   
Worse sex with Zoloft®
In the PDR I notice that Zoloft® does have a high incidence of
impotence in men (17%) whereas Paxil® and Wellbutrin® are
under 4%. This would imply that women may have a similar difficulty in
sexual response (not all women, however).
Viagra® (sildenafil) successfully treats many men with
impotence. The lead article in the New England Journal of Medicine
recently points out that it does NOT improve sexual desire in men but
it did produce erection ONLY in response to sexual stimulation. The
physiology of the sexual response is very similar in women so I would
expect it to prolong the arousal phases of sexual activity but it
won't prolong orgasm. It doesn't lower the thought barriers if desire
is inhibited. Keep in mind before you try this experiment though that
the doses may be different for women than men (more likely lower at
least by body weight) and that Viagra® in the men's study had a
(20%-30%) incidence of headaches and flushing, about 10% stomach upset
and occasional visual disturbances. These are fairly high side effect
rates as medicines go. Be careful!
In your situation it might make the most sense to work with your
doctor to get on a medicine with the least effects on sexual response
before trying any Viagra®.
Stingingly painful sex
An infection or sore can heal poorly with scar tissue and
constant nerve irritation. Treatment is often started out with
corticosteroid creams or even injections. Sometimes destruction of the
painful tissue can improve pain. For the most part, however, I prefer
excision of the tissue.
Orgasm doesn't last
Are you on any medicines?
I'm not sure either. You said the main problem was early stopping of
orgasm. You didn't mention having decreased sexual desire in the first
place or any difficulty having an orgasm. Are any of these a problem
also? They go along more with stress than what you describe.
When you say orgasm occurs but stops quickly, what physical feelings
are you referring to?
It sounds as if the uterine contractions that occur with orgasm are
almost absent. The only easily changeable things I can think of would
be medications (which you said you weren't taking) such as aspirin,
non steroidal anti inflammatory drugs such as Alleve®, Motrin®,
pain medicines, antihypertensives, alcohol, asthma medicines or
anything that would interfere with smooth muscle contractions.
Putting pressure on yourself can certainly change sexual response.
It does in men with premature ejaculation.
Ibuprofen is the same as Motrin®, a non-steroidal,
anti inflammatory drug (NSAID) and it does inhibit uterine
contractions. I wouldn't think you were using it so often that it
would interfere with relations. It has a short duration of about 6-8
hours. If you are taking it daily maybe it could be affecting this
problem.
Intercourse pain with
pelvic congestion syndrome
Most of time, it is thought to be directly mechanical due to movement of the pelvic
organs during the thrusting of intercourse. Think of it as
varicose veins in the pelvis. There is a chronic discomfort in between sexual
relations also. Many physicians consider it a cause of chronic pelvic
pain but it is somewhat controversial since it is very difficult to
study this type of problem.
Headache at sexual climax
Sex headaches are not common. I've only seen a few women in whom it
has been a significant problem requiring treatment. I've just looked at
Medline at National Library of Medicine to brush up. Here is what I've
been able to glean: It is called different things, sex headache,
coital cephalgia, orgasm migraine etc. It is closely related to an
entity called exertional headache and may actually be the same thing.
The headache can last minutes to days and can be quite painful. It
is actually more common in men than women by a 5:1 ratio. The
distribution of the headache can be that of a migraine, a cluster
headache or just like a tension headache. One French author (see
below) classifies it into three subtypes. The treatment is usually
common, generic medicines such as propanolol (Inderal®, the same
anti-hypertensive medicine that many public speakers use not to be so
nervous) or indomethacin (Indocin®, an anti-arthritis medicine
that also blocks smooth muscle contractions).
Steps to diagnose and treat would probably include a referral from
the primary care physician to a neurologist. The neurologist is going
to determine the exact type of headache it is, if there are other
times that headaches take place and an exam. He/she will need to
decide if any MRI or CAT scan is needed to rule out a brain vessel or
neoplasm lesion (unlikely but possible depending on the patient's
history and exam. After that, the treatment would likely be propanolol
prior to intercourse -- prophylactically so to speak! Enclosed below
are some abstracts of scientific articles from Medline.
*****
Sands GH, Newman L, Lipton R.
Cough, exertional, and other miscellaneous headaches.
Med Clin North Am 1991 May;75(3):733-747
Long Island Jewish Medical Center, Albert Einstein College of
Medicine, New Hyde Park, New York.
We have discussed several miscellaneous headache disorders not
associated with structural brain disease. The first group included
those headaches provoked by "exertional" triggers in various
forms. These include benign cough headache, BEH, and headache
associated with sexual activity. The IHS diagnostic criteria were
discussed. Benign exertional headache and cough headache were
discussed together because of their substantial similarities. In
general, BEH is characterized by severe, short- lived pain after
coughing, sneezing, lifting a burden, sexual activity, or other
similar brief effort. Structural disease of the brain or skull was the
most important differential diagnosis for these disorders, with
posterior fossa mass lesions being identified as the most common
organic etiology. Magnetic resonance imaging with special attention to
the posterior fossa and foramen magnum is the preferred method for
evaluating these patients. Indomethacin is the treatment of choice.
The headache associated with sexual activity is dull in the early
phases of sexual excitement and becomes intense at orgasm. This
headache is unpredictable in occurrence. Like BEH, the headache
associated with sexual activity can be a manifestation of structural
disease. Subarachnoid hemorrhage must be excluded, by CT scanning and
CSF examination, in patients with the sexual headache. Benign headache
associated with sexual activity has been successfully treated with
indomethacin and beta-blockers.
*****
Nick J, Bakouche P.
[Headache related to sexual intercourse].
Sem Hop 1980 Apr 8;56(13-14):621-628 [Article in French]
Coital cephalgia (CC) is rare (1/360 headaches); it occurs more
frequently among men. Out of 16 unpublished cases, in 4 cases, CC was
the inaugural symptom of vascular attack. In the 12 other cases, CC
was isolated or primary. According to the time of onset of headache
during coitus one may distinguish three types: 1) early CC usually
moderate and short lasting; 2) orgasmic CC, abrupt, severe, lasting 15
to 20 minutes; 3) late CC of long duration (hours, days) follows
sometimes orgasmic CC. Isolated CC is usually repetitive but
capricious, episodical, not periodical. Prognosis is good. Mechanism
is mainly vascular and muscular. The role of high blood pressure,
migraine, and psychological factors is discussed.
*****
Johns DR.
Benign sexual headache within a family.
Arch Neurol 1986 Nov;43(11):1158-1160
The occurrence of the vascular type of benign sexual headache (BSH)
is described within members of a family. The most severely affected of
the four sisters was successfully treated with propranolol
hydrochloride prophylaxis. The literature on headache related to
sexual activity is reviewed and the clinical features of BSH are
formulated. The familial occurrence is put forth as further evidence
to consider the vascular type of BSH as a migraine variant.
*****
Silbert PL, Hankey GJ, Prentice DA, Apsimon HT.
Angiographically demonstrated arterial spasm in a case of benign
sexual headache and benign exertional headache.
Department of General Medicine, Royal Perth Hospital, WA, Australia.
Benign headaches related to sexual activity and exertion are being
recognized with increasing frequency. We wish to report a case of
benign sexual headache (Type 2) and benign exertional headache,
occurring sequentially in the same patient. Multiple areas of cerebral
arterial spasm were demonstrable on angiography. This observation
would support the concept that benign sexual headache (Type 2) and
benign exertional headache may have a similar pathophysiology.
Pain with sex since
starting intercourse
It is unlikely that the urethral dilations at age 18 are related to
the current problem. You were right to go to the urologist to get it
checked out, however. The next step would be to have your
gynecological exam and be sure to tell all of the symptoms and fears
you are having. The gynecologist, through symptom questioning and
pelvic exam, will probably try to classify the problem into whether it
is a superficial (near the outer 1/2 of the vaginal or vulva) problem
or whether it is a deep (near the cervix, uterus and internal pelvis)
pain with intercourse. There are many causes of superficial
dyspareunia, (pain
with intercourse) and many causes of
deep dyspareunia
The fact that you are having light, bright red bleeding with
intercourse would slightly favor a superficial dyspareunia category.
This is a serious problem, not inasmuch as it may be a life
threatening disease such as cancer, but because it will forever affect
sexual desire and fear of vaginal intercourse. It needs to be
evaluated. This type of a problem does not usually get better
spontaneously.
Bleeding after
intercourse
Bleeding after intercourse (post coital bleeding) usually means
either the skin lining the cervix or vagina is thin or inflamed, or
there is an anatomical lesion on the cervix such as a polyp or a
precancerous or cancerous lesion. A normal Pap and pelvic exam within
the last year makes cancer highly unlikely, but precancerous lesions
(abnormal pap smears, dysplasia) are possible so a physician's visit
is indicated with any post coital bleeding.
At the time of a visit, in addition to a PAP smear, the physician
should be able to tell if there is an anatomical lesion causing the
bleeding or if the vagina is thin due to low estrogens and just gets
irritated with intercourse. The thinness of the vaginal skin and pain
with sex indicate the lining of the vagina may be the likely problem.
It sounds as if there are low estrogens such as may be seen in
menopause or with the absence of ovulation due to other non menopausal
causes. A history of infection may be related or an independent event.
If the vagina skin (epithelium) is thin and atrophic, the infection
can be a bacterial vaginitis known as atrophic vaginitis. Infections
can be other etiologies however, so more information about that would
be helpful.
Age 39 is quite young for menopause so the recent menstrual history
would help too. Many things such as medications, diseases, stress
etc., can suppress ovulation which in turn causes low estrogens, which
in turn causes atrophic vaginitis, which in turn causes painful sexual
relations and sometimes bleeding after sexual relations. The physician
may order a serum follicle stimulating hormone (FSH) to rule out
menopause and possibly a thyroid stimulating hormone (TSH) and serum
prolactin to investigate the possibility of a central nervous system
cause of the blocked ovulation.
In summary, the problem you describe may not just be a simple
infection problem. It can be a symptom of other bodily changes that
bear investigating. You shouldn't have to fear having sex!
Anal sex
Anal intercourse isn't practiced much in U.S. by women with male
partners that I know of. It is practiced some. It initially causes
rectal fissures and bleeding but not hemorrhoids. It can be damaging
to the external anal sphincter. In the long run that will lead to
rectal incontinence. Some women can get used to it over time but they
have learned to voluntarily relax the rectal sphincter. I don't
recommend it at all.
Gay men practice anal intercourse but they also tend to have a high
incidence of genital warts, herpes and gonorrhea. Hepatitis and HIV
often have their ports of entry by anal intercourse. Presumably there
are small tears in the rectal mucosa quite frequently that allow this.
What do you think the probability is that a man who wants to
practice anal intercourse with his female partner, is having
intercourse with another male/female partner? Sounds like suicide to
me.
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