Sexuality, including sexual functioning, is an important part of health and well-being. Sexual dysfunction is the persistent impairment in a domain of sexual function (desire, arousal, or orgasm) or sexual pain that is associated with significant personal distress. The relationship between infertility and sexual dysfunction is not well understood, though evidence suggests that this relationship is likely bidirectional and individuals with infertility have higher rates of disruptions in sexual functioning. The etiology of male and female sexual dysfunction is most commonly multifactorial and treatment for sexual dysfunction typically requires an interdisciplinary approach. Routine screening for sexual dysfunction is recommended. Infertility mental health professionals are well-suited to screen for sexual dysfunction, and therapeutic interventions for the management of sexual dysfunction exist. Commonly used existing approaches that are summarized here include cognitive–behavioral therapy, sensate focus sex therapy, mindfulness-based behavior therapy or mindfulness-based cognitive–behavioral therapy, and directed masturbation training.

Difficulties with communication about bodily differences are strongly linked to sexual experiences. In Chapter 13, the author critiques the dominant ways of talking about sexuality in the wider society. These oppressive ideas can give rise to insecurities, self-objectification and body shame for people in general. Adults who have been medically managed are particularly vulnerable to the effects of objectification and shame. The author outlines typical components of sex therapy programs. However, rather than fix sexual problems, which can perpetuate people’s sense of inadequacy, the author suggests that psychological care providers support clients to process any trauma and develop a more relaxed and appreciative relationship with the body. This work, which requires generic therapy knowledge and skills, can be integrated with a range of specific sex therapy techniques and resources to reimagine a sexual future that focuses on bodily pleasure rather than gender performance. Although the practice vignette is built around a female couple, one of whom has partial androgen insensitivity syndrome, the care principles have wide applications for people with variations more generally.