SEXUAL HEALTH: Not in the mood tonight?

It is usual for patients to visit the Sexology Clinic for the first time then fail to honour subsequent appointments. I was therefore not surprised when James walked into the clinic a year after his first consultation. In the first visit he had been diagnosed with lack of sex desire and failing erections. Tests were ordered to determine any physiological causes of his illness, and he was to be seen a week later with the results. He, however, never came back for the appointment.

“The problem was not of my own making so please just understand,” he explained on this second visit, “the tests were expensive and both my employer and medical insurance refused to pay.”

James, 52, was a marketing manager in an international firm. He was married to Agnes, a 49-year-old high schoolteacher. The couple had three children. At the time of his first visit to the clinic, his marriage was on the rocks. His wife had accused him of having an affair and was even threatening to leave. She could not understand why James was suddenly disinterested in sex, and why his erections failed the few times they attempted sex.

“My wife eventually left with the children a month ago. I have two warning letters for non-performance from my employer and the company doctor has referred me to a psychiatrist,” he said staring into the horizon as his eyes welled up with tears. I noted that his hair was unkempt and his beards were shabby. I called the doctor of the company right away to understand his reason for referral to the psychiatrist.

“He is depressed, I think he has family problems, our human resources manager thinks that a psychiatrist’s report may just save his job because he is scheduled for termination in the next three months,” the doctor explained, “if you think it is more of a sex issue and not a medical problem, deal with it but he still needs to see a psychiatrist and get a report.”

PROBLEM

I asked James to have the tests done as initially advised a year ago. I also called his wife and urged her to be kind enough to see me at the clinic.

“I do not want to see him so please tell him not to be in your clinic when I come tomorrow, if not then I will not come over,” Agnes said. I complied, and the next day she came over. She was still convinced that James was seeing another woman, which made him not to want sex at home.

“Before I decided to move out he had formed a habit of coming home late, sitting alone in the TV room till I went to sleep and waking up early so I could not touch him in the morning,” she said, “which sane woman would allow such behaviour?”

I explained that a man who has sex problems gets anxious at bed time and gives reasons to avoid situations that can lead to intimacy. I also explained that James had slid into depression and was at the verge of losing his job, and that there was also the risk of suicide. I asked Agnes to be patient and allow me to diagnose the sex problem that James had. She requested for more time to think about my request.

Two days later, James was back in the clinic with his laboratory results. He had used his savings to do the tests because both the insurance and his employer did not want to hear anything about sexual health problems. All tests were normal except one. He had high levels of a hormone called prolactin. Elevated levels of prolactin kill sex desire, interfere with erections and lead to premature ejaculation.

I called the company doctor and explained that James needed support to manage this medical problem that had also negatively impacted his sexual function. The medical insurance company and his employer needed to pay for treatment costs.

“Well, if we approach it from the angle of raised prolactin then it becomes a medical problem, and it can definitely be paid for,” he said. With the company taking up the costs, James received treatment that also involved counselling, his wife having accepted to attend the sessions after realising that the man had a medical problem, and not an affair. It took six months before the couple resumed sexual activity.

“I intend to sue the insurance firm and my employer for damages resulting from their refusal to take care of my medical bills in good time. This lead to the problems that I and my family have gone through,” James said on their last visit to the clinic.

“The ball is in your court and I have no say on this,” I replied, “maybe it will help everyone realise that sex problems are medical problems.”