Research suggests that men and women differ in their psychological responses to infertility. Samaira Malik, from the Institute of Work, Health, and Organizations at the University of Nottingham, UK, said, “men are in fact equally affected by the unfulfilled desire for a child but are less open about their feelings.” Men undergo various battles when facing personal infertility. These battles include anxiety concerning potency, masculinity, and sexual adequacy. Dr. Rheta Keylor of the Massachusetts Institute for Psychoanalysis stated that, male infertility is an "assault on a man's sense of self revives feelings of competition, castration, and experiences of developmental trauma.” Studies concerning such effects on infertile males are few in number and have come to the forefront in the past decade starting in 2001. In the Psychoanalytic Electronic Publishing archives of the seven primary psychoanalytic journals from 1927 to 2000, not a single article on male infertility appears. Paradoxically, the male partner is either the sole cause or a contributing cause of infertility in 49% of couples. Throughout history men have recognized the desire for paternity and the possibility for male infertility; however, women are typically the subject of fertility studies. Effects of infertility on potency Feelings of stress, depression, guilt, or anxiety in infertile men can cause psychogenic impotence, which heightens the feelings of inadequacy that already accompany infertility. The psychological stress of infertility has been shown to affect sperm parameters in significant and demonstrable ways that may further contribute to difficulties with erectile potency; emotional reactions to the infertility may alter or even undermine a previous consolidation of a sense of self as sexually adequate. Infertility weighs on many males' minds; this creates mental instability, which often results in impotence. Psychological causes of impotency may include: Clinical depression Medications Fatigue Stress Relationship issues social interaction All of the listed issues above can arise as a result of psychological effects of infertility in men. Effects of infertility on masculinity The diagnosis of infertility causes many males to question their masculinity. Male factor infertility is frequently associated with high levels of social stigma; for example, in a study exploring the views of fertile individuals towards infertile men and women, Miall (1994) found that male infertility was frequently seen as arising from sexual dysfunction and was thus associated with higher levels of stigma than female infertility. Many people assume that infertile men cannot perform sexually. This stigma adds to the heightened