I (23f) am struggling with some things in my relationship with my fiance (27m)

My fiance and I have been together for 5 years. With how long we have been together there has been struggles, notably and recently with our intimacy and my college education.

(Apologies on the typing and the longness of this, new to posting on reddit)

I started birth control when him and I started dating. I was on the cheapest pill for almost 2 years before going to an actual OBGYN. That’s when I found out I have “signs” of PCOS (the doc didn’t want to diagnose me because he is an actual moron) through an ultrasound. They also found a cyst, but it wasn’t (and still isn’t) big enough to be surgically removed. Since then, I have had issues during intimacy. I am in pain in certain positions. My new gyno recommended I try an IUD to see if it helps balancing my hormones (her theory as to why I might have my cyst). The IUD has done nothing for months. I have lost my libido because I am scared of the pain. It’s been almost 2 years and I haven’t been able to move on. My fiancé thinks it’s because I don’t find him attractive but every time I talk to him (recently), he doesn’t believe me. When this first started, we were going with the punches and figuring it out… now it’s just a strain. I can’t afford the libido pills (my insurance doesn’t cover it) and no “herbal” remedies or chews have worked.

To keep this short, I have had a journey with my college life. My associates degree was all online due to COVID, and I have had to take two gap years due to COVID messing with FASFA. I also have struggled with some of my classes in Uni, so I have put myself behind a semester. Tests are my nightmare, have been since high-school. There’s no real accessibility that I can have besides more time… which is not helpful for my situation. It’s like I know the material but I step into a test and it all goes out the window. Test performance anxiety idk. Anyway, with me having to drop a class and flunking two, my fiancé doesn’t want to “deal with this”. I have told him I am trying my best, and that I do most of my work on campus (i.e. this semester I went three days a week and had a 5 hour gap in-between my two in person classes) so I can come home and relax, but that doesn’t seem to be enough. He thinks I’m not trying due to my grades, but it’s truly not the case. I have tried explaining to him my test performance anxiety thing, but he thinks it’s because I am not studying enough.

I am just at a loss on what to do in both of these situations. To give more random information, I work the three days I am not at school and off Sundays, which makes me pretty busy trying to balance school/life/work. This is also my first longterm serious relationship, so I have no prior experience with this. Does anyone have any guidance or advice?

(happy to answer any non overly invasive questions in the comments)