ANSWER
It is important to understand that there is no right
or wrong way to behave before, during or after sex. There are no rules
that say you “should” be cuddling and talking after sex.
However, you do have every right to tell your husband what you would
like to do after being intimate. Keep in mind that just as you
have your way of going about things, so does your husband. He may
feel that sex is physically exhausting work and that nothing sounds
more appealing right afterwards than falling into a deep sleep. Be
cautious about misinterpreting that as him not loving you or not connecting
with you. Please try not to compare his behavior to that of former
lovers. Everyone is different. Remember, there are other qualities
that obviously made you choose your husband over prior boyfriends.
A good compromise may be to cuddle as you both fall asleep—and
if any loving words pass between you, even better.
QUESTION
I am in a wonderful, supportive relationship with
my boyfriend and we are sexually active. I enjoy making love but have
a very hard time reaching orgasm. This has been a problem for many
years before this relationship. Because of depression, I am currently
on Zoloft, and I know it has sexual side effects. I am also on Wellbutrin
to counteract these side effects, as prescribed by my doctor.
I am feeling happy with my life and secure; I’m just frustrated
that even with this medicinal tactic I am unable to reach orgasm and
I am starting to wonder about other things, like the fact that I cannot
reach orgasm while masturbating—what does that mean? I have
to tell you, I am very comfortable with my body and my sexuality,
so it's not like I have problems in that area. I have tried vibrators
but to no avail. I just don't know what to do. I don't care how it
happens as long as it does, but I hate the fact that I can't control
it and have to hope it might happen.
I have been on medication for several years, but
I was experiencing problems with orgasm before then. It is important
to note that prior to therapy and medication I was not doing too well
mentally and emotionally, which may be the reason behind the sexual
problems. And then with the medication, I had side effects.
What I am getting at is that currently I am happy with my relationship
and my own life, career, etc. I am on this antidepressant cocktail
to help me with the side effects. And I still cannot climax regularly;
hardly ever. I hope you can give me some advice.
ANSWER
It seems that you are in a very good place in your
life, with regards to your relationship and work. Now, you’d
like to figure out how you can go about improving things in your sexual
life. Without question, the situation that you’ve presented
is quite complex. So, I will start off by saying that absolutely any
changes you plan to make to your medications must be made in conjunction
with the doctor that is presently treating you.
Zoloft is known as an SSRI, or Selective Serotonin
Reuptake Inhibitor. It is used in the treatment of depression and
anxiety disorders such as posttraumatic stress disorder, panic disorder,
obsessive compulsive disorder and premenstrual dysphoric disorder.
Essentially, when one nerve releases serotonin, it is then picked
up by a second nerve where the serotonin can go on to do its work
in controlling sleep, appetite, temperature, and much more. For those
who suffer from depression, it is believed that there is an imbalance
in the amount of serotonin available. The medication acts to block
the first nerve from picking up the serotonin, thus making more available
for the second nerve to pick up and eventually producing the end result
of improved mood. Because serotonin is involved in so many other functions,
there are side effects when there is too much serotonin that has built
up. These side effects include dry mouth, insomnia, sexual side effects,
diarrhea, nausea, and sleepiness. Wellbutrin is also used in the treatment
of depression. While Zoloft acts by increasing the available amount
of serotonin, Wellbutrin increases dopamine and norepinephrine, which
is also effective in treating the symptoms of depression. Like Zoloft,
some side effects include dry mouth, nausea, and insomnia. However,
studies have shown that Wellbutrin does not cause sexual side effects.
Although Zoloft is known to have sexual side effects,
not all patients experience them. For others, side effects may even
improve over time or if their dosage of medication is decreased. As
in your case, some physicians may add Wellbutrin to help counteract
the side effects of sexual dysfunction. Another option is to slowly
taper the Zoloft until Wellbutrin is the only remaining medication.
Truth be told, there are some people who will not be completely “normal”
sexually while on any anti-depressants. Unfortunately, it
then comes down to choosing what is more important to you—a
balanced, stable mood that allows you to comfortably function in everyday
life or a rocking sexual life that has you swinging from the chandeliers.
Your frustration at being unable to regularly orgasm
with masturbation is clear. You obviously don’t have any inhibitions
standing in your way and are comfortable with your body and sexuality.
However, there may be a couple of hidden factors at play that are
also contributing to your problem.
We’ve already established that the medications
you are on can potentially decrease the frequency, intensity and even
the occurrence of orgasm—regardless of whether the stimulation
comes from you, a vibrator, or your partner. But, you also mentioned
that you had difficulty with orgasm even prior to starting
your anti-depressants, and that you were “not doing too well
mentally and emotionally” at that time. Think about what was
going on in your mind at that time that may have inhibited your orgasms.
Was it that you had a different attitude towards sex or masturbation?
Perhaps you thought that it was taboo, dirty or not appropriate behavior
for a “good girl”? Or, is there something in your past
that you are suppressing that could be having a significant impact
on your psyche now—such as a history of abuse or molestation?
Try working together with your doctors to see what
further adjustments can be made in your medications. Be sure that
they understand that the sexual side effects cause great distress
to you. Bear in mind the positive impact these drugs seem to have
already made on your life and the progress that you have made.
Clearly, there are no easy answers. By working together with your
doctor and delving deeper into your past for any hidden memories or
feelings that are interfering with your sexual life, you’re
on the right path.
Dipika Dandade, 31, is an obstetrician/gynecologist practicing
in the Los Angeles area.
ABCDlady does not provide medical advice, diagnosis or treatment. See
additional information.
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