Many couples find that problems with their sex life can have severe repercussions for their relationship if they are not addressed.
Many couples find that problems with their sex life can have severe repercussions for their relationship if they are not addressed.

Rekindling the sexual fire of a once passionate marriage has sparked a deeper emotional link.

“What he said he found weird about me was that I wanted to talk after sex,” says writer Marie Linde* (44). She giggles self-consciously and a flush of colour rises to her cheeks. She looks inquiringly at her husband sitting on the couch next to her and asks: “Do you want to elaborate?”

“Well,” begins property developer Marco* (59), almost reluctantly.

“It speaks to our relationship,” she prompts.

“It does,” he agrees. “I’ve always found it very difficult in all my relationships to talk to the woman I was with. I’ve always had this frustration about not being able to really communicate.”

The slim, tall man closes his eyes momentarily while he looks for the right words.

“But with Marie, there was suddenly this person I could engage with in conversation on any topic, no matter how deep or even weird,” he says and looks at her while she nodded back at him.

“In the beginning our relationship was founded on sex,” Marie adds. “But it’s certainly no longer based on that.”

“That’s the important thing,” continues Marco: “Although the sex was always very intense, what kept us together was this connection between us – deeper than the physical.”

“And the talking after sex?” Marie inquires playfully.

“Yes, the talking after the sex, in between and before. We had already connected and bonded, which made the sex even better,” he says.

The middle-aged couple, who have been together for 20 years and married for 18, have a teenage daughter who can be heard rummaging through cutlery in the kitchen of the family’s Randburg home.

But for the past 10 years their previously active and satisfying sex life has dwindled – going from sex every night to once or twice a month “at best”.

“We still wanted each other,” explains Marco. “It was just a matter of our bodies not responding like they used to.”

Unable to contain her excitement, Marie bursts out: “But now I have ‘the magnificence’ back in my life.”

Marco lovingly squeezes Marie’s left knee.

“But let’s start from the beginning. From where it all started to go wrong,” she says, reluctantly dragging her gaze from her husband.

“Ja,” he says. “From when I died.”

Ten years earlier

Marie, her left hand on the steering wheel, spoke urgently into her cellphone: “He’s been dropping things, like mugs. As if he’s losing control of his hands.”

“Something’s definitely wrong,” said the doctor on the other end of the line. “Bring him to my rooms.”

“I’m already on my way,” she replied, mentally mapping the route to her general practitioner’s surgery.

Marie glanced to her left just as Marco fell forward into a tightening seat belt, his eyelids drooping.

“He’s passing out,” said Marie into the phone, a note of hysteria entering her voice.

“Marie,” said the doctor after a moment’s silence, “I think you need to take him straight to the hospital.”

Marie ended the call, readjusted her mental road map to the Netcare Olivedale Hospital in Randburg and sped in that direction.

In a few minutes the pair arrived at the hospital’s emergency entrance, where Marco was

whisked away in a flurry of stretchers, stethoscopes and medical personnel.

Marie’s panic escalated as she watched him being taken away. A doctor appeared at her side and began asking questions. Does he have a heart condition? Does he take drugs? Are you sure he doesn’t? Have you been with him the whole day?

“No. No. Yes. No, but I’m almost 100% sure he hasn’t taken anything,” Marie managed to answer.

Both women, wife and doctor, turned their heads sharply in the direction of the emergency room as loud shouting erupted over the buzz of general activity. The doctor rushed towards it.

“I will not die!” cried her husband, his voice growing louder as the doctor opened the door to the emergency ward before disappearing into the beds, wires and hospital staff as the heavy door swung back into place.

The beginning of the end

Ten years later the couple, reclining on the faded green couch, recount the episode that marked a drastic turning point in their relationship and sex life.

“His heart stopped beating and they revived him,” Marie explains.

Marco spent a week in hospital, undergoing myriad tests to find out why his body stopped working that day.

“After all the tests came back fine, saying he was physically healthy in every way, they told us it was stress and depression,” says Marie, sitting back on the couch and stretching her legs over Marco’s.

He strokes his wife’s shin distractedly and says: “And that’s when our sex life nearly died.”

The two were silent for a moment.

“We went from having extremely satisfying sex almost every day, often many times a day, to almost nothing,” says Marie.

His hand tightens momentarily on her shin in acknowledgement.

For the past 10 years the pair has experienced many setbacks in their attempts to reignite their sex life. Marco’s “near death” and depression was followed by Marie having a hysterectomy and then Marco experiencing erectile dysfunction.

But then, two months ago, they finally succeeded.

How? Marie answers playfully: “The little blue pill.”

Little blue pill

The pill that Marie and Marco say has restored their sex life and improved their marriage is the most common treatment for erectile dysfunction – one of a group of drugs described in scientific terms as PDE5 inhibitors.

The first of these – Pfizer’s Viagra – became available to men in 1998 and works to strengthen and maintain erections by encouraging vasodilation [widening of the blood vessels] in the penis, according to University of KwaZulu-Natal pharmaceutical expert Andy Gray. Viagra was followed by products from other companies, such as Levitra from Bayer, and Cialis from Eli Lilly.

The authors of a 2005 study on perceptions of erectile dysfunction, published in the Journal of Sexual Medicine, define the condition as the “inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance”.

Research has shown that this condition affects about half of the men in the United States over the age of 40 and, although there is no equivalent estimate for South Africa, some studies indicate that just as many men in this country, if not more, have experienced erectile dysfunction.

A sample of 803 men of varying ages attending a primary healthcare clinic in Durban revealed that almost 65% had erectile dysfunction, according to a 2013 study published in the medical journal South African Family Practice.

Sex and emotional health

Numerous studies have shown that erectile dysfunction has a negative effect on self-esteem and perceived quality of life, which can cause or contribute to marital or relationship difficulties.

Research into female sexual dysfunction – an inability to reach orgasm or a lack of libido as identified in one 2002 study – came to similar conclusions.

The study, published in the Archives of Sexual Behaviour journal, found that “general emotional wellbeing” was negatively affected when women experienced “distress” about their sexual relationship or their own sexuality.

About a quarter of the 987 US women who took part in the study experienced sexual problems, the most common being “arousal, vaginal lubrication and orgasm”, and described a “knock-on” effect on other aspects of their lives.

These women reported feeling “downhearted and blue” with “work and other functions [being] impaired by emotional problems”.

“When we first got together I had only had one sexual partner,” recounts Marie, as she plays with the tassels of the quilted blanket draped over the couch.

“And Marco had had many – over 200,” she added with a playful sideways glance at her husband.

On their first night together, Marie “stopped counting at 12” sexual interactions.

“I remember phoning my best friend the next day and saying: ‘Emma, I finally get what the big fuss about sex is’.” She takes a deep breath, her cheeks reddening.

“I’m multiorgasmic and, with me, Marco discovered he was too.”

Seeing her discomfort, Marco explains: “When she starts climaxing she can have one orgasm after another.”

In the beginning, sex was the driver of their relationship but Marco says that what he had with Marie “became much deeper”.

“She was the first person I could really talk to. She understood me.”

Marie hooks her right foot under his knee as a smile creeps over Marco’s face.

Obstacles and anxiety

To an outsider, it’s hard to believe that this relaxed and highly affectionate couple only two months previously would have been sitting on opposite ends of this couch – the thought of touching each other bringing only anxiety.

“Marco dying was just the first obstacle of many,” says Marie.

His “breakdown” and depression that followed shocked his family and doctors, who prescribed him a cocktail of five drugs to stabilise his mental health. The medication had the effect of “numbing” Marco to

his emotions. It also “killed” his libido.

After two years, when he began showing signs of becoming “his old self” again, Marie underwent a hysterectomy at the age of 35 after a Pap smear test revealed precancerous cells in her cervix.

Almost immediately after, she went through early menopause – a natural experience for women in their late 40s when a woman’s ovaries stop producing the hormones that control menstruation.

“I remember after I had my daughter I could barely wait the medically indicated six weeks to have sex and Marco would literally touch my pinky or baby toe and I would be instantly lubricated,” she says. But after her hysterectomy Marie experienced vaginal dryness and a loss of sex drive.

“It was the first time I had experienced pain during sex to the point where I was getting infections because I was so dry.”

“It was devastating,” she sighs. “I couldn’t have another child or enjoy sex.”

Marie visited doctors, dieticians and sex therapists for advice. Each visit was followed by a new possible solution – all of which she tried with “varying success”.

“Have you ever used KY Jelly [a water-based lubricant]?” she asks incredulously. “It’s disgusting. It’s sticky. It rolls up and makes these little balls like disintegrating tissues. And it comes out like toothpaste.”

She shifts her legs off Marco and sits up. “Nothing sexy about that.”

“I was never that person,” she says. “I was always incredibly lubricated and multiorgasmic … and then to be completely dry and no orgasm because …”

“You were experiencing pain,” Marco finishes her sentence.

During this period, about eight years ago, Marie gained 30kg – a side effect of one of her prescribed medications. She battled to get used to “this new bigger body”.

“And so our sex life trundled along,” says Marco.

Communication and misperceptions

Johannesburg-based sex therapist Elna McIntosh suggests that these events caused or contributed to a breakdown in communication between the two, communication being, she says, the most important aspect of good sex.

When Marco began experiencing problems with his erections two years ago in 2012, neither he nor Marie felt comfortable enough to speak about it.

“There was so much anxiety around sex for us,” says Marie. “All these years with my issues Marco has been so kind and understanding that when I noticed his erections were weakening I couldn’t bring myself to say anything,”

And Marco, not wanting to place sexual pressure on his wife, “because of our history”, left the topic out of their conversations.

According to McIntosh, many men with erectile dysfunction, embarrassed and sometimes confused by the condition, “suffer in silence”.

Leigh Gunkel-Keuler, from Pfizer’s South African branch and an expert on Viagra, says that about 30% of men worldwide seek help for erectile dysfunction and only 11% receive successful treatment.

McIntosh says this is largely because of misperceptions about the drugs used to treat the condition as well as embarrassment “on the part of the usually ageing male”.

Marco says he used to think these drugs, which McIntosh calls sexual stimulants, were for men who could not get an erection at all.

“I thought, ‘hey I can still get it up, so those pills aren’t for me’,” he said. He also believed that taking this medication would result in uncontrollable erections.

But PDE5 inhibitors, according to Gunkel-Keuler, can be effective for any level of erectile dysfunction.

McIntosh says she often sees clients who have these misperceptions. “A lot of people have said to me that they took the pills and nothing happened,” she says. “It’s not like you take the pill and you’re suddenly erect. The normal rules of arousal apply.”

She was part of the team who trained doctors about counselling patients. “Most doctors are really clued up” about these medicines, she says.

“General practitioners are in the best position to educate and prescribe. Most have undergone training and are literally waiting for patients to ask them.”

Breaking the silence

Two months ago Marco unwittingly broke the silence. He told Marie he was going to see the doctor: he wanted to see whether his weakening erections were a sign of other health problems.

“This gave me an opening to say, ‘What about Viagra?’?” laughs Marie, her legs again draped over Marco’s.

She had done her own research, and explained to him that the drug was intended to help to maintain an erection as well.

After a visit to the doctor and a prescription for two types of “sexual stimulants”, Marie and Marco have spent the past two months rediscovering each other – physically and emotionally.

“After 20 years …” Marie pauses, looking for the right words, her voice cracking with emotion. “I didn’t realise how much it was affecting us.”

Marco adds: “What I never really realised is what our sexual relationship did on a deeper emotional level for our relationship.”

Tears well up in Marie’s eyes and she brushes them away. “I mean, he’s a different person in normal life!”

The anxiety between them has vanished, she says. “Only now I realise how much I was missing that connection: the physical intimacy leading to this much deeper emotional intimacy.”

Armed with their sexual aids, Marie with her lubricant and Marco with his little blue pill, the couple have reignited their sex life.

“It’s levelled the playing field because we now both need something,” Marco smiles.

Marie grins back.

“I mean, that first night he took the pill we made love four times,” she exclaims.

“No, it was three,” corrects Marco.

“Are you sure?” she asks with a raised eyebrow.

“Yes, it was three times that night and then once the next morning,” he says, raising both eyebrows playfully back at her.

“And then the next night and the next morning and the next morning again.”

*Names have been changed

What is erectile dysfunction?

Erectile dysfunction is the inability to attain or maintain penile erection sufficient for satisfactory sexual performance.

  • Why does it happen? Male sexual arousal involves the brain, hormones, emotions, nerves, muscles and blood vessels – a problem with any of these can result in erectile dysfunction.
    The condition is associated with age or a number of physical and mental health problems including heart disease, diabetes, obesity, depression and stress. 
  • How common is it?
    It affects almost half of men over 40 in the United States. 
  • Can it be treated?
    A group of drugs called PDE5 inhibitors is the most common treatment for erectile dysfunction and is successful in about 80% of cases.
    But when erectile dysfunction has an underlying medical cause, such as diabetes, it is better to treat that and often there is a knock-on effect on penis function once the original condition is addressed. 

Source: Journal of Sexual Medicine, Mayo Clinic

What is vaginal dryness?

Vaginal dryness occurs when the layer of moisture coating the vaginal wall, which increases in moisture during sexual arousal, dries up. 

  • What goes wrong?
    Vaginal dryness is usually caused by the thinning and inflammation of the vaginal walls because of a decline in estrogen, which can happen for many reasons including menopause, childbirth, breastfeeding, surgical removal of the ovaries and smoking cigarettes. 
  • How common is it?
    Vaginal dryness affects about half of menopausal and post
    -menopausal women. But insufficient vaginal lubrication can also be found in women of any age. 
  • Can it be treated?
    The condition is mostly treated with oestrogen therapy. Menopausal women may be given oral oestrogen or a skin patch. Most medical professionals prefer either topical treatment with a cream or a vaginal pill that delivers the hormone directly to the affected area. 

Source: Mayo Clinic, International Menopause Society

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Amy Green was a health reporter at Bhekisisa from 2013 until 2016.