Sex and Therapy 5/6: Less Common Presentations

People are often curious about the issues sex therapists work with, frequently presuming they’re especially unusual, perverted or funny. Most of the time, similar issues arise, compounded and maintained by familiar relationship dynamics, thinking and behaviours. Occasionally, though, less well-known issues arise. Once they’re recognised, so are the ways of dealing with them, which may not even need a specialist sex therapist.
 

Sexomnia

A good example of this is Sexomnia. Couples present saying one of them is regularly woken to discover the other making love to them in their sleep. This can be very upsetting to both partners. One may not believe the other is really asleep, and they may be horrified to discover what they’ve been doing. They can be reassured that sexomnia is a sleep disorder and not a sexual problem. Indeed, clients often have a history of related issues such as sleepwalking or sleep apnoea, so referral to a sleep clinic is the appropriate response.
 

Post-orgasmic illness syndrome (POIS)

This is a condition in which flu-like symptoms occur immediately after ejaculation, and last up to a week. Like sexomnia, this is not a sexual problem as such, though it may obviously cause sex and relationship issues for the individual and couple. There are many theories about the causes of POIS, from allergy to one’s own semen to some sort of chemical or hormonal imbalance provoked by orgasm, so considerable investigation is needed. Post-orgasm headache is a similar condition.
 

Persistent genital arousal disorder (PGAD)

PGAD occurs when someone is aware of unprovoked sensations that are like sexual arousal but are irritating and unresolved by orgasm. They’re more common in women, especially around the menopause, and may be much more prevalent in western societies than is appreciated. Some people experience multiple orgasms, which may appear unprovoked but often follow a wanted orgasm and can continue endlessly for hours or even days.

Treatment for PGAD has included Botox and local anaesthetic, but often therapy to help someone deal with the effects on daily life is the most helpful intervention. Sometimes antidepressants are offered, but coming off them has been implicated in the development of both PGAD and POIS. The good news is that instances of PGAD gradually diminish and eventually stop, though can sometimes recur at a later date.
 

Fishy smell

A fishy smell from the genitals is often associated with bacterial vaginosis or urinary tract infection, but sometimes clients complain of fishy smell occurring specifically after orgasm. This can happen when high arousal leads to an exchange of bodily fluids, and their differing chemical makeup can cause a fishy smell when they’re combined, including during same-sex encounters. Use of barrier contraceptives often solves the issue, but if the smell is present before sex, or if it persists, the individual and their partner(s) need to be checked for infection.
 

Postcoital tristesse

Crying spontaneously occurs in some people during or after sex. Therapists obviously need to determine whether someone is not enjoying sex or experiencing pain, but the combination of emotion and hormones can cause crying in both men and women, known as postcoital tristesse. If there’s no pain or actual distress, couples can be reassured that this is a natural phenomenon.

Postcoital dysphoria

However, sometimes people experience postcoital dysphoria in which there is anxiety or aggression that can last for several hours. This may be the result of previous trauma, bodily memories of which are triggered by sex, or it may again be caused by a hormone surge. Referral to a trauma therapist is often helpful, and relationship therapy can help with the effects on a couple, together with safeguarding checks and support.

Next week, in the final part of this series, I will focus on what it is that specially trained sex therapists do.