We all know that infertility and sexuality are closely linked and this connection has multiple relationships. Thus, having sex infrequently will obviously affect fertility, and this is a surprisingly common problem in today's day and age in metropolises like Mumbai , where many young couples are too stressed out and too tired to be able to have sex. Job pressures , cramped houses with no privacy, and long commutes contribute to this. Perhaps the only occasion when they can carve out time for themselves in order to have baby-making sex is during a weekend, and obviously ovulation is not always that obliging. This contributes to their infertility , which means this is often social , because of their work pressures, rather than because of medical reasons.

Infertility also affects sexuality. Often a woman who is labelled as being infertile doesn't feel like having sex; and the husband who feels that he's forced to have sex on demand just in order to make a baby is going to find his libido takes a beating. Often a woman who has been told that her tubes are blocked or that she has endometriosis has poor self-esteem, and this kills her sexual desire, because she feels that her reproductive system is "defective".

The big problem is that even though sexuality is the elephant in the room , it's something which is never discussed. Often, this is because the husband is ashamed - for example, because he has erectile dysfunction. This affects the wife as well, who starts feeling that she's contributing to the problem because the lack of an erection means that her husband doesn't find her sexually desirable, and this causes an inferiority complex .

Doctors also contribute to the problem. They are very busy, and during the consultation they are more focussed on the medical details, which means they don't even either bother to take a sexual history; or when they do so , they do it extremely perfunctorily . This often means that they will just mindlessly check off a box on a form which says - Frequency of sexual intercourse ? Thrice a week. This is the standard answer which most couples will give , even when they know that it's not true, because they don't want to admit that they're just not having sex frequently . They know that this could be one of the reasons for their infertility , but they're ashamed to discuss this openly in front of a doctor, especially in the first visit.

In order to get over this problem, I think a simple question every infertility doctor should ask is: When did you have sex last? Now, this is not such a threatening question, and it's much easier for people to answer. If you see that the couple looks embarrassedly at each other , or is sheepish about the fact that they haven't had sex for the last two or three weeks, then this at least gives them permission to discuss what their problem is , so that you can provide solutions. For example, you could prescribe medication to help the erectile dysfunction ; or advise them to use sexual toys such as vibrators ; or tell them to use liquid paraffin to reduce pain during sex because of vaginal dryness.

The important thing is to be able to discuss the topic openly and freely, and this is a very useful question which can help the doctor to get the ball rolling. You will be quite surprised with the range of answers you will get , if you learn to ask this question !

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