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Sexual Function and Male Infertility

By Kelly Chiles MD

Can sexual dysfunction affect my fertility?

It is important that the male fertility work-up include an evaluation for sexual dysfunction. Premature ejaculation and erectile dysfunction are the most common disorders of sexual function, and it is important to talk to your doctor about any such problems because they could have a serious negative impact on your fertility. Other kinds of sexual dysfunction that could affect your fertility include decreased sex drive and difficulty with ejaculation.

What are the symptoms of the different kinds of sexual dysfunction?

Premature ejaculation:
Premature ejaculation is when ejaculation occurs sooner than desired, including before any vaginal penetration or almost immediately after penetration. This is the most common kind male sexual dysfunction, and ejaculating before being able to deposit semen deep in the vagina can make fathering children difficult. There are treatments available for this problem.

Erectile dysfunction:
Erectile dysfunction is the inability to get or maintain an erection that is hard enough or lasts long enough for successful intercourse. Many medical conditions can contribute to erectile dysfunction. Diabetes, high blood pressure, and smoking are just some of the common medical problems that men may have which can affect their erections. Sometimes this problem can be from the “pressure of trying to get pregnant”, especially during the “fertile period of the month”. The brain can send chemical messages to the penis to decrease the quality of the erection. There are also excellent treatments for this.

Decreased libido:
Lacking the desire to have sex can be common in couples who are dealing with the stress of trying to conceive. While it can be a normal response to a stressful time in many men, sometimes it can be a sign that there is a hormonal imbalance which needs to be fixed in order to optimize not only their sex life, but also their sperm production and ability to father children. Any decrease in sex drive that lasts longer than a few weeks should be evaluated by a doctor, particularly if it occurs while trying to conceive or if it’s accompanied by any other symptoms such as depression or fatigue.

Symptoms of ejaculatory problems:
Although ejaculation and orgasm are often considered to be the same because they usually occur simultaneously, they are actually separate physiologic processes. There are many men who can have an orgasm, yet do not ejaculate. The cause of this lack of ejaculation can occur in men with diabetes or those who have had certain operations, such as some types of prostate surgeries or big abdominal surgeries. In others, the cause may be from a blockage in the ducts which carry sperm and semen and allow the fluid to leave the body and be deposited in the vagina. Any men who have found that they orgasm but do not ejaculate, should inform their doctor because this could be a sign that they have an obstruction somewhere in their reproductive tract.

Can being infertile cause ED?
Infertility by itself does not cause erectile dysfunction the way that sexual dysfunction can contribute to infertility.However, just as the stress of trying to conceive can decrease a man’s libido, the stress can also manifest itself in other ways.Sometimes men can find it difficult to “perform on demand” – for example when they are in the doctor’s office attempting to provide a semen sample, or having timed intercourse to coincide with ovulation.When the stress becomes great enough that the ability to achieve erections and ejaculate becomes compromised, it is necessary to address the situation and find stress-reducing solutions or consult a physician for medical treatment.

Are there treatments for these dysfunctions?
The first step to identifying whether or not treatment is available is finding a healthcare provider who will work with you to obtain the right diagnosis. Once you have been evaluated for sexual dysfunction as a contributing factor for infertility, your doctor can discuss what treatments are available for your particular medical condition. Excellent treatments are available for erectile dysfunction with medications such as Viagra, Levitra or Cialis. There are medical and procedural options to treatment men who do not ejaculate. There are also some treatments available for premature ejaculation. Consulting a specialist who is familiar with both sexual dysfunction and fertility problems would be very beneficial, and counseling could also be helpful for both a patient and his partner.