Levan Kobaladze, MD, Sexologist
Specially for New Factor Magazine
Modern reproductive medicine and sexology are undergoing a fundamental paradigm shift. Recently, a landmark development was announced in the international scientific community: a Joint Global Scientific Statement by the International Federation of Fertility Societies (IFFS) and the International Society of Andrology (ISA) was published in the prestigious journal Andrology.
As a practicing sexologist, I find this document exceptionally valuable. It definitively shatters traditional, often narrow and fragmented clinical approaches, establishing three interconnected fundamental pillars of modern medicine: sexuality, infertility management, and contraception.
Sexual Function and Fertility: Breaking the Vicious Cycle
In my daily practice, I frequently observe how sexual health is overlooked during infertility treatment. Clinicians often focus solely on biological indicators—hormonal profiles, anatomical patency, or semen analysis parameters—while sexological issues and infertility are deeply intertwined.
On one hand, certain sexological disorders can physically hinder conception. On the other hand, the diagnosis of infertility itself, along with the exhausting, prolonged anticipation of having a child, can disrupt a previously healthy sexual life. Consequently, sexual dysfunction can be both a cause of infertility and its consequence.
Sexual Dysfunctions That Can Cause Infertility:
- In Women: In cases of vaginismus and dyspareunia, involuntary, painful spasms of the pelvic floor and peri-vaginal muscles make penetration physically impossible, or intercourse may terminate prematurely before intra-vaginal ejaculation occurs. The constant fear of pain leads to subconscious avoidance of intimacy, minimizing the chances of fertilization.
- In Men: Chronic erectile dysfunction directly blocks the possibility of conception, as sperm cannot be transported to the cervix. A similar outcome occurs in cases of anejaculation or retrograde ejaculation. In premature ejaculation (ante portam), where ejaculation occurs upon contact with the vaginal vestibule prior to penetration, the vast majority of spermatozoa remain outside the vagina and fail to reach their target.
- Marked Decrease in Libido: When either partner (or both) experiences a chronic lack of sexual desire and intimacy occurs only once a month or every few months, the mathematical probability of coinciding with the “fertile window” drops significantly. Since the ovum survives for only 12–24 hours post-ovulation, low coital frequency leads to missing this critical time frame.
Infertility as a Cause of Disrupted Sexual Life
The Phenomenon of “Scheduled Sex” and Emotional Burnout
When a couple receives an infertility diagnosis and embarks on long-term treatment, sex often loses its natural charm and primary function—pleasure, relaxation, and emotional connection. It becomes a scheduled, mechanical task, subjecting the couple to severe psychological pressure. As soon as a reproductive specialist assigns optimal days for fertilization, spontaneity, playfulness, and romance vanish. Intercourse becomes a mechanical procedure—an item on a schedule. Partners view sex not as a means of bonding and pleasure, but as a process of “submitting biological material.” As a result:
- In Men: “Performance Anxiety” develops, which in turn triggers erectile dysfunction and anejaculation (the inability to achieve ejaculation during intercourse).
- In Women: Infertility-related stress directly impacts physical arousal. When a woman focuses solely on “whether she will conceive this time” during intercourse, her limbic system (the brain’s emotional center) inhibits the parasympathetic nervous system. This reduces vaginal lubrication secreted by the Bartholin glands, making intercourse dry and physically painful, often leading to anorgasmia. Consequently, the desire for sexual contact diminishes or disappears entirely, intervals between coitus lengthen, and the chances of pregnancy decline further.
As a result, we enter a vicious cycle: infertility-induced stress impairs sexual function, while sexual dysfunction further reduces the likelihood of natural conception.
The Necessity of Psychosexual Support
The core message of the IFFS/ISA document is that the diagnosis and therapy of sexual dysfunction must become an integral component of infertility treatment from the very first visit. Couples must maintain sexual pleasure and emotional intimacy throughout the reproductive therapy process.
The Male Factor in Infertility and Early, Integrated Diagnostics
A pervasive stereotype persists in society that infertility is primarily a female issue. However, modern epidemiological data proves quite the opposite:
- In 50% of infertile couples, the cause is attributed to the male factor (either isolated or in combination with female factors).
- Over recent decades, a global decline in both qualitative and quantitative semen parameters has been documented.
Joint Evaluation of the Couple
The Joint Scientific Statement strongly urges clinicians to conduct parallel diagnostics of both partners from the initial stage. Early andrological assessment of the male partner:
- Saves Time and Resources: Avoids invasive and costly procedures for the woman when the underlying issue may reside in the male’s semen parameters.
- Relieves Psychological Pressure: Removes unfounded feelings of guilt from the woman and frames the challenge as a shared goal for the couple.
Fertility Preservation
The document places special emphasis on preserving male reproductive potential through cryopreservation (sperm freezing)—particularly prior to gonadotoxic treatments (oncotherapy, chemotherapy) or in consideration of environmental and age-related factors.
Modern Contraception and Male Responsibility
Contraception is not merely about preventing unplanned pregnancy; it is the cornerstone of family planning and sexual autonomy. The IFFS/ISA statement clearly highlights the necessity of expanding the male role in contraception.
Developing novel male contraceptive methods will enable couples to share reproductive responsibility equally and avoid subjecting the female body to hormonal overload.
What Does This Mean for the Georgian Context?
Sociocultural stigmas remain strong in Georgian reality. Men often avoid visiting an andrologist or sexologist, viewing the issue as an infringement on their masculinity, while sexual disorders within families remain strictly taboo.
The primary message of the joint IFFS/ISA statement is: family planning and reproductive health must be built on a couple-centered, holistic approach.
As a physician, I fully share and welcome this paradigm. Our mission is to shatter myths, open taboo topics, create a transparent and trust-based environment, and offer patients not just symptomatic treatment, but complete sexual and reproductive harmony.
Reference: https://onlinelibrary.wiley.com/doi/10.1111/andr.70371