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Low libido, PE, infertility and an unhappy sex life
baasleim posted:
Dear Doctor

Since I got married about 3 years ago (I am 31), I have found my husband(age 38) to have low libido and premature ejaculation which has hugely affected our sex life and caused me a lot of depression, anger, frustration and which has now resulted in a low libido and a dislike for sex myself.
On an average, we used to have intercourse twice a month which has come down to once in 45 days.My husband does say that he is interested in intercourse but this is what we end up having. Even if I played with him sexually until he had an erection, it never excited him enough to have intercourse and I have been thus rejected countless times. When we do have intercourse, he ejaculates right after penetration (within 1-4 few seconds), even if we do not concentrate on his genitals during foreplay. He also doesn't have much of an idea on how to sexually arouse a woman as he is not much of a reader, keeps his hands off my pubic area and so I end up with no orgasm but just a penetration. I do not masturbate either as it is against our religious ethics.I also do not like always having to tell him how he can arouse me. I would like him to know himself.
He has a lot of stress from work and his family and is generally the kind of person who gets tense quickly. I do not know how much of the stress he can control since many factors are beyond his control like his bad boss, the fact that his family does not support or approve his conversion of religion and the fact that his family is unaware of our marriage. I wouldn't be surprised if it was stress that was killing his sperms.. His work schedule also gives him no time for exercise. He also has never shown much interest in going to a urologist which is what worsened the situation. He is a very good person, kind, caring and pious, short-tempered too but is not the communicative type of guy and so I have been battling it out alone, got depressed myself and have lost interest of late. However, yesterday, he asked me to find a good urologist and book an appointment for him and that he wanted to finally do something about it.
My email is about 2 things, primarily our troubled sex life and secondarily conception. I wouldn't want to have children without straightening out the first problem. However, we have had unprotected sex so far. A year ago, I had done an ultrasound scan and found out that I had been ovulating normally and then my husband got his semen analyzed and we found out that he had a low sperm count (8million per ml) but more importantly an indeterminate liquefaction time. So I really do not know if IVF is going to work in this case as his sperms are of poor quality, but then I do not know if anything can be done to improve the quality of his sperms. He was also made to do a hematological analysis,bio-chemical analysis, TSH analysis, serological analysis (HSV 1&2 IGG, IgM, Anti-Chlamydia ab IgG) of blood; urine analysis, microbiological of urine and semen and a scrotal ultra sound & doppler - all came out normal and a minimal bilateral hydrocele was noted. My husband also did say that the physical characteristics of his semen has changed over the years in that, in his late teens, it used to be more gel-like and now its more of a fluid of a spreading nature.

Yesterday, I had another ultra sound scan done (13th day after onset of periods) and the gynec saw some PCOS and asked me to do further check-up between days 1 and 3 of my next periods and a hormonal check-up. I would be following up on that even though I do have regular periods.

Dear doctor, regarding our problem of my husband's lack of interest to have sex, whom do we need to consult? A urologist? A sexologist? A marriage counseller?

Secondly, can we do much about his infertility? When and by whom should we treat that? We do not have the financial means to undergo infertility treatments, however I would still like your advice and know our options.
AmyAALC responded:
Your husband should see a urologist for this matter. Make sure he is not just put on testosterone since that will cause decreased sperm production. He needs to work with the urologist to find the cause to his low libido and it is very likely he has a hormonal imbalance and this is can be treated. He needs to make sure the urologist is aware that fertility is of concern since you are trying to get pregnant.

Amy Perkins, MS, TS
Laboratory Supervisor
Arizona Andrology Laboratory & Cryobank
International Center for Vasectomy Reversal

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