Let’s talk about Sex!

Sex by the calendar or as much sex as possible – These are the tips couples get when the desire to have children doesn’t work out. But what if sex is the real problem?

In couples who have already tried for a while (6-12 months) to get pregnant and in whom physical causes for the unwanted childlessness can also be ruled out, a sexual disorder may be the cause of the unfulfilled desire to have a child.

We asked Prof. Henry Alexander, MD, a few questions about this. He is emeritus director of the Center for Reproductive Medicine, Gynecological Endocrinology and Sexual Medicine at Leipzig University Women’s Hospital. With his support, one of the first IVF babies in Germany was born at Leipzig University Hospital in 1985, and he is one of the few reproductive physicians specializing in sexual medicine.

1. In the case of an unfulfilled desire to have children, the sexual health of the couple should definitely be taken into account in the therapy.

Question: How did you come to specialize in sexual medicine in addition to reproductive medicine?

Answer: When one comes from reproductive medicine, one is confronted with the problem that – if physical causes are ruled out – sexual disorders may be present. These are often the cause of infertility, for example, when couples have sex very rarely and wonder why they don’t get pregnant.

My goal has always been to feel responsible for the couple’s sexual health in fertility treatment. I have then, from case to case, put the infertility treatment on hold a bit in order to first treat the sexual communication disorder and to see the desire to have a child more comprehensively, with everything that goes with it.

2. A satisfied partnership also includes living one’s desire.

Question: What advice would you give to couples who wish to have children?

Answer: If you are having problems conceiving, you must always question your sexuality. If couples who are childless come to me and do not have sexual intercourse, but want me as a reproductive physician to bring about a pregnancy using medical methods, I do not agree with this. Because in this way the basic problem – a probable sexual disorder – is not addressed or treated. Couples want to be together for the next 50 years and a satisfied partnership also includes understanding each other and living pleasure.

It should be checked whether there is a healthy intimate togetherness and if not, “e.g. in case of existing suffering pressure”, the couple should seek advice on how they can achieve this. This is because infertility treatment puts a strain on sexuality, for example by recommending sex at a certain time. This can lead to frustration in the long run.

By the way, it is often the men who show little awareness of the problem and think everything is fine because they are not willing to address the disorder.

In my opinion, questioning sexual health is always part of fertility treatment. If it is apparent that there is a relationship problem based on a sexual interaction disorder in the broadest sense, then as a doctor you have to look at how you can help. If I see that the sexual togetherness is disturbed, this problem should be addressed first before a desire to have a child is medically fulfilled. Because once the child is here, the couple again cannot turn to each other adequately and normalize their sexuality due to time constraints, then the problem is only further postponed. In the long run, a child cannot repair such a disturbed relationship.

3.The solution is to communicate and talk things out.

Question: In today’s enlightened times with media publications, Internet, etc. are there still topics related to sexuality that people do not talk about or know about?

Answer: In the media sexual fairy tales are presented, one can see and learn sexual techniques, but this is not reality. There is a lack of pleasure and play, of feeling for each other. It’s only about the act itself, but what happens before that is not reflected. The fact that one approaches respectfully, without violence, without coercion and without discrimination, and reveals one’s desires, is forgotten. It can be said that the prelude is missing, the intimacy and security that actually everyone is looking for.

Love is a game and there you have to adjust to each other. This includes talking about sexuality, your desires, experiences and expectations, but this is not communicated in public.

Sexual dysfunction is caused by insecurity because togetherness does not simply work as it is always portrayed in the relevant media. If, on top of that, people don’t talk to each other, they don’t get closer to each other, and there’s the problem. Communicating and talking things out is the solution.

The sexual is very present in the media and everyone thinks they understand something about it, but I have the feeling that the general awareness of sexual health is unfortunately not yet comprehensive enough.

4. One’s own well-being in sexuality as well as finding a partner who resonates with one is the basis of sexual health.

Question: What do you mean by sexual health?

Answer: Sexual health has several references with individual and social background. It is connected with one’s overall health, in the sense of well-being and quality of life. It refers to the state of physical, emotional, mental and social well-being in relation to sexuality. It is important to note that sexual health requires a positive attitude toward sexuality and sexual relationships, and ultimately has to do with a counterpart. Sexual relationships should be free from coercion and should be consensual – without discrimination, violence or disenfranchisement.

It is an important topic, because if you feel good about yourself in sexuality and you find a partner who harmonizes and resonates with you, you can achieve sexual satisfaction – based on sexual health.

5. Further tips and links

In addition to Prof. Alexander’s advice, the BKiD (Beratunsgnetzwerk Kinderwunsch Deutschland) has also compiled tips for couples with an unfulfilled desire to have children. Of course, there is no general recipe – but there are various ways in which affected couples can help and strengthen themselves during the time of unfulfilled desire to have children.

• Tips for couples wishing to have children: Tips from BKiD (the network of psychosocial counselors for couples wishing to have children unfulfilled in Germany.
• Addresses of counselors: If you as a couple are unable to find a solution on your own, the BKiD has a list of addresses of counselors in your area who offer psychosocial/psychological counseling in cases of unfulfilled desire/unwanted childlessness.
• Self-check sexuality: The Leipzig physician and sex therapist Dr. med. Carla Thiele has developed a questionnaire for women and men with which you can find out whether you may have a sexual dysfunction. Take the test now!