SEXUAL HEALTH: An inferiority complex infection

Betty and Andrew were having one of the worst of their 22 years of marriage. The tension between them was palpable when they walked into my consultation room. The problem was that Andrew had screamed so loudly while having sex that everyone in the house was woken up and rushed to the couple’s bedroom to find out what was going on.

“If I had not locked the bedroom door our children would have found us in a very compromising situation!” Betty lamented, shaking with emotion. “In fact two of our neighbours immediately called us on our mobile phones to ask if we had been attacked by robbers!”

‘DO NOT TELL ME HE HAS INFECTED ME!’

The couple was very embarrassed and unable to explain what had happened to their teenage children and neighbours. “I have never heard anything like that!” Betty lamented. “I always thought that only women vocalise during sex.”

Andrew was quiet as Betty expressed her concerns. I explained that all animals make some form of noise during sex and it is not necessarily a female thing. I turned to Andrew and asked him to say something. Sexual issues can be embarrassing and many times a hurting person remains mum to avoid extending the embarrassment.

“Well, I had excruciating pain on ejaculation,” he said avoiding eye contact. “It was like someone slicing my testicles with a razor blade.”

Wow! So Andrew had a painful ejaculation. This is a symptom that is brought about by a number of disease conditions.
“Do not tell me that Andrew has a sexually transmitted disease and he has infected me!” Betty immediately interrupted.

I requested her to allow me time to explain. Painful ejaculation can be due to inflammation of the urethra – the pipe in the penis where urine and ejaculate passes – or other tubes that carry semen and sperms from the testis to the penis. Also, inflammation of the testis itself, called orchitis, can cause painful ejaculation. Part of the semen also comes from the prostate gland and problems of the prostate can similarly lead to pain.
Inflammation can also be due to sexually transmitted diseases.

“That is what I mean!” exclaimed Betty, “Don’t tell me I am infected! I have always suspected that Andrew has another woman.”

She suddenly started weeping. Andrew was shaking his head and frowning. I reminded them that I needed time to arrive at Andrew’s problem.

MORE THAN JUST AN STI

Other than infection, enlargement of the prostate or even cancer of the prostate can cause painful ejaculation. Pain can even be a side effect of treating prostate diseases. Surgeries on the prostate and its surrounding structures or radiotherapy due to prostate cancer can all lead to painful ejaculation.
“I really do not think I have any of the problems you have described,” Andrew said.

Incidentally he had been going for annual prostate check-ups which showed a normal prostate all along. I examined Andrew and yes, his testicles were quite painful, especially the right one. There was a bit of swelling too. I ordered for blood and urine tests as well us ultrasound of the testis to unravel the diagnosis.
Results showed that Andrew had a bacterial infection.

He and his wife needed immediate treatment to prevent damage to his organ.

“But doctor isn’t it possible that this infection could have come from Betty?” Andrew asked, obviously distressed.
“You are a devil! You infect me with disease and turn around to accuse me?” Betty shouted back. She was shaking with rage.
Beyond the infection, I realised that the couple had relationship issues that needed attention. They were both accusing each other of infidelity. It was hard to know where the truth lay. I booked them for relationship counselling.
After five sessions, it turned out that Andrew felt inferior in the relationship because of Betty’s high ambitions and expectations. He was not coping with her demands. As a result he withdrew emotionally. At the same time he got close to the housemaid and started confiding in her.

He ended up having sex with the housemaid.

Andrew broke down and cried uncontrollably, asking Betty for forgiveness.
Betty was hurt and disappointed. She had to forgive and trust Andrew again or to quit the marriage altogether.

After two days of reflection she announced that she would be forgiving Andrew; he jumped and ululated so loudly the emergency team in the clinic rushed into the consultation room thinking that a serious emergency had happened.

The man was loud and that I now fully understand the kind of noise he must have made when he had painful ejaculation!