In 30 plus years of clinical work in Australia this is the first time this subject was initiated by a patient, prompting me to declare my interest in the subject and requesting if I could ask some questions.
Patient A a gay man, is suffering from Major Depressive Disorder, and having problems in his relationship. The Same Sex Marriage vote, prompted his partner to propose marriage. Rather than jubilation, he felt more depressed. Much time was spent trying to ascertain the cause of worsening depression symptoms? Was it a biological exacerbation of symptoms and a deterioration of a clinical disorder vs environmental, was there something wrong in the relationship?
In conducting an audit of the relationship, he stated sex wasn't as good as he would like it to be. He himself is Intact but his partner is circumcised. He stated he always preferred to be with intact men, but that his partner was the first man that he felt a deep connection with, and didn't think the circumcision was a deal breaker. He stated the biggest negative about sex with a circumcised man was receptive anal intercourse, it tended to be much more painful than pleasurable, when compared to being with an intact man. He stated that other forms of sex with a circumcised man were good and enjoyable, though just slightly better and more pleasurable with an intact man.
In conclusion, Treatment is ongoing, and the biological symptoms of the disorder appear to have deteriorated making his perceptions much more negative than usual. He believes he will accept the marriage proposal, as the person he loves is far more important than the sex.