How to rise to the occasion and end vicious cycle

Rose came to the clinic complaining about genital pains following sex with her husband. This had been a recent development.

“I now dread sex. The burning pain following the event is unbearable,” she explained, “and last night I saw blood spots too and feared that something terrible could be happening to me.”

I examined Rose; she had bruises and inflammation in her vagina, a sign of severe friction during sex.

“It appears you do not get lubricated and you are having dry sex which damages tissues in your vagina,” I told her. She nodded in agreement, sadness painted all over her face. She avoided eye contact with me and stared into the horizon.

Rose, 37, has been married to Juma, 40, for nine years. They have two children.

“This problem started when Juma started having problems with his erections,” Rose explained. “Many times he is flat but when he notices an erection he pounces on me immediately!”

“Oh, so that happens when you have foreplay?” I asked.

“What foreplay? We stopped having foreplay,” Rose answered.

Theirs was a case of performance anxiety. When one has suffered erection failure, they develop fear when exposed to a sexual situation. The fear causes the failure recur because sexual stimulation cannot happen in a state of anxiety. It becomes a vicious cycle.

People develop various coping mechanisms. Some keep off sex. It is painful to fail so why try? Such relationships end up turning into sexless marriages which have their consequences.

The second way people respond to fear of failure is to drown themselves in alcohol. Initially when they are high, they are able to overcome the fear and face the dreaded sexual situation. They soon realise that they have to keep drinking more alcohol to conquer the fear. But then another problem sets in; they get intoxicated or addicted and this only serves to worsen their sexual problem.

But Juma had taken a rather interesting route. It is a route that many people take: Rush into sex when there is some form of erection, and before it disappears! The problem with this approach is that it is rather inconsiderate of your partner.

“Actually I feel that my husband has been raping me at every opportunity. It is depressing and I do not know what to do,” Rose interjected.

I asked her to bring James along to the clinic the next day. They were there early the next morning and when I arrived at 8am they were waiting.

“So last night my wife refused to have sex with me and said we have to come and see you,” Juma said.

“I think you are misrepresenting me. Did you even have an erection last night?” Rose answered back.

I sensed the tension building and took charge of the conversation. I got further medical history from Juma. He was a known hypertensive and was on medication. His medicine had been changed when his pressure went out of control. Three weeks later he developed the erection problems.

“The inability to rise after foreplay was the worst experience ever,” Juma explained. “So I stopped the foreplay.

“I still become soft in the course of sex. I am actually very frustrated. I feel I am no longer a man. Can you help?” Juma asked.

I noticed that one of the hypertension drug interfered with the sexual function. We agreed to stop the medicine immediately. The couple also underwent couple therapy to recreate their lost intimacy.