When medicine interferes with his libido

It had been a long day at the sexology clinic. It was already 6pm and there were still seven patients waiting. Jane was the next patient. She was a 39-year-old high school teacher and, in her own words, a serious woman of faith. She had been married for eight years to Richard, a 45-year-old pharmacist. They had one child.

"My family is in a crisis but I am not sure you are the right person to help," she pronounced as she took her seat, "A Nganga curse has befallen my husband."

I stared at Jane with a blank look. I did not know what a ‘Nganga' curse was. She asked me if I knew Pastor Nganga, the famous televangelist. I nodded, encouraging her to say more.

"The pastor has threatened men who misbehave that he can command their erections to disappear!" she said. She explained that for a long time she had been warning her husband to stop extramarital affairs and he did not heed. She was convinced that God finally decided to strike him below the belt with a Nganga curse even though they were not members of the pastor's church. The man had no erections and the couple had not had sex for four months.

I asked Jane why Richard himself did not come to the clinic. She explained that the man was withdrawn. He rarely talked. He was eating infrequently and refusing to eat many times. He had lost a lot of weight. I concluded that Richard was sliding into depression and asked Jane to persuade him to come to the clinic. I explained that there were many causes of erectile dysfunction and even though she had beliefs around it, it was important to have Richard undergo a full medical check to determine possible medical causes of erection failure.

ERECTILE DYSFUNCTION

Richard came to the clinic three days later. "The gods have conspired against me, I am finished," Richard said, "I wish I listened to my wife when she warned me."

This was getting complicated. I went into detail explaining what we know medically about erectile dysfunction.

Erections result from a build-up of blood in the penis. This process is regulated by several hormones and chemicals from the brain to the testis. Some diseases such as diabetes, high blood pressure, and high cholesterol do interfere with blood vessels leading to erection failure. It is important to check if a person with erectile dysfunction has any of these diseases.

Sometimes erectile dysfunction can be a result of hormonal problems. Inappropriate levels of hormones such as testosterone, prolactin and thyroid hormones among others can be the cause of erection problems.

There are times when erection failure is a result of intimacy problems. Sex skills also play a part. When sex is not pleasurable due to a lack of emotional connection, erections just fade.

MEDICATION

"We have had trust issues, I had an affair but I stopped it," Richard interrupted my explanation, "my wife is convinced that God is punishing me for being unfaithful."

Well, psychological distress can lead to erection failure. The distress can arise from issues in the relationship, personal beliefs about sex and religious values among others. Ensuring that your sexual life matches your values reduces possibilities of internal conflict that lead to erection failure.

It is also important to note that men do have occasional erectile failure and recover from them without intervention. These transient failures could be due to life stresses.

After some tests, it turned out that Richard was hypertensive and that he had been put on medication a month before his erections failed. The medicine was the cause of his erectile dysfunction. Many such medicines are not compatible with erections and doctors should always alert their patients about this possibility but in this case, they did not. I immediately changed the medicine to one that did not affect erections.

PSYCHOLOGICAL TRAUMA

It was also clear that the family had undergone serious psychological trauma. The trauma was partly due to an extramarital affair that had not been fully resolved. There were also religious values that conflicted with the way the couple had managed their sexuality. Further, there was waning intimacy and the state of the relationship was rather shaky. I, therefore, put the couple on counselling and sex therapy.

"You mean you do not have medicine to jump-start me?" Richard asked as we started the counselling and therapy sessions. I prescribed him a dosage; men always want instant solutions to these erection problems.

It was three weeks before Richard was fully back to function.

"The God that you offended has forgiven you," Jane said as we concluded the therapy sessions, "sin no more; next time you will not recover!"