For men their lack of fertility is often felt as failure as a man and therefore leads to questions about their maleness, whilst their masculinity is challenged by the inability of their spermatozoa to fertilize eggs and may give feelings of loss of power and potency. This latter feeling can make them impotent for a time or, conversely, promiscuous.

For women there is a profound questioning of their femaleness if they cannot conceive a child, be pregnant (have a baby in her tummy), giving birth and be a mother and then questions arise about their femininity, in doubting their sexual attractiveness to their partners. Menstruation every month is a sharp reminder to both partners of what they have failed to do and sexual intercourse may seem pointless, but particularly when, for months, intercourse has become focused on conception, and pleasure may well have become secondary, if not non- existent.