Doctors vs Orgasms

Doctors, hey, can I talk to you for a minute? As a patient? Because I think it’s time we had a chat.

See, docs (is it okay if I call you “docs”? I’d like to think we’re all friends here.), I’ve been having some trouble with one of your own. I mean, overall she’s great, but on this one thing, not so much.

In November, I walked into her office.

“I’m depressed and anxious. November is always a hard month for me, but this is different. My lows are lower and the anxiety is worse. Normally I manage these things by running but it’s interfering with my life to the point that sometimes I’m too overwhelmed to leave the house to run it off. I need help. Pretty desperately.”

So she asked me what I’d been on that worked in the past. I listed a few, but she didn’t want to try those. They cause weight gain, you see. So she gave me one that doesn’t.

Within a week or two, I was having bad side effects and needed a switch.

Back in the office.

“Remind me what’s worked in the past again.”


No. No Paxil. Paxil causes weight gain.

“Let’s try Effexor.” She says.

“Um… I’ve taken it in the past and… um… well… you see… I… um… couldn’t have an orgasm when I was on it.”

“That’s a risk you have to take with any antidepressant.”

“Not with Paxil” I mumbled…. inside my head.

A few months and dozens of, ahem, “missed connections” later, I’m spinning into a horrific downward depressive spiral. It’s clear the Effexor isn’t working. And it’s clear if we don’t fix this NOW, I don’t have much time before I am consumed by it and it becomes deadly. (Also, my lady parts are starting to cry me to sleep at night.)

Back in the doctor’s office. Husband in tow.

“What’s worked in the past?”


“Yeah, when she had postpartum depression, Paxil saved her life and got her back to being a mom again. It worked really well. And fast.” says my husband.

“But, did you gain weight?”

“Um, actually, no?”

“No, she didn’t. She just got better.”

“Are you sure? I’m worried about you gaining weight.”

“I am a marathon runner without a stomach.” I finally spoke up on my own behalf. “I don’t even know if it’s possible for me to gain weight. It’s not my concern. I just want something that works.”

“But…. hmmm…. are you still running?”

“Yes! I just ran the Little Rock Marathon a couple of weeks ago. I have a half marathon on Sunday. A 5K the next weekend. I’m still running.”

Finally, with a bit of hesitation, she agreed to Paxil. Results are pending, but I feel hopeful.

Here’s the thing that freaks me out a little, docs. Why are you so worried about my weight, above all else?

I get it. Your jobs are to make sure I stay healthy and “weight gain is unhealthy” is canon, if debatably so.

But depression and anxiety are pretty unhealthy, too. Prioritizing those over weight gain is important. If you think gaining weight will increase my depression, ask me if that’s a risk I’m willing to take to get better. Because I am. I can undo a few lbs. I can’t undo suicide.

And one more thing? I really need you to hear me out on this one. This is important. Pay attention.

I understand that I live in a world where my worth is based on my attractiveness and that the concept of me as a sexual being vs a sexual object is foreign to a lot of people. I understand that doctors are not immune from internalizing this. You’re humans. And your job is to fix bodies, not necessarily to smash the patriarchy. But I want you to know this: I am a sexual being. And I’m really sad that I wasn’t even able to make a case for wanting orgasms over my size 2 jeans.

And I actually do wear size 2 jeans! Let me repeat that: I wear size 2 jeans and my doctor still thinks a satisfying sex life is worth sacrificing over the risk of me growing to a size 4. And we’re talking about depression.

Do you think I’m going to be less depressed if every time I get into bed with someone I have to be like “No, it’s not you, it’s me… it’s my antidepressants. I mean really, you tried and it was great. Really. I’m not complaining. It’ll happen. If anything was going to do it for me, THAT was going to. REALLY it’s okay.”? Because that’s not really how happiness works. Happiness works better without that added anxiety. And maybe you hadn’t considered this, but anyone getting in my pants when I’m a size 2 and not getting off is still going to want to get into my pants when I’m a size 8 and cumming all over the place. So my worth as a human being probably doesn’t go down all that much when I gain weight.

My mental health is just as important as my physical health. My mental health is imperative to my physical health. When we have these conversations about what sacrifices I will make to be mentally healthy, I want to have a say. And part of that is not having my humanity dismissed. I honestly don’t believe that men who walk into the doctor with concerns about their medication interfering with erections have those concerns completely dismissed. But as a woman, mine were. The thought of my happiness being linked in any way to having robust, satisfying and enjoyable sexual experiences never even occurred to my doctor.

I am a complete human being in the same way men are. This means I want to get off. Would I prefer to get off without it being at the expense of having to buy a new wardrobe? Of course. But I want you to take time to think about whether it’s fair to make that choice for me. Whether you would make that call for a man.

If I am speaking up to say that I am hesitant to take a medication that interferes with my sex life, it means that I have very real concerns about that affecting my quality of life. The question of whether that is okay with me never came up. In the middle of a conversation about improving my quality of life.

So docs, I’m asking one thing today. Just one thing. Challenge yourselves to put aside your internalized assumptions about female sexuality, that it is a secondary thing that exists for the pleasure of men, and the idea that being able to have vs being able to enjoy a romp are two very different things. Yes, women can still function perfectly well as sex objects without pleasure. We can still satisfy others. We can still engage with others. We can still give pleasure. So we can still be partners. But we don’t want to just function as partners. We want to be satisfied.

I mean, I know you know that. You know women enjoy sex. Probably because you’ve met and had sex with and/or as a woman. Your patients? Just like those women. Really. And just like those women, we deserve to be satisfied from every sexual encounter in the same way that men are. Don’t take that away from us.

Equality in the exam room is better for all of us, isn’t it?

Photo credit: Flickr/paul Quinn photography


Elyse MoFo Anders is the bad ass behind forming the Women Thinking, inc and the superhero who launched the Hug Me! I'm Vaccinated campaign as well as podcaster emeritus, writer, slacktivist extraordinaire, cancer survivor and sometimes runs marathons for charity. You probably think she's awesome so you follow her on twitter.

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  1. Life would be so much better if being female weren’t always tied to an assumption that weight loss/gain are our number one priorities. Also, listen to your patients, doctors, listen to their concerns, desires, lifestyles, explanations, experiences. It may only take a moment, but the end result could be that you practice better medicine and your patients have better results.

  2. That sounds like a harsh battle. As if anyone would feel comfortable going into a doctor’s office and demanding the right to have orgasms. Sheesh.
    The other interesting thing about your doctor, though, is that your sexual happiness didn’t seem to matter until your husband came in, seeming to indicate that your sexuality became more important once it mattered to him. “Oh! Your husband sees you as more than combination brood-mare-frustration-pencil? I had no idea! Why, this might even effect *his* sex life, couldn’t it? Can’t have that.”
    It would be best if you imagined your husband holding a scepter and saying the following in the voice of your favourite Python:
    “Woman, I decree that you may gain up to THREE POUNDS if it will help you have an orgasm. THREE shall be the pounds of thy weight gain … etc”

    1. A couple of years ago I went on an anti-depressant, and one of the side effects was no orgasms. I called my doctor and he said, “Oh, that’s not good. Let’s try someting else.” As it happened, I also gained some weight, but he didn’t think it was too much to worry about.

      Now, while I have a good relationship with my doctor, it’s not like it was easy to call and say I was having orgasm problems. But the fact we are both men probably contributed to an alternate medication being quickly and easily suggested.

  3. Flip side: if a patient is ace, don’t see an inability to have/want orgasms as a negative side effect of meds, or as a reason to get off of meds. Every patient has the right to prioritize their own needs, whether it’s as a sexual being, a less sexual being, someone who cares oodles about weight gain, someone who cares more about nausea, whatever it is that matters to you and your mental health. I wish docs trusted us to tell them when something is working or not working for us.

    1. EXACTLY! (Though I hasten to add, Paxil can cause low sex drive and difficulty having orgasms, and in men, lower ejaculatory volume; that might manifest in women as less vaginal lubrication, but I know of no studies to back this up.) It is absolutely vital to discuss potential side effects and interactions with patients, but the patient should always have the right to choose which side effects are ‘worth it’.

      Of course, I wouldn’t worry about an athlete gaining weight, personally.

  4. I hate the “deep concern” docs have about weight over everything else.

    I’m overweight, have been all my life. I’m also depressed, have social anxieties, some of the lovely symptoms of fibromyalgia and am asexual. Guess with one of those concerns my doc the most.

    Yeah, because when I’m in pain from head to toe, dragging my ass tired, and terrified of leaving the house, going for a walk or trying yoga is totes high on my list.

    I’m afraid to even bring up the ace thing, lest that get completely misinterpreted.

  5. Snrk, now I’m remember my doctor’s reaction to my blood pressure going dangerously high when I was on Effexor/Wellbutrin. She kept saying “it’s a rare side effect” in this accusing tone of voice as if I was DOING IT ON PURPOSE.

  6. I am sorry you had to go through this, Elyse. I am on an antidepressant that has the possible side effect of inability to orgasm; fortunately I do not experience it. But my doctor asks at every visit whether I am experiencing any of the known side effects, and goes through the litany. I know if I did start experiencing this particular side effect, he would take it seriously.

  7. This is one of the problems with some doctors. I mean, I get the ethics of it when it’s something like the patient is diabetic and this drug is linked to higher blood sugar, but when it’s just having to buy *gasp* size 3 jeans? Not so much.

  8. If your doctor is a primary care doctor, she might not know a lot about psychiatric meds because there is so much they do have to know about. That being said, a good doctor will listen to the patient. For a while, some doctors denied that Paxil could cause weight gain but it is obvious when a medicaiton is causing weight gain. The goal for doctors should be picking a medication with the most efficacy and least side effects for that individual. And it is often hard to predict how a medicine will affect that individual. As a doctor, I am always relieved when a patient has told me what works for him/her. I don’t have to put the patient through trying different medications until we find the right one.

  9. As my pharmacology profs used to say: “All drugs have side effects, you just have to find the ones you want”. Inability to orgasm is a problematic side effect for anti-depressants because a lot of people aren’t willing to talk about it and it’s a common reason for non-compliance (i.e. they don’t tell their doctor about it, they just stop taking it). Weight gain seems easier for your doctor to monitor, but she may be afraid you’d stop taking it if you start to gain weight. She probably has a bad history of women not taking their meds that make them fat, even if they won’t admit it. But, no matter what disorder you’re seeking treatment for, if your doctor isn’t willing to listen to you about which side effects you want (regardless of what they are), then find another one. This isn’t a feminist issue, or a body image issue, it’s a health issue. If your doctor doesn’t listen, find one that does.

  10. This is a side issue but I hate when doctors insist on weighing patients no matter what. I work with eating disorder patients, so they tend to freak out around a scale. It is important to note if there has been a sudden change in wt but you talk to a patient asking that person if he or she has noticed any changes in wt, especially if too freaked out to get on the scale.

  11. My experience with doctors is that some of them just won’t take you seriously, in any fashion, for any symptom you may be experiencing, if you have a psychiatric condition. I went into a doctor once with an open wound on my ear leaking pus down the side of my face, and the only discussion we had was on my psychiatric meds. Then in the last 2 minutes she wrote me a script for one of those candy-level antibiotics they write for people who come in with colds and refuse to leave without a script. I threw it away and my immune system eventually deal with the infection on its own and thankfully I have no scars.

    I was younger then, very easily intimidated. I just sat there in cowed silence, wondering why she was talking about =that= instead of about the (lemme say this again) open wound that was leaking pus down the side of my face. I was angry, furious, but i said nothing.

    I have a few years now and it’s possible now for me to speak up for myself and get the doctor back on topic and off my psychiatric meds. Doctors remain intimidating and I’m not always capable of this, but at least I’m more capable of it now than I was back then. Which is why I’m going to ask this:

    Have you shown this letter, or a version of it, to your doctor? If you haven’t, I think you should consider doing so. It’s good for everyone to see this, but the person who needs to see it the most is the doctor who treated you this way.

  12. @earthboundmisfit

    She kept saying “it’s a rare side effect” in this accusing tone of voice as if I was DOING IT ON PURPOSE.

    Heh, yes, I’ve had a similar experience. It reminded me of when my wife tells me about problems with her computer. I say “but…it SHOULDN’T DO THAT….” and get irrationally angry at the computer.

    That’s how the doctor made me feel. Like a broken computer. Which I suppose is what I was, come to think of it. But it was as irrational for the doctor to get annoyed at me for his failings as it is for me to get annoyed with my wife’s laptop. Although, to be fair, I don’t go around deliberately eating germs while she does seem to delight in downloading malware.

  13. This is expressed so powerfully and so coherently. I think it is so important that women be seen as full human beings, not just in light of what they offer as a mate or mother.

    Your experience is in stark contrast to a very similar one I had years ago when working with my doctor to find the right antidepressant. My doctor’s concern, even though I was overweight, diabetic, and at high risk for heart disease, was not potential weight gain, but how it would affect me sexually. I chose to go with the medicine that minimized weight gain. Of course, I had the choice of also trying drugs to help the ED, which I used. This made my doctor’s concern about the antidepressant’s affect on sexual performance vs weight gain even more disconcerting.

  14. It’s always about how fuckable we are to men, and not how fuckable we are to ourselves, isn’t it. I was thinking that there might be more of a wider medically-oriented audience over at the Society for Science Based Medicine page. I haven’t poked around there much, but it might be a good venue for outreach on ths issue. Best of luck. Hopefully you’re cumming all over the place again, no matter what size you are.

  15. OMG, what would that doctor do with size 20 me?
    Chain me to the wall until I’m size 0?
    I can’t hear the “weight” argument without people looking at anything else (like actual medical data of the individual) anymore.

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