Dr. Andrea and The Cases of Post-Vasectomy Sex Pain + The Ellusive Zoloft Orgasm

Welcome to today's installment of Ask Dr. Andrea.  Dr. Andrea is the IBWMW Doctor-at-Large, which is a good thing because the blog spends WAY too much time googling various "symptoms."

Dr. Andrea is a total bad-ass--not only because she's an osteopath at the Center for Sustainable Medicine, with specialties in women's/sexual health, nutrition and Ayurveda--but because she takes time out of her busy schedule (which I imagine involves lots of yoga and kale juice) to answer our questions.*

Dear Dr. Andrea:

I have been a reader of IBWMW for a few years. My husband and I have been together for almost 10 years – married for 6. I am 28. He is 31. He had a vasectomy in 2011. 

Our sex life is different than most (at least I think so). We are only having sex once or twice a month. I wish it was more frequent. When we do have sex I am satisfied – always able to have at least one orgasm and we try just about every position. No complaints about the actual sex.

Since his vasectomy he has slowly admitted to me that he has a lot of pain after sex. He understood it was a risk at the time of surgery. This pain has impacted our sex life in that I don’t feel he enjoys sex as I would like him to. I know that after he knows when I’m “done” he anticipates the pain and is not as hard. I think his inner monologue is something like this: “Ok. She is satisfied. Oh shit! This will be painful!”  I feel badly for him that he does not enjoy things as I do. I am extremely open to discussion but he is a bit more private when verbalizing his sexual needs.

Is there anything we can do to decrease pain? Is there something we can try to help accept the sensation of pain? Meditation? Icing? Breathing? Any insight would be very much appreciated.
--Anoymous
 

Dear Anonymous- 

First off let me express my condolences- this is a tough situation. Any time sex causes pain instead of pleasure can be really difficult physically and psychologically for both partners. 

The first thing I would suggest is going to a really good Urologist- perhaps whoever did his vasectomy if he had a good rapport with the doctor. Ordinarily I would love to suggest holistic or alternative things, but post-surgery several things can happen that need to be evaluated, especially since some of them can be treated so that the pain goes away entirely. 

In the meantime, here is what is likely happening--the sperm have to go somewhere when the vas deferens is cut, so sometimes they build up in the epididymis or in the surrounding tissue and cause chronic pain. If it's happening only during sex or upon ejaculation, it could be partially a positional issue from the muscles around the testicles tensing up right before ejaculation and then the extra pressure of some sperm being released and backing up in the tube (or leaking out and irritating surrounding tissue). 

Some urologists suggest trying ibuprofen, but that would likely work best for the chronic (meaning pain all the time) version. Although it's definitely worth a try. Take the suggested dose an hour or so prior to having sex (assuming you have no allergy to ibuprofen, no stomach bleeding or irritation problems, no high blood pressure, and no kidney issues, etc... of course!) and see if it helps. 

Surgery-wise, they can go back in and clean it up, or remove the epididymis of the side that's most painful, or remove any granulomas or scar tissue that have formed that might be causing positional/ejaculation pain. 

Also, reversal of the vasectomy almost always ends the pain if it's due to one of the above issues. But that requires some definite verbalization of what you're each needing and wanting as a form of birth control and how it affects your sex life. I always try to promote positive thinking in sticky situations--perhaps this issue will help open up the dialogue between the two of you and create more pleasure on both sides. Good luck, let me know how it goes and what works!

 --Dr. Andrea

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Dear Dr. Andrea:

I take 150 mg of Zoloft daily and experience the common side effect of having a harder time reaching orgasm.  I'm sure the 3 or 4 drinks I may have also had don't help.  Is there anything I can do to speed up the orgasm (for my wife's benefit, not so much mine) other than not drink?  What if I also smoke a little pot the same evening, how does that impact my issue?  Would it help if I skipped my daily Zoloft dose on the days I think I'm getting lucky?  Thanks.
 A.K.

Dear A.K. 

Well, it sounds like you actually know what to try first--alcohol is a depressant to the central nervous system, so that makes it responsible for around 80% of the problem here (and by the way, pot would most likely make it worse, especially since you're already combining drugs). It might help to do a trial of a week or month without alcohol and see if that made a difference consistently. Also, Zoloft isn't like Advil. The drug levels build up in the brain over 3-6 weeks, so skipping one day may have no effect, or might give you some withdrawal symptoms, rather than having a benefit, especially with the good-sized dose you're taking. There's also always Viagra (not that that helps with orgasm, but some people say it helps with arousal in general), but that brings me to the next point...

What concerns me most is it that there might be some masking of issues going on with all these nervous-system-affecting drugs you're ingesting. If you are having depression issues, alcohol is definitely going to make those issues worse, as would pot, in both the short and long term. Also, as with all intimacy challenges, there might be some other things that you could work on that would help on mental/emotional as well as physical levels (variety and experimenting with your partner can makes a big difference)... I would suggest going back to the basic first issue of why you're taking the Zoloft and see if you can't work on it a bit more intensively, which may lead to possibly decreasing your dose eventually (thus likely decreasing side effects as well). 

Another option is to shift to a medication with side effects that are not as bothersome to you--every SSRI has a different profile and one may work better for you than another. Depression can be very treatable and sometimes even resolvable, so if it were me, my goal would be to tackle it head on and see if therapy (more frequent or a different type than you've tried if you have already), mind-body techniques and/or meditation, and things like exercise and outdoor activity (again, if you already do these things, maybe a different type, more regular, or something new you've been wanting to try) might help more in combination than a medication alone. 

All of those suggestions may improve your sex life in general anyway! Either way trying more of those types of things may make it possible to at least decrease the amount of medication. Be kind to yourself, do what you can, let me know if any of these ideas help!

-Dr. Andrea

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Say 'thank you' to Dr. Andrea everybody!  And remember, send questions in a comment below, an email or using the (fully operational!) contact form in the right margin.

 *(Note: This is NOT a substitute for individual medical advice or care. So if Dr. Andrea tells you to stick a rusty tin can up your butt or something, check with your doctor first. Go on, check with them. I dare you.)