Julia came to the Sexology Clinic with the complaint that she felt no pleasure during penetrative sex. She complained that sex was no longer worth looking forward to. Of course, pleasure is difficult to quantify. So I questioned Julia further.
“I can’t feel him during sex, it is like there is nothing going on down there,” she said pointing to her pelvis. “I hear men say that their organs have grown small, could that be the case with my husband?”
Julia was 35 years old. She was a mother of three and had given birth to all her children vaginally. Her last baby was eight months old. She said that in all her deliveries she had been cut to widen the way for the baby to come out.
“In the last delivery they said that I had tears because the baby was big and they made many stitches which took time to heal,” she explained.
Although many women have problems with sexual desire after giving birth, Julia did not seem to have such a problem. She felt like having sex from the third month after giving birth. Unlike many women who experience pain when they resume sex, Julia did not.
“Lubrication? It is perfect, I do get wet pretty well,” she explained when I asked about her ability to get aroused.
I examined Julia and the main findings were on her genitals. The vaginal cuts and tears during childbirth had damaged the structures around the vagina, leaving the vaginal opening wide open. The vaginal walls were also lax and lacked the natural turgidity that holds the penis during penetrative sex. This usually happens when the pelvic muscles that hold the genital structures in place have been affected. In Julia's case, the interference was caused by injuries sustained during childbirth.
“Wow, so what next? That sounds scary,” Julia said in obvious distress.
I asked her to bring her husband along to the next clinic visit. When it comes to sex, it is always important to listen to both parties. The sexual experience is a joint effort and treating one partner without the other is usually counterproductive.
And so Reagan, Julia's husband, accompanied her to her next clinic visit. He was a shy man who needed a lot of probing before he could 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, so I sought to understand Reagan's problem more fully through in-depth enquiry and medical examination.
As fate would have it, Reagan suffered from weak erections and sometimes loss of erections.
“That started a while back and it cannot be blamed on problems that came with the delivery of my last child,” Julia interjected in an attempt to absolve herself of blame. It turned out that Reagan was always busy and paid little attention to sex, so he never got adequate stimulation before penetration. His problems worsened when he began to rush penetration to avoid erection failure.
I made a diagnosis of Lost Penis Syndrome. In this condition, a couple have a common problem of loss of pleasure in both partners during penetrative sex. Neither partner feels comfortable during the penetrative phase of sex.
Apart from pelvic muscle laxity, which can occur after childbirth, pelvic floor surgery or a lack of pelvic floor exercises, the other cause of the problem in a woman can be excessive vaginal discharge, often due to vaginal infections.
In men, the main cause of 'lost penis syndrome' is weak erections. This can be caused by medical conditions such as diabetes and high blood pressure. It can also be due to reduced intimacy between a couple, as well as relationship problems leading to inadequate relaxation and response to sexual stimuli from the partner. In Reagan's case it was more an inability to relax during sex.
Treating the causes of the problem in both parties and rebuilding the intimacy does bring back the lost pleasure. So I had Julia's genital defects surgically corrected and subjected her to pelvic physiotherapy.
At the same time, I put the couple through sex coaching to rebuild intimacy and help Reagan relax during sex. In particular, I coached them on how to have better foreplay so that both of them were sufficiently aroused before penetration.
“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, bursting into a staccato laugh. For all his shyness, he had an interesting sense of humour.
