In 30 plus years of clinical work in Australia this is the first time this subject was initiated by a patient.
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 he loved his partner but that he is obsessing that the sex with his partner 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 that he always found 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 just as good and enjoyable, though he just slightly preferred to have sex with an intact man.
We discussed what was important in a long term relationship, and he agreed sex was not the most important thing, and that long term commitment, love and companionship were the most important ingredients. He didn't believe painful receptive anal intercourse was a deal breaker.
In conclusion, Treatment is ongoing, and the biological symptoms of the disorder appear to distort his perceptions and are making his thinking much more negative than usual. We are focussing on the positives, creating hope for the future, and he believes he will accept the marriage proposal, as the person he loves is far more important than the sex. If biological symptoms of depression do not improve, medication will be considered.