While cystic fibrosis (CF) is most commonly associated with adverse effects on lung and pancreatic function, the disease has an impact on reproductive health as well. This article explores the topic of cystic fibrosis and sexuality.

Delayed puberty is common in young boys and girls who have CF. However, good nutrition and medical guidance can stimulate height growth, body mass, and hormone production.

Adults with CF have normal levels of sex hormones (progesterone, estrogen, and testosterone) and can lead normal sex lives, as the sexual performance or desire for intimacy is not affected. However, people with CF have thick mucus which can affect fertility.

CF and male infertility

Fig. 1. Male reproductive system. (Courtesy, NIDDK Image Library, NIH)

Men with CF can have normal sexual relations, and their ability to have an erection and to ejaculate is not affected. However, the majority of adult men with CF (97%-98%) are infertile. Although they can produce normal sperm, the sperm canal is blocked or missing, and the sperm never gets into the semen, making it impossible to fertilize the egg. This is known as congenital bilateral absence of vas deferens (CBAVD) and is thought to be associated with the CFTR gene mutation.

Men with CF who want to conceive a child can seek help through assisted reproductive technology (ART). With this technique, the sperm is collected from the epididymis (fine tubules behind the testicles) and injected directly into the egg (which is removed from the woman’s body). This procedure is done in combination with in vitro fertilization.

CF and female infertility

Fig.2. Female reproductive system. (Courtesy, National Cancer Institute website; https://www.cancer.gov)

Women with CF have thick vaginal mucus due to abnormal CFTR function. This makes it harder for the sperm’s movement in the body, and fertilization can be difficult. Although women with CF have difficulties in becoming pregnant, neither pregnancy nor fetal development is affected. Some ART procedures, such as insemination (the sperm is placed into the cervix or directly into the uterus) or in vitro fertilization (mature eggs are collected from the woman’s body and fertilized with sperm to produce an embryo, which is later transferred to the uterus) are available options in helping conceiving a child.

Contraception and sexually transmitted diseases (STDs)

Despite fertility issues, adults with CF have normal sex lives, as the sexual performance or desire for intimacy is not diminished.  Unplanned pregnancies and sexually transmitted diseases (STDs) can occur, and as a result, protective measures should be taken. Different types of contraceptives include condoms, vaginal contraceptive rings, oral contraceptive pills, intrauterine devices (IUD), and diaphragms. Caution should be taken when oral contraceptive pills are taken together with certain medications, such as lumacaftor/ivacaftor (Orkambi) and antibiotics, as they are known to decrease the pill’s effectiveness.

Men with CF may also experience a rare type of infection known as male candidiasis. Symptoms such as sores on the penis, irritation, and itching may occur from this infection.

In women, fungal vaginitis (caused by the frequent use of certain antibiotics and corticosteroids that are known to affect the levels of acidity and bacteria in the vagina) and stress incontinence (the uncontrolled release of small amounts of urine) are common reproductive health issues. Kegel exercises can help in controlling stress incontinence as they strengthen the pelvic floor muscles that support the uterus, bladder, small intestine, and rectum. These exercises involve the contraction and relaxation of the muscles that are used to stop urination.

CF and sex life

CF does not reduce sexual performance or the desire for intimacy. However, some people with CF have persistent coughing, chest pain, hemoptysis (coughing up blood or blood-stained mucus), or trouble breathing, which can cause physical discomfort and pain during intercourse. Some practical advice before having sex includes the use of a bronchodilator and physiotherapy exercises to remove mucus. Avoiding strong-smelling products (e.g., perfumes) and adopting positions that do not put pressure on the chest may also help. Talking with a doctor or therapist, as well as reading online community support groups, may assist in finding answers and strategies that work for you.

For more information, visit the CFF webpage on Reproductive Health and Fertility and the CysticFibrosis Canada webpage on Sexuality, Fertility and Cystic Fibrosis for Adults.

Cystic Fibrosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

References:

  1. NIDDK Image Library
  2. National Cancer Institute