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.