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“Sex, fertility and commitment: what men really think”: Times Weekend fails to fully explore psychosexual problems and infertility

May 1st, 2010

Dr Petra

Today’s Times Weekend focuses on an important yet taboo issue – Infertility. ‘Sex, fertility and commitment: what men really think’ includes in depth interviews with several men about the topic. While it’s right to talk about this issue from a male perspective, there are messages within the feature that are worrying in relation to sex, orgasm, fertility and gender. Not least because the issue of sex is not covered in any depth, but what is discussed about sex and orgasm is misleading.

Part of the feature focuses on an interview with Lord Robert Winston, a recognised pioneer in fertility treatments. He states: “Many years ago I did a study that, to my great regret, was never published. It was on women who were not orgasmic. We showed a clear correlation between women who did not enjoy sex and unexplained infertility. The study indicated that women who didn’t achieve orgasm and were having IVF were more likely to experience unexplained infertility”

This is troublesome for several reasons. Firstly it is always difficult when practitioners talk of research they’ve done but never published. It means we have no idea of assessing the work, and it won’t have been subjected to peer review. If we’re hearing about a study it needs to be treated according to standard academic conventions. Which usually include noting other evidence in the area. As in this case there is an established body of research on sexual functioning and fertility that has been steadily growing since the 1970s. This is not discussed.

The idea of orgasm as something to ‘achieve’ has long been a worry within the sex research community, not least because it sets up sex as something that must end in orgasm and prioritises orgasm as the main focus of sex. It overlooks wider areas of pleasure couples may explore. And in relation to fertility these aspects are crucial.

For couples looking to enjoy sex within the confines of infertility treatment the Times represents sex in a narrow way, with orgasm as end goal, something you ‘achieve’. It does not help the readers appreciate a more varied approach to pleasure and affection which may be vital to a couple where sex is increasingly becoming only about conception. It gives no guidance on how that might be explored. Something we might expect when headlines promise a discussion of sex and fertility.

Moreover it does not fully explore the wider and more complex issues relating to sex and infertility that result in sexual problems. Just a few examples include the stress of treatment, anxiety about fertility, fears of being childless, relationship breakdown, preoccupation with having a baby, and the cost of treatment (if one is paying privately). While these are all talked about within the Times interview they are not really presented as a clear explanation of a complicated problem that contribute to psychosexual difficulties. Instead the piece highlights women’s lack of orgasm/sexual pleasure as a major contributor to infertility.

We know women’s fertility problems and psychosexual issues are intertwined (see here and here). However the nature of this relationship is complex. In some cases psychosexual dysfunctions lead contribute to infertility, while in others it may be the anxiety around fertility problems or undergoing infertility treatment that leads to psychosexual difficulties (see for example here and here).

Men’s psychosexual dysfunctions similarly experienced, regardless of whether it is the man or his partner who has the clinical problem (see here and here). Indeed if a couple is struggling to conceive and the man is unable to get an erection or is struggling with premature ejaculation (during intercourse or masturbation) it adds to the strain they are already under. Given the Times’ feature focuses on men, sex and infertility it is somewhat worrying this issue is not fully explored.

For women and men sexual pleasure is possible without orgasm. And while some theories have argued women need to orgasm to conceive, this is not the case. Discussions that focus on sex only in terms of orgasm miss the wider pleasures couples may experience, and also overlooks more important questions about the general quality of couples’ relationships. The Times could have used this opportunity to explore how couples might experience this, but they sadly failed to do so.

From the reporting of Lord Winston’s comments in the Times report readers could be forgiven for thinking women can control their fertility by making more of an effort to enjoy sex or having orgasms. This massively oversimplifies the wider body of research on this area.

Healthcare professionals, therapists and sex educators also need to take greater responsibility in this area. There is plenty of evidence about psychosexual problems and infertility. What we lack is clear advice programmes for couples that focuses specifically on addressing those problems as they arise, and to combat them in the first place with support and information about pleasure and intimacy that is not goal oriented to the ‘achievement’ of orgasm. We need more research on this topic and more training for professionals working with couples to help them maintain a positive relationship under highly stressful and often very distressing conditions. Part of the reason couples do struggle in this area may well be to do with professionals failing to provide this information in a timely fashion.

The issue of infertility is still taboo and highly emotive. Any practitioner talking about the area needs to do so in a way that fits with current evidence based practice and focuses on couples not women or men. We also must ensure advice given does not make people feel they have contributed to their infertility by a lack of female orgasm, which is likely to scare anyone considering trying for a baby – whether they have fertility problems or not.

The Times undoubtedly covers the male experience of infertility with their case studies. But given its focus was on sex and infertility it fails to engage on this level and misses a vitally important opportunity to help readers with a major worry couples struggle with.

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