Chronic sexual dysfunctions have far-reaching negative effects on both individual well-being and relationship quality. First and foremost, sexual pleasure capacity deteriorates, as affected couples may stop having regular sexual intercourse years earlier than well-functioning peers. This age shift also does not favor late-planned pregnancies. In addition, the psychological effects of sexual dysfunctions are significant, including negative impacts on self-esteemand the frequent coexistence of mental health disorders such as depression and anxiety.
For these reasons, rapid and professional identification of sexual dysfunctions and effective therapy are critically important for those seeking help.

As a sex psychologist working with couples, I take part in the effort made by those affected to improve their intimate relationships and sexual lives. Below I summarize the sexual disorders most commonly encountered in clinical practice and how they relate to fertility.

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Reduced or Absent Sexual Desire

According to the diagnostic criteria of sexual desire disorder, it refers to a persistent or recurrent reduction or absence of sexual desire and sexual fantasies.

Among healthy couples, we often observe that men typically have stronger sexual desire and seek more frequent intercourse, and they usually express this more openly. This can affect relationship dynamics, because the female partner may perceive this as pressure or even pursuit, and may respond by withdrawing or avoiding her partner.

Interestingly, when a couple is affected by fertility problems, the situation often reverses: the male partner’s desire frequently becomes low or even minimal. In fact, reduced sexual desire is the most common sexual disorder in infertility.

This pattern is not surprising given the psychologically demanding and highly stressful period that trying to conceive represents. A sex life focused on the fertile window is unfavorable for spontaneous desire, because one must achieve an erection and ejaculation on schedule. The expectation placed on a man’s own masculinity, together with the female partner’s impatience—especially if prolonged—can provoke such strong anxiety that the man may unconsciously choose to avoid sexual contact altogether.

The myth of spontaneous desire frequently appears in therapy, but it deserves special attention in fertility treatment. Besides spontaneous desire, there is also responsive / triggered / secondary desire, which is no less valid. This simply means that desire arises in response to arousal rather than before it. This is a completely normal and healthy sexual pattern, and partners should not demand spontaneous desire from each other.

Recognizing and accepting responsive desire, and ensuring that during the fertile window the female partner initiates not with expectations but with kindness and seduction—similar to their earlier sexual style—can often be sufficient to normalize low desire. This requires a conscious decision by both partners to have sex outside the fertile window as well, where the only goal is mutual playful pleasure.

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Erectile Dysfunction

Arousal disorder refers to a reduced or absent physical and psychological response to sexual stimulation. In men, this means partial or complete absence of penile erection and testicular elevation.

As with desire disorders, sexual anxiety often plays a role, especially when men link sexuality to performance. Most men struggle with what they achieve at work, at home, in relationships, in material success, etc., and this strong performance orientation can dominate sexuality as well. Sex becomes reduced to penetration, one’s own orgasm, and a shared orgasm with the female partner.
Besides the fact that simultaneous orgasm is itself a myth, penetration may not even occur if anxiety prevents erection. During fertility treatment, this is compounded by the expectation of conception—the ultimate performance goal becomes producing a viable embryo, which further increases the risk of erectile dysfunction.

Erectile problems are best alleviated by reducing stress, including a pleasant, supportive environment, relaxation techniques, body awareness, and a reassuring, encouraging female partner. For couples facing infertility, special emphasis should be placed on the frequent practice of “pleasure sex”—sexual activity in the infertile period aimed purely at mutual enjoyment.

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Male Orgasm Disorders

These include premature ejaculation and delayed, inhibited, or absent ejaculation.

Premature Ejaculation

This is the most common male sexual disorder and is frequently seen in infertile couples—many men do not reach vaginal ejaculation. Because couples often find ways to work around it, the problem may remain hidden until they start trying for a baby.
Besides stress reduction, it is important to explore relationship dynamics and the true intentions behind wanting a child. Body-focused therapy can help both partners learn to recognize early bodily signs of orgasm and practice “edging”—the intentional delay of ejaculation.

Delayed Ejaculation

Previously rare, delayed ejaculation has become increasingly common in the last decade due to widespread pornography use and the use of psychoactive substances, often together. In such cases, ejaculation occurs very late, outside the vagina, or not at all—making natural conception impossible.
Here, long-term success requires patient couple-based therapy and complete abstinence from the contributing substances.