A Longitudinal Examination of Sexual Functioning and Relationship Adjustment in Couples with Infertility

Prevailing models suggest sexual and relationship outcomes are bidirectionally linked, yet this association has rarely been tested under conditions that medicalize sexuality. In this one-year longitudinal study, we examined the directional relationship between sexual functioning and relationship adjustment among 66 mixed-gender couples undergoing treatment for infertility. Longitudinal Actor-Partner Interdependence Models (APIMs) with three waves of data were used to account for dyadic interdependence and estimate actor and partner effects. Our findings suggest that these typically interrelated domains may operate independently in the context of infertility, with neither sexual functioning nor relationship adjustment predicting cross-domain outcomes over time. This is consistent with evidence suggesting that the impact of sexual dysfunction on relationship satisfaction is more variable than commonly assumed. However, one partner's relationship adjustment predicted the other's subsequent relationship adjustment. Men showed significant declines in sexual functioning across the one-year period, but relationship adjustment remained stable for men and women. Successful conception during the study period was associated with improved relationship adjustment for women. The findings suggest that the medicalization of sexuality during fertility treatment may be one factor contributing to the relative independence of these domains in this context. Clinically, sexual and relational concerns should be addressed separately, as improvements in one domain may not generalize to the other. The observed partner interdependence within the relational domain highlights the importance of couple-based approaches to addressing infertility stress.