8.3: Sexual Responsiveness and Reproduction in Early Adulthood (Ob10)

Sexual Responsiveness

Men and women tend to reach their peak of sexual responsiveness at different ages. For men, sexual responsiveness tends to peak in the late teens and early twenties. Sexual arousal can easily occur in response to physical stimulation or fantasizing. Sexual responsiveness begins a slow decline in the late twenties and into the thirties although a man may continue to be sexually active. Through time, a man may require more intense stimulation in order to become aroused. Women often find that they become more sexually responsive throughout their 20s and 30s and may peak in the late 30s or early 40s. This is likely due to greater self‐confidence and reduced inhibitions about sexuality.

Reproduction

For many couples, early adulthood is the time for having children. However, delaying childbearing until the late 20s or early 30s has become more common in the United States.

Couples delay childbearing for a number of reasons. Women are more likely to attend college and begin careers before starting families. And both men and women are delaying marriage until they are in their late 20s and early 30s.

Infertility

Infertility affects about 6.1 million women or ten percent of the reproductive age population (American Society of Reproductive Medicine [ASRM], 2000‐2007). Male factors create infertility in about a third of the cases. For men, the most common cause is a lack of sperm production or low sperm production. Female factors cause infertility in another third of cases. For women, one of the most common causes of infertility is the failure to ovulate. Another cause of infertility is pelvic inflammatory disease, an infection of the female genital tract (Carroll, 2007). Pelvic inflammatory disease is experienced by one out of seven women in the United States and leads to infertility about twenty percent of the time. One of the major causes of pelvic inflammatory disease is Chlamydia trachomatis, the most commonly diagnosed sexually transmitted infection in young women. Another cause of pelvic inflammatory disease is gonorrhea. Both male and female factors contribute to the remainder of cases of infertility.

Fertility treatment

The majority of infertility cases (85‐90%) are treated using fertility drugs to increase ovulation or with surgical procedures to repair the reproductive organs or remove scar tissue from the reproductive tract. In vitro fertilization is used to treat infertility in less than 5 percent of cases. IVF is used when a woman has blocked or deformed fallopian tubes or sometimes when a man has a very low sperm count. This procedure involves removing eggs from the female and fertilizing the eggs outside the woman’s body. The fertilized egg is then reinserted in the woman’s uterus. The average cost of IVF is over $12,000 and the success rate is between five and thirty percent. IVF makes up about 99% of artificial reproductive procedures.

Less common procedures include gamete intra‐fallopian tube transfer (GIFT) which involves implanting both sperm and ova into the fallopian tube and fertilization is allowed to occur naturally. The success rate of implantation is higher for GIFT than for IVF (Carroll, 2007). Zygote intra‐fallopian tube transfer (ZIFT) is another procedure in which sperm and ova are fertilized outside of the woman’s body and the fertilized egg or zygote is then implanted in the fallopian tube. This allows the zygote to travel down the fallopian tube and embed in the lining of the uterus naturally. This procedure also has a higher success rate than IVF.

Insurance coverage for infertility is required in fourteen states, but the amount and type of coverage available varies greatly (ASRM, 2000‐2007). The majority of couples seeking treatment for infertility pay much of the cost. Consequently, infertility treatment is much more accessible to couples with higher incomes. However, grants and funding sources are available for lower income couples seeking infertility treatment as well.