Couple Facing Infertility

Content: Kate and John are close to 40, in a long-term relationship, and want to have children. They have been in couples therapy for two years, complaining of an unconsummated marriage, with no success. They refer to a good and satisfying relationship, open communication, and shared goals. They always have pleasurable sex without intercourse, but their repertoire is narrow and repetitive. They never had intercourse. John reports strong sexual desire, good erections, and always orgasms. Lately, a few episodes of erectile dysfunction. He’s afraid to cause her pain with penetration. Kate refers to good sexual desire and motivation. No problem with arousal, lubrication, and orgasms. She never attempted intercourse with previous partners for lack of trust. When she had tried with John, she realized it was too painful. But she kept trying. She does not masturbate. A thorough anamnesis and gynecological examination led to lifelong vaginismus and acquired vulvodynia diagnosis.

The sexological treatment effectively gets them to have pleasurable sexual intercourse, but the difficulties are not over. Problems with fertility arise, and John develops performance anxiety. Both partners are now exhausted and need to deal with medically assisted reproduction.

Dr. Sheryl Kingsberg shares her experience with couples facing infertility and sexual dysfunction as correlating factors. The case is presented by Francesca Tripodi, who stimulates discussion about:

1. Management of John’s anxiety and reactions
2. Strategies for successful attempts in the “fertility week”
3. How to support the couple’s alliance and their sexual life
4. How to manage the termination of reproductive treatment without a live birth

Produced in 2022