How to tackle sex problems resulting from mental health

It was the eighth month of Janet and Richard seeing me at the Sexology Clinic. They had visited the clinic every month without fail. This time, as always, and after the usual greetings of familiarity Janet pronounced that they were visiting for their routine check and to report on Richard’s wellbeing as well as sexual performance.

“For once he has ejaculated twice since we were last here,” Janet said, gazing at Richard affectionately. Richard smiled back.

The couple came to the clinic for the first time as a referral from a psychiatrist. Richard was suffering from Schizophrenia, a chronic mental health problem. The problem is controlled by medication which have to be taken consistently. Default in treatment leads to flare up of symptoms. The disease interferes with and disorganises thinking, causing one to see and hear what is not there. They have delusions, hallucinations and illusions. The result is that one behaves in unusual manner, is fearful, agitated and reacts inappropriately to situations. They lack pleasure and motivation in everything and do not speak much.

The psychiatrist referred Richard to me because he was unable to ejaculate during sex. He also had weak erections. The situation was worsening by the day. By the time the couple came to me they had not had sex for four months.

“I know sex is important for both of us but more important for me is to be able to get a child,” Janet explained, “We can fumble around and find ways of satisfying each other but without ejaculation and with weak erections the baby cannot come.”

In my review I found that Richard was very fine. The medicines the psychiatrist gave were working well. Janet had been instrumental in making him comply with treatment. She loved him truly and was dedicated to supporting him in whatever way the doctors advised. She was looking forward to bearing children and figuratively described how Richard would be caring for the babies because he was loving and would make the best father of her children. Because of the schizophrenia and now the sex problems, the couple had not been able to conceive.

“Sometimes people ask me if Richard’s chronic mental condition worries me,” Janet said, “I ask them why they do not ask a similar question to women married to asthmatics, diabetics or hypertensives.” I nodded in agreement. There is no disease, mental or otherwise, which should hold us hostage. We must break loose and take charge whenever chronic medical conditions afflict our loved ones.

In my assessment I found the reason for Richard’s inability to ejaculate as well as weak erections to be due to medicines that the psychiatrist had prescribed.

“The medicines are important and we cannot stop them,” I said. “The challenge you have presented me with is to bring back your erections and the ability to ejaculate while you maintain the use of the medicines prescribed by the psychiatrist.”

This was a challenge that I frequently face with patients on treatment for mental health problems. Most of the medicines they use sometimes interfere with sexual function. Of course, the diseases themselves, if not treated, have worse effect on sexual function, be it anxiety, depression, bipolar disorder, schizophrenia or any others. It is therefore still much better in terms of effects on sexual function to use the medicines than to have the disease untreated.

My first prescription to Richard did not work well. He got a flare up of schizophrenia. He went back for psychiatric assessment and the treatment I had given him had to be stopped. The medicines, while reviving his sexual function, neutralised the function of the ones for schizophrenia, making him get a flare-up. The psychiatrist consulted with me and I had to get alternative treatment.

Seven months down the line we had made little headway. Janet and Richard came to the clinic faithfully to report on progress. Janet was a super woman. She was not only an encouragement to Richard but also to the psychiatrist and to me.

“It shall be well doctor, keep trying and change the medicine as you deem necessary,” she said in their seventh month of visit. “We both appreciate your efforts and we know it is a matter of time before things work out.” Richard nodded in affirmation. The couple had read desperation on my face. This was for sure a tough case.

And so, on this eighth month’s visit, when the couple reported that ejaculation had happened twice and that there was no flare-up of schizophrenia I was elated.

“When did you last have your periods,” I asked in excitement to which the couple went quiet.

“I actually stopped memorising my dates because I realised there was no need,” Janet replied. “But now that you ask about it I think it has taken a while before I saw my periods.

I sent Janet for a pregnancy test. It was positive. For once I could not hold my emotions in front of a patient and found tears rolling down my cheeks. Richard moved over to me and hugged me tightly.

Janet was there seated and composed, patiently looking at two beaten men in a story where she was the hero.