Brief Answer:
Consultation

Detailed Answer:
Hi, thanks for asking from HCM.


I can understand your concern. Your psychological symptoms (depression, confusion, mood swings, confusion, brain fog) are most probably due to painful sex and its after effects. All these should subside along with relief in painful sex.

Now coming to the cause, painful sex could be

: Infection like STD, candidiasis, vaginitis (bacterial or parasitic) - It has already been ruled out.
: Pelvic inflammatory disease - It presents as back pain, foul smelling discharge, irregular periods.
If you have such symptoms, consult gynaecologist for it.
: Cevical narrowing - It is cervical narrowing after endpoint of vagina. It causes painful sex after deep penetration.
It can be confirmed by cervical examination. Gynaecologist can confirm it.
: Endometriosis - It is deposition of endometrium (lining of uterus) in tubes/around uterus and peritoneal cavity.

All above mentioned conditions can be discussed with and evaluated by gynaecologist.

Lack of vitamin D presents as pain in all limbs, weak bone causing fracture with minor trauma, weakness, fatigue, weak muscles. So it should not cause your symptoms.

Thyroid problem (hypo or hyper) should cause with excessive bleeding with frequent periods (hypothyroid) or less bleeding with increased duration between periods (hyperthyroid) with other system involvement. If you are having any of above symptom, you can ask for thyroid function test after discussing it with doctor.

Post orgasmic syndrome can be a possibility if symptoms are occurring after ejaculation. But you have clearly mentioned that symptoms are not related to ejaculation. Its cause is still not clear, some says allergy or hormonal imbalance or brain neurotransmitter imbalance. Five preliminary criteria are described:

:one or more of the following symptoms: sensation of a flu-like state, extreme fatigue or exhaustion, weakness of musculature, experiences of feverishness or perspiration, mood disturbances and / or irritability, memory difficulties,

All symptoms occur immediately (e.g., seconds), soon (e.g., minutes), or within a few hours after ejaculation that is initiated by coitus, and / or masturbation, and / or spontaneously (e.g., during sleep);

:symptoms occur always or nearly always, e.g., in more than 90% of ejaculation events
:most of these symptoms last for about 2–7 days and
disappear spontaneously

You can consult urologist for post orgasmic syndrome who is also specialized in organic sexual problem.

Regarding comprehensive stool analysis or candida antibodies, don't go with it right now. First discuss above mentioned complaints with Gynaecologist and then go for test.

Hope it will help you. If still in doubt, let me know.

Thanks. Take care.

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Brief Answer:
Post coital dysphoria

Detailed Answer:
Hi, thanks for asking.


I am sorry that I could not provide you satisfactory answer because your complaints were not that common. After reading and understanding your complaints carefully, I am suspecting it as a case of

"Post coital dysphoria".

It is psychological syndrome in which after intercourse (not related to orgasm or ejaculation), both partner or single partner may feel sad, anxiety, brain fog, guilt feeling or sometimes severe depression.

Previously it was considered rare, but now research has shown it to be common (approximately 40-45% experience it).

Reason is not clear yet as it is still in research stage. It could be due to
:Sudden hormone change after sex
: Some says brain releases deep emotions along with pleasure emotion during sex.

It can be controlled by

: Behavioural therapy - You need to consult "Psychiatrist" for it. Discuss it with your partner and try to feel totally relaxed while having sex. Do not think as it is some severe illness.
: You and your partner can do Yoga and meditation to calm yourself
: You and your partner can take serotonin reuptake inhibitor like Sertraline after proper prescription
: You can your partner can take antidepressant like Fluoxetine after proper prescription.
Medicine decrease sexual pleasure and drive, but controls psychological disturbance.
: If there is history of sexual abuse of any kind in you and your partner, discuss it with psychiatrist to control it.

Hope it will help you. If still in doubt, let me know. I will be happy to help you.

Thanks. Take care

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Brief Answer:
Consultation

Detailed Answer:
Hi, thanks for asking.


I read your complete query again. I have interpreted that

: You and your husband are feeling psychological distress like brain fog, memory problem, confusion, sometimes depression after sex.

: All these complaints are more common in your husband

: You are happily married for 6 years with two kids.

: You have undergone tests for thyroid, candida, STD and all were negative.

: There is no discharge, vaginal pain, foul smell, periods normal, no fever.

: Both of you get relief after some time or day.

Now if I am not wrong, it all suggest that

: There is no vaginal infection as no organic complaint.
: There is no STD in both of you as there is no painful sex, discharge or foul smell either.
: Thyroid is ruled out as you are having regular periods, no change in your body (weight gain or loss).
: Regarding bacteria which can travel through whole body only after sex and then completely disappears after that, I don't think there is such bacteria. However if both of you were having STD, sex can cause generalised body complaints due to rubbing of infected part (vagina and penis). This usually causes itching, burning, painful sex, bleeding, foul smell and associated psychological symptoms like distress, sweating, palpitation, may be depression.
Only psychological symptoms without organic symptoms can not occur in true bacterial or fungal (Candida) infection.

Still you are having a doubt, you can get vaginal swab culture and XXXXXXX staining to rule out infection. My suggestion is do not waste money on Vit D, thyroid function or culture tests.
It is better to get ESR done. If it is raised in both of you, it means something inflammatory or infection is going on.

Now coming to the diagnosis of "Post coital dysphoria", it is not same as "Post orgasmic syndrome".
It is newly coined term and a type of sexual dysfunction. It is not necessary that if both of you are having emotional disturbance, only then it will occur. It can occur at any time (even after 6 years of happy marriage).

I am suggesting you this disease because
: Both of you are experiencing same type of symptoms after sex which is not related to ejaculation or masturbation.
: Organic disease or infection/metabolic disease signs are absent in both of you.
: Your test results were normal.

You can understand it better if you discuss it with psychiatrist only. If you want to spend money rightly, kindly spend it on Psychiatrist.

Hope it will help you. If you have time, kindly read about "post coital dysphoria" on sex related journals. Do not go by wikipedia.

Thanks. Take care.
If still in doubt, do let me know. Your case is different and I really want to solve it and help you.

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Brief Answer:
Consultation

Detailed Answer:
Hi, thanks for asking.


If you are so sure about bacterial infection, then you should get

: Vaginal culture for bacteria and fungus both
: ESR, total leucocyte count and differential leucocyte count - For both

If anything positive comes, then it can be investigated further.

Any bacteria can travel through whole body via blood which results into septicaemia, a type of dangerous manifestation of infection. It is not there in you and your husband. Otherwise, there is no bacteria, in my knowledge, which can travel whole body after inetrcourse.
These symptoms are systemic manifestation of your illness which get aggravated by intercourse. After investigation and confirmation, it can be treated. Treatment of it will lead to subsidence of all symptoms.

One more thing, why do you think it is bacterial or any infection? I have given few reasons in my last answer to rule it out. If I was wrong in any point, correct me.


As a doctor, I don't want you to get wrong diagnosis.

Thanks. Take care.

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Brief Answer:
Consultation

Detailed Answer:
Hi, thanks for asking.


It is good that at least vaginal swab has been sent. Kindly get ESR, total and differential leucocyte count done also. It will help in detecting presence of any infection or inflammation in your body.

I agree with you that first we have to find out bacterial/infective/inflammatory cause for your complaints. Do not disappoint if the doctor had no idea as your symptoms and disease are not common complaints.
I have few questions

Whether doctor examined you properly and looked for any presence of infection? What about your husband?
Were you prescribed any medication?

We have to wait for the reports of test and then we will proceed further.

Thanks. Take care.

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