The webs we don t know we weave : Sex therapy protocol in infertility settings

Sexual problems in a couple with infertility are a complex area of specialty. Reciprocal association between sexual problems (SP) and infertility has argued worldwide. Infertility has a negative impact on the sexual relationship of infertile couples. The adverse impact is essentially associated with the sexual self-concept of infertile individuals and their partners. Sexual self-concept is manipulated through the treatments an infertile couple receives. Evaluation process and treatments are offered in infertility clinics influences the ways couples organize their intimacy, particularly their sexual life. Communication between partners is altered and affectionate exchanges lose their spontaneity. Consequently, sexual function is affected by infertility due to limited or avoided sexual relationships. Risk of sexual dysfunctions, primary vs secondary to infertility is high (OR 9.53; 2.27-40.01). In infertile men, low sexual desire and lack of sexual satisfaction are the most prevalent types of sexual dysfunction, ranging from 8.9-68.7%. 1/6 and 1/10 infertile men experience erectile dysfunction and/or premature ejaculation, and orgasmic problem respectively. Women with infertility have a high rate of sexual dysfunction compared with men; 65% with primary and 77% with secondary infertility. Genito-pelvic pain/penetration disorder (GPPPD) and low sexual desire (32%) are commonly diagnosed in women with infertility issues.In sum, sexual difficulties often remain or get worse after treatment ends successfully or unsuccessfully. Often, health providers and clinicians ignore or restrain the SPs of infertile couples. Lack of consultative support from specialized sex therapist alters the quality of care in infertility settings. One of the main reasons for this gap can be the question that how should we take care of these couples through their sexual lives Adoption of a patient-centered framework for evaluation and treatment is acknowledged as the essential concepts underlying the management of sexual problems in infertility clinics. Consideration of treatment principles is the second seminal concept. After complete assessment, the first step in the management is case formulation. Understanding the contribution of each partner to the problem is vital second step, a sex therapist must take to achieve the goal of balancing partners. Determination of treatment options is the third step. Treatments for SP can be broadly classified into general and specific approaches. Sex education and relaxation exercises are utilized as the general approach. The specific approach can be either pharmacological or non-pharmacological or a combination of both. The final step is the selection of treatment which is accorded to patient/couple s choice. Follow-up assignments enable the therapist to evaluate the treatment effectiveness and its impact on infertility treatment plan.