughts and fantasies; lack of initiation of sexual activity and rejection of the partner's attempts to initiate sexual activity; disappearance or reduction of excitement and pleasure during sexual activities lasting at least 6 months. Although men with reduced sexual desire (which they have always had) do not experience high levels of personal suffering, they do experience high levels of stress due to partner problems caused by lack of interest. In men with this problem, it is not possible to produce a visual or verbal sexual stimulus.

There can be many reasons for reduced sexual desire biological, personal psychological until partnership. Of the biological ones, these are most often health problems, from hormonal disorders to depression, and often the result of treatment, especially of some mental illnesses and disorders of addiction to psychoactive substances. However, psychological and social factors also play a significant role. Of the psychological ones, high levels of stress and anxiety should certainly be highlighted, but also interpersonal ones such as bad partner relationships, poor communication, lack of closeness and intimacy or too closeness in a long-term relationship, the appearance of sexual boredom and saturation.

It is also sometimes necessary to investigate whether there are any other specific sexual preferences such as a specific pattern of arousal, preference for masturbation over coitus, presence of paraphilia, sexual disorder of the partner, unprocessed sexual trauma as well as conflict over sexual orientation.It is possible that the person has some other sexual disorder (erectile or premature ejaculation), which is why he avoids sex due to shame and discomfort and the anxiety of waiting for an unsuccessful sexual relationship.

Erectile disorder

The problem with sexual arousal in men is the problem of achieving or maintaining an erection or the firmness of the penis necessary for sex. According to the criteria, a man cannot achieve or maintain an erection in at least 75% of sexual activities, or the rigidity (firmness) of the erection is insufficient for sexual activity. Many men are afraid of such a situation, and how strong the fear of performance is, the fact that almost every fifth young man fears that he will have problems with erection during the first sexual intercourse tells us.

It should be emphasized that most men occasionally have problems with erection and this is completely normal.It is unrealistic to expect that the firmness of the penis will not change from the moment of achieving an erection. Likewise withErectile dysfunction is part of the normal aging process, so the erection that a man has at the age of 20 will become weaker as he ages. If a man feels that his penis is getting softer during sex and is afraid that "he will fall", "that he will not be able to last in sex", "that he will not be masculine enough", "that his partner will leave him" or "that this is a sure sign that he is impotent" - there will be an additional decrease in sexual excitement and his negative prophecy will come true, i.e. he will lose his erection. Once they completely lose their erection, men most often make a key mistake, which is to stop sexual activity, i.e. run away from the discomfort.If they continued with various other forms of sexual behavior (caressing, kissing, stimulating the partner with the hand, oral satisfaction), as a rule, they would become excited again, i.e. experience an erection. Of all sexual disorders, this is the one for which men most often seek help because, as it seems, that it represents significant frustration and suffering for men.

The causes of erectile dysfunction are different, some are physical and some are psychological. It is important to be able to distinguish whether someone's erection is caused by a physical problem or psychological factors. If a person has morning erections, if he has an erection during masturbation, if he experiences spontaneous erections during the day or if he has an erection with another partner, we can be sure that the problem is influenced by psychological factors. If the answers to these questions are negative, then it is necessary to have a specialist examination by a doctor - preferably a urologist.

The most common physical causes of erectile dysfunction are blockage of blood vessels, which leads to reduced patency of the artery in the penis.A sedentary lifestyle, blood fats, metabolic syndrome, cigarette smoking, obesity and chronic exposure to stress are the most common factors in the development of these disorders.

There are many psychological factors, from personal emotional problems (such as anxiety and depression, fear of performance during sex, fear of intimacy), partner problems (e.g. bad relationship, partner's sexual disturbances or physical illnesses and conditions) and negative attitudes about masculinity ("You are a real man if you can always and never fail"). Although less common, the possibility that erectile dysfunction may be a reflection of some other sexual interests and desires, due to which current sexual relations are not sufficiently exciting, should not be ignored.

Premature ejaculation

Premature ejaculation is not easy to define.Although it is difficult to determine how fast is really and problematically too fast, the latest interpretations say that it is a sexual disorder in which a man reaches orgasm and ejaculates (i.e. ejects sperm from the penis) within 1 minute or before he wants it from the beginning of vaginal penetration. Unfortunately, in some men (albeit very rarely) ejaculation occurs even before the penetration of the penis into the vagina has been achieved, which also causes frustration for the partner. This kind of situation is an obstacle to conception.

It is known that men with this problem do not pay enough attention to the level of their own arousal in the pre-orgasm phase, and non-pharmacological treatments are precisely aimed at training and good recognition of arousal levels, which change rapidly, in order to develop a sense of control.Among men who have premature ejaculation, there are a large number of them who have elevated levels of anxietye osobito socijalne anksioznosti. Za istražiti je te osjećaje – sram i krivnju – koji zasigurno ne pomažu kod ovog problema.

Delayed ejaculation

Delayed ejaculation is a significantly less common sexual problem for men (between 1% and 3%), compared to premature ejaculation and erectile dysfunction. Delayed ejaculation is a sexual problem in which a man, despite adequate stimulation, cannot achieve ejaculation and orgasm or achieves them with great difficulty. For diagnostic purposes, it is necessary to distinguish whether it is retrograde ejaculation (when a man experiences an orgasm, but does not ejaculate normally, but instead into the bladder and ultimately wets the ejaculate), anejaculation (a disorder when a man achieves an orgasm, but does not ejaculate, i.e. does not eject sperm) or the inability to achieve an orgasm and ejaculate. It should also be determined whether there are circumstances in which a man can ejaculate (eg during masturbation or with a specific fantasy) or whether he cannot ejaculate under any circumstances.

Biologically the causes are mainly related to certain health problems that can trigger this problem, such as hypogonadism, insomnia, thyroid disorders, pituitary gland disorders, consequences of prostate surgery, drug abuse and alcohol consumption (especially long-term), reduced sensitivity of the glans penis, spinal cord injury, multiple sclerosis, long-term and severe diabetes and taking certain medications (e.g. antidepressants). From psychological factors delayed ejaculation is usually the complete absence of ejaculation in sexual intercourse, while ejaculation can be achieved without major difficulties in masturbation, and these are partner problems in the form of broken relationships or lack of attraction towards the partner.

Furthermore, this problem is associated to a significant extent with anxiety, which can arise from an extremely high need to satisfy the partner, a lack of confidence that he will be a good enough sexual partner, a bad image of his own body and genitals, feelings of sexual unattractiveness, negative comparisons with other men that his partner had until then, etc. Such thoughts would be more reflected in some men's loss of desire for sex or a decrease in excitement, i.e. a loss of erection. In this group of men, the erection is preserved, but the discomfort caused by such considerations during sex reduces the subjective feeling of excitement, so it is logical that the climax is experienced with difficulty or not at all. Therefore, it is logical that men with delayed ejaculation achieve orgasm and ejaculation more easily by masturbating than during partner sex, because then the aforementioned concerns do not disturb them.Sometimes the problem also occurs due to a specific pattern of stimulation during masturbation (eg a strong and rough squeeze of the penis) that is difficult to achieve in other ways in partner sex.

Važno je i naglasiti kako različita istraživanja i klinička opažanja pokazuju da se kod muškaraca s odgođenom ejakulacijom nailazi na značajno više, snažno izraženih, religioznih stavova. Vodeći se uvjerenjem kako seksualna aktivnost, koja ne vodi reprodukciji, predstavlja ‘rasipanje sjemena’, muškarci s ovim problemom izbjegavaju masturbiranje te rjeđe ejakuliraju u seksualnim odnosima. Ako i masturbiraju, onda je masturbacija vrlo često praćena snažnim osjećajem krivnje. Takav obrazac potpomaže nastanku i održavanju smetnji.

Author: Ph.D. Tanja Jurin, Univ. spec. wedge. psycho.

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