What was lost can always be found

Julia came to the sexology clinic to be treated for what she called boring sex. It is hard to figure out what ‘exciting sex’ means as it differs from one person to another. I therefore interrogated Julia to be able to fathom her concern.

“I can’t feel him when he penetrates, it is like there is nothing inside there,” she said pointing to her pelvis. “Maybe he is no longer as big as he used to be.” Julia was 35 years old and a mother of three who delivered all her children vaginally. The last born was eight months old. She reported that in all her deliveries, she got an episiotomy to expand the way for the baby to come out. “In the last delivery the baby was big and they made many stitches on the episiotomy which took time to heal,” she explained.

Although many women have problems with desire following delivery, Julia did not seem to have such a problem. She felt like having sex from the third month after delivery. She did not have any pain on resuming sex, either.

I examined Julia and found that the vaginal cuts and tears during delivery had damaged the structures around the vagina and left the vaginal opening wide. Her vaginal walls were also lax and lacked the natural turgidity that holds the penis during penetrative sex. This normally happens when the pelvic muscles that holds the genital structures in place have been interfered with. In Julia’s case the interference was caused by injuries during the delivery process.

“Wow, so what next?” Julia asked, distressed. I asked her to bring her husband along for the next clinic visit. In matters of sex it is always important to listen to both parties. The sexual experience is a joint effort and treating one partner without the other has been shown to be counterproductive.

And so Reagan, Julia’s husband, accompanied her for the next clinic visit. He was a shy man who needed much probing to talk. “Sex is not bad although I feel like I am wallowing in a bottomless ocean these days,” he explained. Although Julia’s problem could have caused such a feeling in Reagan, the feeling could also be due to weak erections or reduced sensation in the penis and so I sought to understand Reagan’s problem more through medical examination. As fate would have it, Reagan suffered weak erections and sometimes loss of erections.

“That started a while back and it cannot be blamed on problems that came with delivery of my last child,” Julia interjected. It turns out that Reagan was always busy and paid little attention to sex, and so never got adequate stimulation before penetration. In fact his problems got worse when he started hurrying to penetrate so as to avoid erection failure. Other this he was in perfect health.

I made a diagnosis of lost penis syndrome. In this condition, a couple has a shared problem of loss of pleasure both ways during penetrative sex. None of the partners feels good in the penetrative phase of sex. As Reagan put it, they feel like there is nothing going on down there.

Other than laxity in the pelvic muscles which may follow delivery, the other cause of the problem in a woman can be excessive vaginal discharge which happens in infections of the vagina.

For the man, the main cause of the lost penis syndrome is weak erections. This can have medical causes in diseases such as diabetes and hypertension. It can also be due to reduced intimacy between a couple. Reagan’s was more of inability to relax during sex.

“So does this mark the end of our sex lives?” Julia interrupted my explanation. Treating the causes of the problem in both parties and rebuilding intimacy does bring back the lost pleasure. I therefore had the defects on Julia’s genitals surgically corrected and scheduled physiotherapy of the pelvis. At the same time I had the couple go through sex coaching to rebuild intimacy and help Reagan relax during sex.

“You have literally repaired a tear in our marital fabric and we are forever grateful!” Julia said on their last visit to the clinic.

“And I want to assure the doctor that my penis is no longer lost; it has finally been found” Reagan said smiling. I noted that in his shyness he had an interesting sense of humour.