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.

Dr. Andrea on the Safety of Oral Sex and the Comfort of Anal Sex. For other kinds of sex, you're just gonna have to wing it.

Doing this? You're on your own.

Welcome, possibly troubled Gentle Reader, to today's installment of Ask Dr. Andrea. For you new subscribers (thank you!!!), Dr. Andrea is the IBWMW Doctor-at-Large, which is a good thing because the blog is a bit of a hypochondriac.

Dr. Andrea is a total bad-ass--an osteopath at the Center for Sustainable Medicine, with specialties in women's/sexual health, nutrition and Ayurveda--and I can still scarcely believe this, she's still willing to take our questions.*

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HPV is in the news as causing throat cancer in Hollywood stars. Is it a danger to a, say, 57-year-old het? And if they can immunize kids against it, can they immunize adults? Oh, and if they can, why aren’t they offering it? Cost? Liability? We’re already doomed?

Dr. Andrea: Throat cancer is a danger to anyone who's ever had oral sex, including having had a penis in his or her mouth (especially one without a condom on it.). The reason HPV (the kind that, say, likes living on penises) loves the back of the throat, is that there are tonsils there ( = lots of folds and crevices to hide in) and the back of the tongue also has lots of bumps and stuff stuck to it (bad breath bacteria, adenoid/tonsil-like blobs, etc. yum. :/ ) that make for a lovely spot for HVP to stick.

As for immunizing adults- sort of. The vaccine seems to work well for females up to age 25 and males up to age 21. The thing is, once you've been exposed to the viruses, the vaccine we have doesn't seem to do much so it's recommended to be given before the first sexual encounter for best prevention. I wouldn't say we're doomed exactly, but prevention does seem to be our best (only?) weapon at the moment. That and decreasing risk by having fewer number of partners (the risk tends to go up the more you've had), not also having HIV, and using protection (although condoms aren't 100% especially if the skin that has the virus in it is outside the condom). The good news is, despite throat malignancies in general being pretty terrible, spread seems to be slightly rarer with HPV types, and treatment seems to be working as well as it can be expected to, with the usual gnarly side effects, but still not as bad as possible. Sorry for a not Mary-Sunshine answer, but you did ask about throat cancer. :/ [see also: this NYT article]

We are exploring open arrangements. What STIs are men at risk for when performing oral sex on women? (I'm as open to precautions as anyone, but sorry, dental dams are like I'm having oral sex with a love doll. And that I can do at home, alone. I mean, if I did that kind of stuff. )

The simple answer is: all of them. I guess I'm not being very Mary-Sunshine on this one either.  The reality is that beyond monogamy, things get statistically way more risky. I would suggest choosing partners and weighing risks of this idea carefully, discussing it again with your main partner at regular intervals to make sure you're both ok with it, and have full testing done on everyone before you are physically intimate with each new partner. And of course, do a thorough visual inspection of each partner before intercourse. [IBWMW note: I am immaturely picturing one of those miner's caps with a halogen light for said visual inspection.] Complicated, yes, but this is the world we're in- it's not just HIV, HSV, gonorrhea and chlamydia, but even bugs like syphilis are making a huge world tour comeback. Be safe out there!

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My husband and I are interested in trying anal sex, but our attempts so far have been much too painful even with copious amounts of lubricant. Fingers are fine, and a tapered dildo smaller than my husband's penis, but any attempts with his penis are excruciating. I've not found any advice that was specific enough to help, just generalities about 'relaxing.' Any ideas?

Honestly, for some people, anal sex is not pleasurable. But it sounds like you've done a great job of trying various versions of it, easing yourself into it, and being creative, so what is the motivation for this if it's not an workable progression that is fun for you both? If the smaller items are pleasurable for you, it could simply be a size issue, which could be worked on (using increasingly larger sizes for a few weeks) along with relaxing breathing exercises to remind your body you are safe and shut down the sympathetics that may be causing reflexive tightening. (p.s. that can work for mild cases of vaginismus or size differences also. Think SLOW- slowly increase dimensions, use very slow movements). Just take it easy as you don't want to stretch yourself permanently or tear anything- pain may be an indicator that that's about to happen.

Aside from general cleaning preparation and lubricant, generally that suffices if it is going to be a pleasure-inducing activity. That said, this next part isn't directed at you necessarily, but in general, the psychological aspects of anal sex can be more pronounced than with vaginal sex (especially for women, in my experience with patients), which can be related to, yes, 'relaxing,' but also deeper sorts of things like vulnerability in general, and letting go completely of control and security to trusting the other partner. My suspicion in this case is that this is a size issue, but looking at your motivations and desire to do it in the first place (when it's excruciatingly painful) might be helpful too- there are many many things to try other than anal sex if it's not doing it for you.
 
Let me know if you figure out a way to make it happen and it's great--I'd love to hear about that for future patients!

-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.

Btw, the anal sex question reminded me of a time Sandra and I were pervishly browsing the "sex" section at a book store and saw a book called something like "Anal Sex, Volume 2."  I wish we would have looked inside it because it was a HUGE book. They must have been doing lots of padding to come up with that much anal sex info, perhaps adding pages and pages of anal sex word searches or something.

Now, I am not an anal sex expert (though I am, as I like to brag, an Anal Bleaching Expert) but it seems to me that there is not *that* much to know about the topic. Surely not two volumes worth? Perhaps an anal sex pamphlet could've done the trick. Or, fuck, maybe even just an informative haiku. Which I have thoughtfully provided here. Clip n' save to consult in times of need. 

Anal Sex, A Haiku

Want some anal sex?
Here's what to know: Use lots of 
Lube and go real slow. 

xoxoxo
jill

*(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.)

(photo courtesy of my beloved Lady Cheeky)

Matthew Stillman's "Genesis Deflowered" and Other Readers Out Doing Stuff

While my primary accomplishment today was drinking an entire pot of coffee, IBWMW readers are out there making %&*% happen.

--Consider longtime Friend of IBWMW Matthew Stillman. He just released the book, Genesis Deflowered --a tarting up of the King James version of the Bible, written in the same language. (i.e. "Sedeqetelebab did pray for strength in the staff of Shem; and she did find her heart there.")

The idea wasn't so much to make Bible smut, but to start a conversation about religion and sex, in a scholarly sort of way.  “Religion and love get along incredibly well, but religion and sex don’t,” said Stillman in this interview with Fox News. “There is sort of this flirtation they have in the Bible, and so I felt that to be able to feel this more deeply and to speak it in the original Elizabethan English would be a way to have that conversation happen and have people connect to it in a new way.”

Even though his project was completely over my head and I was a terrible support team, pretty much only offering a "Yes, you go on and write that book" as my "help," Stillman dedicated the damn thing to me. So feel free to order a copy or two of Genesis Deflowered and throw a few shekels his way.

More at Chaffyn.com

--Meanwhile, longtime IBWMW Big Daddy Chaffyn has been working--mad-scientist-like-- on a IBWMW University site which grows stranger each day.  Right now, he reports, it's "feral, fetal, prenatal, unfit for human consumption."

In the meantime, Chaffyn had this to say about the post on Authentic Happiness.

"Anyone with an IQ above a fish (and fish are naturally happy) who isn't astounded perpetually by the miracle and luck of their amazing sentience and who isn't grateful for this brief chance to live on this gorgeous, fragile rock in the freaking middle of NOWHERE and who doesn't understand that there are far too few hours in each day to completely take care of what should be a plethora of interests and explorations, practice their native skills, create or appreciate something jaw-dropping beautiful, watch a tiny spider weave a web, make sure their friends are laughing and that the despondent ones get a few strokes, dote on their mate, stir up a couple of very tasty meals has got problems I don't know how to fix and I can fix just about anything. Oh, I didn't mention doing the laundry, folding it, and putting it away. Good grief. People are bored???"

Which, yes, yes, well said. See more of and/or order Chaffyn's artwork here.

--And finally, reader T wrote this response to True Husband's Tale, "Having no intimacy with her for 23 years is killing me."

My story is similar (37 year marriage) but rather than “vulvodynia” my wife suffers from depression and alcoholism.  Things changed after our daughters were born in the early 1990s.  My wife is angry that I did not know she was having problems back then.  But she did a good job of hiding it, I was busy trying to make a small business successful against difficult odds.  I could have been a more understanding partner.  When I asked about the no sex situation, I became a pig in her eyes.  She thought my only concerned was “getting some”.  I have never been able to make wife understand the deep emotional and spiritual connection that grows from intimacy.  She was raised to be a good Catholic girl that did not do whorish things – ever.  In her mind anything sexual is whorish.  The more I tried to fix our relationship, the worse it got.

I have been researching ours and other troubled relationships over the past 10 years.  Everyone asked, “When will you fix yourself?”  About 2 years ago I finally “got it” that I could not fix my wife.  I could only fix myself.  I needed to wake up to the fact that our sex life was over.

I’m 62 years old.  My mother and my wife’s parents are all in their 80s (and damn close to their 90s).  I see old age up close and personal every day.  It is sad and scary.  I will be there in 20 years and if I’m going to enjoy my life – I had better get busy.

This is only a test

Wish I was here

Fuck, I miss you all. Working to make money blows.  I don't recommend it at all.

Anyway, a few wee things.

1.  Dr. Andrea is in. Now, I am quite sure that every one of you aren't completely free of embarrassing health issues, sexual problems, genital questions and such. This is a chance to get your question answered by a real doctor, for FREE and anonymously (except for all of us, you know, reading about your itchy wiener or whatever). Man--or chick--up and send your question to: jillhamilton001@gmail.com or test out the snazzy new contact form at lower right and let me know if it works.

2.  Expert Predict Sexbots Will Be Part of Our Lives by 2050 is my latest article in DAME magazine. Go on over and give it some love if you will. Worst thing I discovered: Some sexbots are available for RENT.

3.  Some lady sent me this comment/unsolicited advice on Facebook: "Please try to use 'polyandrous' instead of 'slutty'. Thank you."  It was the preemptive "thank you" that got me, as though I'd be heeding her advice. 

4.  Naomi Wolf is now following me on Twitter. Squee.

5.  I was happy to see that some of you bought the aforementioned Naomi Wolf's book  Vagina: A New Biography via the Amazon link at right. Will love to hear what you think. (My 11 year old saw me reading it--as my daughter, this is her cross to bear--and goes, "Hey, what's that book about? VAGINAS?")

6. Someone also used the Amazon link to purchase "Cottonelle Ultra Comfort Care Toilet Paper, Mega Roll Economy Plus Pack, 27 Count," which means that in that person's brain there is now a tiny, tenuous neurological link between the blog and their mega/plus/ultra toilet paper needs. I am tentatively happy about this.

7.  And speaking of overly dramatic toileting-related product adjectives, my current favorite is Fresh Step Extreme Odor Control Scoopable Clumping Cat Litter.

No more Purina Hot Pockets cat food for you, little kitty

I am not a package designer but, really, trained professionals sat in on probably countless long meetings and not one person thought it was a bad idea to mark up the package with the words "EXTREME URINE & FECES"? In big-ass red letters? We are plenty crass in this country, but I think "odor control" would've worked just fine.

8. 8, 8, I forgot what 8 was for.

9.  Don't forget about your Dr. Andrea question...

xoxox
jill

(gorgeous photo from Lady Cheeky,)