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The ins an outs of a sexologist

When people find out that I’m a “sex doctor”, it is either a great conversation starter or the ultimate convo killer. Yes, I’m a sex therapist – but I’m also a qualified medical doctor. Some think I watch people have sex, others think I just suggest kinky positions or toys and some don’t even allow their minds to go there. Many have mentioned that they would love to be a fly on the wall in my practice. So allow me to share some of what I’ve learnt over my years of getting people naked (once they leave my office). These four cases represent the most common reasons couples and singles book time with me. And the advice I give them will no doubt keep your bedroom fires burning…

 

The case: Unconsummated marriage

The couple: Erica and Paul, late twenties, married for seven years, both still virgins

Erica and Paul refrained from sex before marriage for religious reasons, but they were excited about finally having sex on their wedding night. They tried, but it felt like he was hitting a wall inside her vagina – it was impossible. Erica knew that the first few times can be uncomfortable, but nothing could have prepared her for the excruciating pain she experienced when Paul tried to insert his penis. She felt like he was cutting her open and after the attempt, the area would burn for hours. They tried lubrication, alcohol, sedatives, foreplay – nothing worked! They saw many doctors who told her that there is nothing wrong with her and psychologists who were convinced that she must have been abused, but she hadn’t been. When they came to see me, she could orgasm through other forms of stimulation, but they desperately wanted a baby.

The treatment: Take control of your vagina.

On examination, I discovered that Erica was born with a condition called Neuroproliferative Provoked Vestibulodynia, where there were too many nerve endings around her vaginal opening (and in her belly button!) The sensitivity made the muscles around her vagina contract, much like an eyelid protects the eye.

This sensitivity and resulting muscle spasm made inserting tampons impossible, never mind a penis! We had to take the sensitivity away, relax the muscles and teach Erica’s brain that something can be inserted into her vagina without causing her pain. In my examination room, she inserted something into her vagina for the first time – an ear bud! A specialist pelvic function physiotherapist taught her relaxation techniques and how to use her pelvic floor muscles. She practiced at home with vaginal dilators every day and applied a special cream around her vagina to help the nerve problem.

Within four weeks, Erica was able to insert a dilator the size of an erect penis into her vagina without any physical or psychological discomfort. Paul then began to help with the dilators and he also attended a few of the physiotherapy sessions. After a follow-up with me, they got the “all-clear” and were able to carefully attempt penetration at home. Success! The better news? Erica popped into my office a few weeks ago – pregnant with their second baby!

 

The case: He comes early – every time

The patient: Nkosi, 35, single

Every time he had sex, Nkosi ejaculated within less than a minute of penetration. At times it was so bad that he ejaculated even before penetration. He was so embarrassed that he began to avoid relationships. He read about the stop-start and squeeze techniques and had been practising for years, but they didn’t work. He also ejaculated within seconds while masturbating.

The treatment: Pop a pill

This doesn’t mean your sex life needs to come to a shuddering halt! Ejaculation is a learned behaviour and can be controlled. If a guy consistently ejaculates in less than a minute, it’s a genetic problem with a specific receptor. No amount of sex therapy, psychotherapy or exercise will get it right. I prescribed Nkosi with an SSRI – an antidepressant that works on this particular receptor.

Nkosi takes the SSRI every day and now lasts about 10 minutes. He’s seeing someone now and they’re planning to get married next year.

 

The case: She can’t orgasm

The couple: Lisa and Ben, married for 15 years

Lisa and Ben are happily married, but both feel like they are missing out on something… Despite Ben’s efforts with oral sex, manual stimulation and penetrative sex, Lisa has never been able to have an orgasm. They have also tried using a vibrator together, but to no avail. Lisa comes from a typical Afrikaans household – she found it difficult to embrace her sexuality initially, but now enjoys sex.

The treatment: Take things into your own hands

The first step is always education: only a third of women orgasm from penetration alone and many don’t know that the most sensitive spots are the clitoris and nipples, not the vagina itself. Lisa and Ben were instructed to do erotic massage, sensate focus exercises (where each partner becomes more aware of the sensations they feel) and up their foreplay skills. I changed Lisa’s antidepressant and sorted out her hormones – she was on a Pill that broke down and blocked her testosterone, making orgasms very difficult. She felt better and they enjoyed the exercises, but still no orgasm.

That’s when I suggested masturbation. After all this time, the pressure of losing control in your partner’s presence makes orgasm very unlikely. She had to do it alone. The idea was strange for her, but she gradually became more and more comfortable and eventually had her first orgasm with the help of a small bullet vibrator. By herself. She then did it in his presence and eventually with his help.

When Lisa came for her check-up this year, she mentioned that it is the best thing that she has ever done for herself and for their relationship. Her husband sent me a big bouquet of flowers!

 

The case: She wants more

The couple: Claire and John, have been together for four years

When Claire and John, who has an extremely demanding job, started dating, they had sex almost daily, but for the last year, it only happens about once a month. Claire cried during the consultation and said she feels completely rejected and it’s influenced her self-esteem. She loves him and didn’t want to leave, but would if the problem wasn’t solved.

The treatment: The two Ts (time and testosterone)

When men don’t want to have sex, there is a good reason for it: either psychological or physical. Being a medical doctor, I always exclude the medical first. John had very low testosterone levels – the hormone he needs for libido. Due to stress, the stimulation of the testis to produce testosterone was shut down. He didn’t make time for any exercise, ate poorly, didn’t sleep enough and was constantly worried about work. He needed to look after himself and de-stress. John was shocked to see how his lifestyle affected his health, and made radical changes. I also advised them to plan for intimacy twice a week, have date nights and do fun things together.

Three months later, they are having sex at least once a week, John’s testosterone is back to normal and Lisa is beaming.

 

NOTE:

  • All images courtesy of Google.
  • Courtesy of Women’s Health