Case study ( 2606 views as of May 27, 2019 )
Jason is a 42-year-old executive with three children. Although both busy with their careers, Jason and his wife had a good sexual life, and he had no erectile or ejaculatory difficulties. He recently underwent an uncomplicated vasectomy, and when he resumed sexual activity, he was disappointed that his erection was not as firm and that the orgasm he experienced was not as strong. He blamed it on a diminished penile sensation since the vasectomy, and dismissed it as temporary.
Unfortunately, this issue continued and several months later, Jason visits his family doctor. His physician reassures him it is not the vasectomy per se, and tells Jason this should resolve itself as his psychological outlook improves. However, Jason requests a referral to a urologist for a vasectomy reversal.
The urologist repeats what the family doctor had said, and feels that Jason should see a sexual medicine specialist or a psychologist as there is no organic or medical cause for his sexual changes and does not want to do a reversal without further assessment.
Jason sees the sexual medicine physician who re-explains anatomy and introduces the idea of how the mind-body connection can affect sexual function and sexual signals to the pelvis, and what the vasectomy meant to him in terms of manhood and stages of life. A 3-month trial of daily PDE5i is introduced to improve nocturnal, spontaneous and sexual erectile function and improve pelvic vasocongestion. Jason also sees a sexual therapist for three visits. Over time his erectile function and orgasmic quality improves substantially, although not to what he feels are pre-vasectomy levels.
Jason could benefit from continuing discussions with his family doctor and urologist to monitor his physiological symptoms. He could also continue seeing the sexual medicine specialist and perhaps the sexual therapist to work on any psychological component to his condition.Author: Dr. Stacy Elliott