One limitation of our study is

One limitation of our study is that we did not use a validated scale to measure risk of sexual dysfunction, such as the Female Sexual Function Index and instead used questions taken from the Fertility Problems Inventory. However, the Fertility Problem Inventory is a validated measurement of infertility-related stress and assesses stress in five specific domains including sexual concerns. It assesses diminished sexual enjoyment or sexual self-esteem and difficulty with sexual relationships. This scale is unique because it was developed specifically to address infertility-related stress. Therefore, although this scale is not traditionally used in the sexual health literature, our results provide valuable information about the sexual impact of infertility and could provide insight into patients at high risk for sexual dysfunction. As noted earlier, the effects of infertility and male sexual impact using this scale have been published. Another limitation is that our selective serotonin reuptake inhibitor might be an underrepresentation of patients from lower socioeconomic strata and is from a somewhat limited geographic region. Nevertheless, although not representative of the general public, this population is more likely to present for care and interact with the health care system, and this population is representative of one that would typically be seen in an infertility clinic practice. Our population also had lower rates of male infertility than seen in the general infertility population. Although only 7% of respondents had infertility from male factors only, population-based studies have estimated that male factor infertility accounts for close to one fourth of infertility. Therefore, our population is somewhat skewed from the general population seeking infertility care. We also could not adjust for underlying medical comorbidities such as diabetes or depression, which are known to have significant impact on sexual function, or for the use of medications known to have a negative impact on sexual function.
Strengths of this study include its large number of couples from a diverse sample of clinics. Moreover, although participation in our study required fluency in English, studies have estimated that more than 78% of the U.S. population speak English “well” or “very well” and therefore we were able to capture a large segment of the patients from the San Francisco Bay area. We also collected detailed medical and demographic information that allowed for controlling for important confounders.


Statement of authorship

It cannot be denied that various disease states affect the sexual function, interpersonal relationships, and psychiatric and physiological well-being of men and women. It is well recognized that human sexuality should be a core part of undergraduate doctor training. However, it has limited representation in those training programs, with no internationally agreed core curriculum or perspective. There appears to be little evaluation of current best practice or evidence reflected in that training. The ability for a doctor to apply a holistic framework in a life cycle context in all aspects of clinical work could be limited according to the training offered at the undergraduate level. It also could be agreed that assessing, diagnosing, and treating sexual dysfunction does require more training and that this should be provided at the undergraduate level.
A 2010 study by Foley et al suggested that an indicator of a doctor\’s ability to assess patients\’ sexual function relates to the level of earlier training and that, equally, increased levels of training and continuing education correlate to increased levels of comfort in discussing sexual matters. Their study concluded that a multidisciplinary team approach is the most efficient way to assess and treat sexual dysfunction, with doctors feeling confident in diagnosing sexual dysfunction and, should they judge it appropriate, referring to sex therapists for more in-depth assistance.