It was the second time I was seeing Joyce. She complained of soreness in her birth canal.
This was the same complaint she had previously. I had made a diagnosis of dry sex leading to high friction that caused soreness and pain.
I needed to dig deeper into her problem during her second visit. It was not usual to have the same problem a week after I had prescribed a lubricant and advised on prolonged foreplay.
Joyce was 34 years old and married for four years to Andrew. They had one child. They had had a good sex life but things seem to have changed over one year.
"My lubrication has not changed. I believe I respond quite well to sex but I think we are taking rather too long to finish a round. I have severally asked Andrew to stop to limit the damage I go through," Joyce reveals.
They had resorted to having sex only once a week to allow for healing but even then every act left her with more damage.
"Do you mean Andrew is unable to ejaculate during sex?" I asked, to which Joyce nodded.
I noted that her moods had suddenly changed and she looked rather apprehensive. She seemed to have been worrying over this for a while.
She was fighting a fit of emotion. I asked her to bring Andrew along the next day for medical evaluation.
"I cannot tell exactly what has happened to me," Andrew said when I met him. "I never seem to reach the end of a sexual act and even when Joyce does not stop me, I just give up because of exhaustion."
The diagnosis was clear, Andrew had delayed ejaculation and sometimes non-ejaculation. This is a problem that has many causes.
Abnormalities of hormones such as testosterone and prolactin can cause it.
Some medicines used for the treatment of other diseases can similarly impact on ejaculation. In some cases, a nerve problem can be the cause of the problem as happens in complications of diabetes.
I examined Andrew and ordered a battery of tests to unearth what was causing his problem.
Test results were ready three days later and Andrew came to the clinic promptly for review. Andrew had low testosterone.
Commonly, men with low testosterone first present to a doctor with loss of libido. Others first report erection problems.
In rare cases, the first symptom may be fatigue and loss of vitality. It is quite rare that the first symptom is delayed or non-ejaculation. Andrew's case was therefore unique.
"So, what could have caused my testosterone to reduce?" Andrew asked. I had told him that he would be put on a hormone replacement treatment for a long time to maintain good health. This worried him.
In many cases, the male hormone levels fall as he ages. It is estimated that men achieve their peak at around the age of 30 years and that a decline starts thereafter.
For most men, this natural decline results in low levels in ages above 50, sometimes 60 or even later. It was therefore unusual for Andrew to have a low count at 34.
I ordered for further tests but these failed to identify a cause to the problem. The treatment at this point was to put Andrew on hormone replacement therapy.
"And how long will it take before the ejaculation problem is solved," Joyce asked. It appeared the prolonged sex duration had traumatised her.
She went ahead to ask if sex could be postponed all together till Andrew got well.
Unfortunately in some of these treatments, one is never sure of how long it would take to reverse the problem.
At the same time, sex cannot be postponed indefinitely. Intimacy among couples holds supreme.
The solution was to find safer and mutually acceptable ways for the couple to have sex. This called for sex coaching.
A month after initiating testosterone treatment, Andrew's ejaculation normalised. The couple was back to their usual sexual activity.
Their experience confirmed that whenever a sex problem happens, both should see the doctor. You never know who exactly between the two of you needs treatment.