Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option psychologie clinique (Ph.D) / L'infertilité est reconnue non seulement comme une maladie médicale, mais aussi comme une condition sociale et émotionnelle (Burns et Covington, 2006; Pawar et al., 2020; The Lancet Global Health, 2022). Bien que les études aient, de plus en plus, commencé à étudier l'impact de l'infertilité sur le bien-être psychologique et social (p. ex., Drosdzol et Skrzypulec, 2008; Hasanpoor-Azghdy et al., 2015), les chercheurs en connaissent toujours peu sur le bien-être sexuel des couples qui suivent un traitement de fertilité. Des recherches ont montré que les couples ayant recours à la procréation médicalement assistée (PMA) sont plus susceptibles d'éprouver des difficultés sexuelles que les couples fertiles (Starc et al., 2019). Toutefois, les facteurs qui permettent d’expliquer ces difficultés chez les couples ayant recours à la PMA ont été très peu étudiés à ce jour. Ainsi, en utilisant une approche biopsychosociale de la compréhension de l’infertilité (Gerrity, 2001; Grinion, 2005; Williams et al., 1992) et de la sexualité (Althof et al., 2005; McCabe et al., 2010), cette thèse examine à la fois les facteurs spécifiques à l'infertilité et les facteurs dyadiques sous-jacents au bien-être sexuel des couples infertiles. Afin de mieux comprendre les facteurs spécifiques à l'infertilité associés à la fonction sexuelle des couples qui ont recours à la PMA, une première étude transversale dyadique a été menée auprès de 185 couples de sexes mixtes en processus de PMA qui ont rempli en ligne l’outil Fertility Quality of Life Tool et soit le Female Sexual Function Index (femmes) ou le International Index of Erectile Function (hommes). L'étude a examiné les facteurs de stress personnels et relationnels, et le désir sexuel, l’orgasme, l’excitation et la satisfaction sexuelle des deux partenaires. Les associations entre les caractéristiques liées au diagnostic de l’infertilité et au traitement et les domaines de fonction sexuelle et la satisfaction sexuelle des deux partenaires ont également été examinées pour déterminer si ces variables seraient incluses comme covariables dans les analyses principales. Les analyses acheminatoires ont révélé que pour les hommes et les femmes, les facteurs de stress émotionnels liés à l'infertilité étaient associés à leur propre désir sexuel et à celui de leurs partenaires. Pour les femmes, les facteurs de stress émotionnels liés à l'infertilité étaient également associés à une satisfaction sexuelle plus faible chez leur partenaire et les facteurs de stress corps-esprit étaient associés à une excitation sexuelle plus faible chez leur partenaire. Les facteurs de stress relationnels liés à l'infertilité étaient également associés à une excitation et satisfaction sexuelle plus faibles des individus et à une satisfaction sexuelle plus faible chez leur partenaire. Pour les femmes, les facteurs de stress relationnels liés à l'infertilité étaient également associés à leur propre désir sexuel et orgasme. Ces résultats suggèrent que les interventions portant sur les sphères émotionnelles, psychocorporelles et relationnelles des couples en PMA pourraient aider à faciliter l'amélioration de la fonction et de la satisfaction sexuelles et à mieux répondre aux besoins des couples infertiles. S'appuyant sur les résultats de la première étude, qui suggèrent que l'expérience subjective des couples en matière d'infertilité et de traitement, en particulier les facteurs de stress relationnels, semblent être plus fortement associés à leur santé sexuelle que les facteurs objectifs liés au traitement, le deuxième article visait à étudier les processus relationnels qui sous-tendent le bien-être sexuel des couples. Plus précisément, l'étude a examiné si les perceptions de gestion du stress dyadique (GSD) du partenaire et de la façon dont les deux partenaires gèrent ensemble le stress (GSD commun) sont associées au bien-être sexuel des deux partenaires chez les couples en processus de PMA. Les participants comprenaient 232 couples avec une infertilité médicale qui ont rempli des questionnaires évaluant la gestion du stress dyadique et le bien-être sexuel (préoccupations sexuelles liées à l'infertilité, détresse sexuelle et satisfaction sexuelle). Les analyses acheminatoires ont révélé que les perceptions que le partenaire utilise plus de stratégies de GSD négatives étaient associées à un bien-être sexuel plus faibles des individus. Les perceptions que le partenaire utilise plus de stratégies de GSD positives étaient associées à une satisfaction sexuelle plus élevée pour les hommes et à des préoccupations sexuelles liées à l'infertilité plus élevées pour les femmes. Les perceptions d’une utilisation plus élevée de GSD commun étaient associées à un bien-être sexuel plus élevé chez les deux partenaires. Pour les hommes, les perceptions d’une utilisation plus élevée de GSD commun étaient également associées à des préoccupations sexuelles liées à l'infertilité plus faibles chez leur partenaire. Les analyses étaient ajustées pour la satisfaction relationnelle. Ces résultats suggèrent que le bien-être sexuel des couples pendant les traitements de fertilité pourrait être facilité en favorisant une gestion de stress dyadique commun plus élevée et soulignent que le contexte interpersonnel entourant la sexualité de ces couples devrait être systématiquement abordé auprès des deux membres du couple. / Infertility is recognized as being not only a medical illness, but also a social and emotional condition (Burns & Covington, 2006; Pawar et al., 2020; The Lancet Global Health, 2022). Although studies have increasingly begun to investigate the impact of infertility on psychological and social well-being (e.g., Drosdzol & Skrzypulec, 2008; Hasanpoor-Azghdy et al., 2015), little remains known about the sexual well-being of couples undergoing fertility treatment. Research has shown that couples seeking assisted reproductive technology (ART) are more likely to experience sexual difficulties than fertile couples (Starc et al., 2019). However, very few studies have examined the factors that may explain these difficulties in couples seeking ART. Hence, using a biopsychosocial approach to the understanding of infertility (Gerrity, 2001; Grinion, 2005; Williams et al., 1992) and sexuality (Althof et al., 2005; McCabe et al., 2010), this thesis examines both infertility-specific and dyadic factors underlying the sexual well-being of infertile couples. To better understand the infertility-specific factors associated with the sexual function of couples seeking ART, a first dyadic cross-sectional study was conducted with 185 mixed-sex couples seeking ART who completed online the Fertility Quality of Life Tool and either the Female Sexual Function Index (women) or the International Index of Erectile Function (men). The study examined the association between personal and relational stressors and the sexual desire, orgasm, arousal, and sexual satisfaction of couples seeking ART. The associations between diagnosis and treatment-related factors and both partners’ domains of sexual function and sexual satisfaction were also examined to determine whether these variables should be included as covariates in the main analyses. Path analyses revealed that for men and women, infertility-related emotional stressors were associated with their own and their partners’ lower sexual desire. For women, experiencing greater infertility-related emotional stressors was also associated with their partner’s lower sexual satisfaction and experiencing greater infertility-related mind-body stressors was associated with their partner’s lower sexual arousal. Infertility-related relational stressors were also associated with individuals’ own lower sexual arousal and satisfaction and their partner’s lower sexual satisfaction. For women, experiencing greater relational stressors was also associated with their own lower sexual desire and orgasm. These results suggest that interventions addressing the emotional, mind-body, and relational spheres of couples seeking ART may help facilitate improvements in sexual function and satisfaction and better serve infertile couples’ needs. Building on the results of the first study, which suggest that couples’ subjective experience of infertility and treatment, particularly relational stressors, seem to be more strongly associated with their sexual well-being than objective treatment-related factors, the second study aimed to investigate the relational processes that underly couples’ sexual well-being. More specifically, the study examined whether perceptions of the partner’s dyadic coping (DC) and of how both partners cope together (common DC) are associated with both partners’ sexual well-being in couples seeking ART. Participants included 232 couples with medical infertility who completed questionnaires assessing dyadic coping and sexual well-being (infertility-related sexual concerns, sexual distress, and sexual satisfaction). The path analyses revealed that perceptions of partners’ use of higher negative DC were associated with individuals’ own lower sexual well-being. Perceptions of partners’ use of higher positive DC were associated with higher sexual satisfaction for men and greater infertility-related sexual concerns for women. Perceptions of higher use of common DC were associated with both partners’ higher sexual well-being. For men, perceptions of higher use of common DC were also associated with their partner’s fewer infertility-related sexual concerns (partner effect). Analyses adjusted for relationship satisfaction. These results suggest that couples’ sexual well-being during fertility treatment could be facilitated by promoting greater common DC and highlight that the interpersonal context surrounding these couples’ sexuality should be routinely discussed with both members of the couple.

In this dissertation, I articulate what I call a personal-is-political ethics, suggesting that the realm of human affairs long called ethics is inseparable from that which is today normatively called psychology. Further, I suggest that these names for this shared realm are situated in different discursive traditions which, therefore, provide different parameters for possible action and understanding. In my exploration of what it is to be human, I strategically centre ethical transgressions, particularly those that are mappable onto systemic forms of oppression. I explore personal-is-political enactments of sexism, ableism, racism, colonization, classism, ageism, and geopolitics, including situations in which several of these intersect with one another and those in which therapeutic, pedagogical, or parenting hierarchies also intersect with them. Without suggesting this is ‘the whole story,’ I closely read people’s narrations of ethical transgressions that they – that we – commit. I claim that such narrations shape our possibilities for harming others, for taking responsibility, and for intervening in others’ lives in an attempt to have them take responsibility (e.g., therapy with abuse perpetrators and critical pedagogy). I work to demonstrate the ethical and political importance of: the impossibility of exhaustive knowledge, the illimitable and contingent power relations that are ever-present and give shape to what we can know, and the ways our possibilities in life are constituted through particular contact with others. I explore ethical transgressions I have committed, interrogating these events in conversation with explorations of resonant situations in published texts, as well as with research conversations with friends about their ethical transgressions and how they make sense of them. I tentatively advocate for, and attempt to demonstrate, ways of governing ourselves when we are positioned ‘on top’ of social hierarchies – in order to align our responses and relationships more closely with radical political commitments.

In this dissertation, I articulate what I call a personal-is-political ethics, suggesting that the realm of human affairs long called ethics is inseparable from that which is today normatively called psychology. Further, I suggest that these names for this shared realm are situated in different discursive traditions which, therefore, provide different parameters for possible action and understanding. In my exploration of what it is to be human, I strategically centre ethical transgressions, particularly those that are mappable onto systemic forms of oppression. I explore personal-is-political enactments of sexism, ableism, racism, colonization, classism, ageism, and geopolitics, including situations in which several of these intersect with one another and those in which therapeutic, pedagogical, or parenting hierarchies also intersect with them. Without suggesting this is ‘the whole story,’ I closely read people’s narrations of ethical transgressions that they – that we – commit. I claim that such narrations shape our possibilities for harming others, for taking responsibility, and for intervening in others’ lives in an attempt to have them take responsibility (e.g., therapy with abuse perpetrators and critical pedagogy). I work to demonstrate the ethical and political importance of: the impossibility of exhaustive knowledge, the illimitable and contingent power relations that are ever-present and give shape to what we can know, and the ways our possibilities in life are constituted through particular contact with others. I explore ethical transgressions I have committed, interrogating these events in conversation with explorations of resonant situations in published texts, as well as with research conversations with friends about their ethical transgressions and how they make sense of them. I tentatively advocate for, and attempt to demonstrate, ways of governing ourselves when we are positioned ‘on top’ of social hierarchies – in order to align our responses and relationships more closely with radical political commitments.