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Ask Your Doctor 176 (18.02.2015)
 

To know more about Dr. Edward Nazareth - Click Here

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Please read this before you ask your question.....!

We are pleased that this column has become popular among our visitors. This column is purely of educative and informative type. We do not intend to suggest any definite treatment or give name of any specific drug or doctor either in India or abroad.

We are receiving questions from many of our visitors from different parts of the world. Though we have the desire to give the reply at the earliest, we are unable to do so. At present we are updating the column once in two weeks, but at times there is inadvertent delay. This results in lot of back log. We answer the questions in first come first serve basis. Even then to answer a particular question, it may take more than a month. We request our visitors to bear with us.
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Even when a person consults the doctor in person, there can be error in diagnosis and treatment! Please remember the answers here are based on the perception of the problem sent in the questions. There can be an error in perception by us and the answer may not be suitable. It is always advisable to consult the appropriate doctor before taking any treatment.
Dr. Edward Nazareth

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1. N.L., Mangalore

*I am 31 years of age. I have a pain in the upper back, right side of the shoulder blade and spinal cord (same position of my breast exact opposite side of my back). It started about two years ago during pregnancy. I consulted many doctors and did the scan, including MRI which were reported normal. The doctor said, some of my neck bones were bulging out so it could be cured by regular exercise and some physiotherapy. But my worry is, at times I get severe pain in my upper back next to shoulder blade and some time I get pain in my front side including breast and under arms. I went for breast scan and report was normal. My mother had breast cancer and died when I was 2 years of age. Is back pain related to breast or should I go for any more checkup for the the breast. 


 **As described by you, most of the upper back aches are due to straining the soft tissues.  Muscles, tendons, and ligaments—the soft tissues that support the spine—can be sprained or strained by misuse or overuse. In your case you could have sprained it during pregnancy.

 It is possible to get an upper back muscle sprain or a strain through poor posture, improper lifting and even carrying heavy weights on the back. Sitting with a rounded back, shoulders hunched forward, can put too much stress on the back muscles. Poor posture is one of the leading causes of upper back pain because so many office workers spend their work days at the computer. It is easy to fall into bad habits of not sitting properly, especially when  one is at the desk for many hours a day. Bad posture during routine work like washing the utensils, cleaning the floor can also cause repeated strain on the back. Other common cause is improper lifting. Not using the proper form when picking something up, can cause strain and pain. Kids are more in danger of getting an upper back injury because of a backpack. An overly loaded backpack is dangerous to the spine, but so is not wearing the backpack correctly (example, just using one strap).

It is unlikely to get back pain due to problems of the breast. Most of the breast ailments are presented with a lump in the breast with or without pain.

As suggested by your doctor, physiotherapy and exercises are better than pain relievers.  At the same time give attention to the posture while sitting and working


2. P.S. Mangaluru 

*I am 54 years of age and I am having corn in both the feet. I am a diabetic. Which doctor should I consult for the treatment? 

** Corns and callus are one of the most common problems of the feet. They can occur on any part of the foot and vary in symptoms from a mild callus under the foot, to an ulcer that can develop under a corn on a toe. Corn is due to the thickening of the skin in response to pressure. A callus generally refers to a more diffuse thickening of the skin (more common on the toes, but can occur under the ball of the foot) whereas a corn is a thicker more focal area (more common on the toes). A corn can occur under and be surrounded by callus.

Corns and callus are caused by too much pressure, usually in combination with some friction. There is no other way to get them - the pressure stimulates the skin to thicken to protect itself, but as the stimulation of the pressure continues, it becomes painful. The common causes are

footwear that is too tight

toe deformities, such as hammer toes- the top of the hammer toe is an area for increased pressure on the top of the toe

bony prominence 

biomechanical or gait abnormalities that cause pressure under different areas of the bottom (plantar) surface of the foot (this is a common cause of callus)

As there are a whole range of problems that can result in a corn or callus, it is often good to consider that they are not really a condition at all, but are a symptom of an underlying condition. As corns and callus are symptoms of underlying problems, self treatment should follow a proper diagnosis of the underlying condition and advice on how to best manage it.

The management plan is likely to take into account several options:

use of padding to prevent the pressure 

Advice about the fitting foot wear.

the use of foot orthotics or supports to relieve the pressure under the foot 

surgical correction of the bony prominence that may be causing the high pressure area 

It is especially important that those with diabetes or poor circulation see a specialist for the management of corns and callus.

Remedies such as corn paint, cure, corn cap or plasters will generally only treat the symptom of the corn and not the problem that causes it. These chemicals contain acid that are supposed to 'eat away' the corn, but the chemical can not tell what is corn and what is normal - it will eat what ever you put it on. While this can be risky in healthy people, it can be very dangerous and risky in those with  poor circulations and/or diabetes. The use of "corn plasters" in those who are at risk or have frail skin are very likely to cause an ulcer (a breakdown of the skin) which could later lead to gangrene and finally amputation

You may consult a specialist who is expert in feet disorders or a general surgeon.

But be careful about local applications or surgical excision as that can lead to disastrous complication.


3.F.P., Mangaluru

*I am 24 years of age; my height  is 5’ 8” and my weight is 61kg. Is my weight normal for my height? I think its less. I would like to be around 68 - 69kg. Unlike others, I gain weight very slow. Kindly suggest a daily diet plan I should follow so that my weight increases soon. 

**Losing some kilograms of excess weight has been a major concern of many people. They are vigilant on their diet, do all type of exercises… but fail in their attempts. There are very few people, who are lucky that they are destined to grow thin and lean. They are otherwise healthy. You are probably one of them.  

If you are destined not to grow fat, you may not gain weight by any means. However you can make some sincere efforts to put on weight. One has to look for a healthy weight gain, not just adding body fat. That means, instead of loading up on junk foods and high-fat nutritional nightmares like cookies and candies, treating yourself to nourishing foods that will help you add muscle and body mass. Here are a few tips:

Eat three meals every day. Yes, this means you need to get up in time for breakfast that you can't skip lunch, and that dinner actually needs to be prepared and eaten. 

Eat three snacks every day. That is midmorning, mid-afternoon and evening. In order to gain weight, you need to fuel your body at regular times. The easiest way is to set up a schedule of three meals and three snacks. 

Stop drinking non-caloric beverages. That includes aerated drinks, and plain coffee or tea. You have to look for calories. Choose skim or 1 percent milk (You need healthy calories, not fat, so avoid milk with higher fat contents), 100 percent fruit juice or sports drinks. 

Choose calorie-dense foods. That means eating rice, chapattis instead of bland vegetable salads and banana chips. Make it a habit to routinely choose foods that are higher in calories. 

Expand your meals. Each meal should include some type of starchy food (rice, bread, potato, and cereal), fruits and vegetables, and a protein source (chicken, red meat, fish, legumes, eggs, cheese). Use small quantities of butter or ghee in each meal to add moderate amounts of fat without going overboard. 

Exercise. Regular exercise and activity will help your body gain muscle and not unwanted fat. One hour walk or thirty minutes of aerobic exercises is plenty to get your system moving yet not so much that you are burning up tons of calories. If you are more active, you will need to increase your calorie intake. 


4. A.K. Navimumbai

*I am a lady of 24 years of age. Recently I found a small swelling in the right side of my private part; like a small tumour and its paining. This happens first time. Is it serious issue? I was taking some medicine for  fever. Can this be medicine reaction?

** The swelling that you are experiencing must be Bartholin’s cyst. The Bartholin's  glands are located on each side of the vaginal opening. These glands secrete fluid that helps lubricate the vagina. Sometimes the openings of these glands become obstructed, causing fluid to back up into the gland. The result is relatively painless swelling called a Bartholin's cyst. At times, the fluid within the cyst may become infected, resulting in pus surrounded by inflamed tissue (abscess). 

A Bartholin's cyst or abscess is common. Treatment of a Bartholin's cyst depends on the size of the cyst, the pain and whether the cyst is infected. In other cases, surgical drainage of the Bartholin's cyst is necessary. If an infection occurs, antibiotics may be helpful to treat the infected Bartholin's cyst. You may consult a gynecologist for assessment and treatment.

5. C.V. Mangaluru

* I am 23 years. I am into body building. I workout regularly as I want to gain muscles. But I masturbate regularly so my question is, will masturbation prevent muscle gaining? or will it make me loose my muscles? 

** There are so many myths and wrong notions about masturbation. Masturbation at your age is common and there is absolutely no harm in masturbation. The most important thing for muscle build up is the male hormone testosterone. There is no doubt that guys with high testosterone levels have higher potential when it comes to building muscle mass. However, high levels of testosterone are also associated with high levels of sexual activity and one of the side effects bodybuilders experience when they are on steroids is strong sexual hunger. So, it turns out that the thing that makes you ejaculate more frequently is the same thing that it supposed to make your muscles bigger. It makes no sense for both processes to be negated by each other. There is no harm in masturbation.


6. N.A.M., Mumbai

*I am 24 years of age. I have itching in my private parts. When I scratch white dry skin comes out. What should I do? Is there any natural way to stop itching.

** The condition is known as jock itch. Jock itch (tinea cruris) is a fungal infection that affects the skin of the genitals, inner thighs and buttocks. Jock itch causes an itchy, red, often ring-shaped rash in these warm, moist areas of the body. 

Jock itch gets its name because it is common in people who sweat a lot, as do athletes. It also is more likely to occur in people who are overweight.  Although often uncomfortable and bothersome, jock itch usually not serious. Keeping the groin area clean and dry and applying topical antifungal medications usually are sufficient to treat jock itch. 

It may be better to consult a skin specialist for proper assessment and treatment. For a mild case of jock itch, the doctor may suggest first using an antifungal ointment, lotion, powder or spray. The rash may clear up quickly with these treatments, but continue applying the medication twice a day for at least 10 days may be needed. 

The organisms that cause jock itch thrive in damp, close environments. Here are some tips to prevent recurrence: 

Dry the genital area and inner thighs thoroughly with a clean towel after showering or exercising. Use powder around the groin area to prevent excess moisture. 

Change the underwear at least once a day or more often if you sweat a lot. Wash workout clothes after each use. 

Do not wear thick clothing for long periods of time in warm, humid weather. 

Do not let others use your clothing, towels or other personal items. Refrain from borrowing these items from others as well. 

Control any athlete's foot infection to prevent its spread to the groin. 


7. F.M., Dubai

*I am 28 years of age. I am having  the problem of premature ejaculation. During oral sex it can takes long time but for intercourse it will finish within a minute. Earlier I had the habit of masturbation. I really fed up with premature ejaculation.

** The culmination of the sex act in man before his sex partner reaches orgasm is defined as ‘premature ejaculation’. This is mainly a psychological problem and there are hardly any physical causes for it. Failure to take the partner to full pleasure once becomes a worry and repeats with every act. The fear of failure persists and repeats.

There are probably no definite drugs which can enhance the duration of act in man. However in some individual cases, anxiety relievers have been tried with various successes. Local anesthetic sprays also help some men by masking the hypersensitivity of the glans.  Drugs used for erectile dysfunction like sildenafil citrate (Viagra) are also used in certain individuals who have associated erectile dysfunctions. These drugs are to be used only if advised by a specialist. Local applications-sprays and ointments normally available on the counter and can be tried. 

There are other therapeutic activities which are done by the partners together. Including the female partner as much as possible in the therapy (treatment and counseling) sessions is important to achieve the best outcome. The first step for treatment of premature ejaculation is to relieve any underlying performance pressure on the male. The couple may be instructed on sexual therapy, such as the stop-start or squeeze-pause technique popularized by Masters and Johnson. These are to be practiced with the help of trained therapist.

If the male always experiences ejaculation with initial sexual excitement or early foreplay, this is a difficult problem which then most likely requires treatment in conjunction with a psychiatrist. 

There are certain medicines are now available and they can be tried. You may consult a psychiatrist or urologist.


8. M.I., Oman 

*I m 26 years old guy. My problem is I am getting night falls at most of the nights. I can say continuously for 3-4 nights and monthly around 10-15 times. It's happening since 2 years. Due to this I am mentally depressed. And my body also weak. Is this a disease? Could you please suggest me how to over come this? Should I consult a doctor? 

**Night falls or wet dream is also known as nocturnal emission; it means ejaculation in sleep. Usually a wet dream happens while men are having dreams about sex. Many may not even remember the dream.

When a young boy  goes through puberty, the body starts producing the male hormone testosterone. Once the body makes testosterone, it can release sperm. Wet dreams are a normal part of growing up. There is nothing one can do to control or stop wet dreams.

Even if one has a lot of wet dreams it does not mean there is anything wrong with his body or sexual system. Some guys have wet dreams a few times a week. Others may only have a couple of wet dreams during their entire life.

Once the man starts releasing semen by masturbating or having sex with a partner, the frequency of wet dreams may be lowered, but normally it does not stop till middle age.

However,  every teenage boy may not have wet dreams. The fact one does not have  wet dreams does not mean there is anything wrong..

Though women can have an orgasm during a dream, they do not  have such dreams as often as men.

The wrong beliefs and myths associated with night falls is the main cause for worries and may cause depression or feeling of weakness as in you. You have to understand and accept that night falls is a natural phenomenon; there is nothing wrong or harmful in it.


9. A.S. Mumbai

*I am 55 years of age. Does giving massage by hand to a nude body except genital parts cause any type of STDs particularly Herpes? During my business trip to Dubai I invited a unknown female through a escort agency as a dinner companion to my hotel room and given her body massage just for a fun although I am not a trained therapist. Neither we touched each others genital nor engaged any form of sexual activities. I only rubbed her feet, legs and breast with my hands for 30 minutes. Does it  cause herpes or transmit any STDs by hand to skin contact or skin to skin contact if she infected with any STDs ?She visibly looked very clean.

** As you had no genital or oral contacts with the stranger companion, possibility of infections are unlikely. Herpes can transmit by contact with the sores. Let me briefly inform about herpes infection.

Herpes simplex viruses -- more commonly known as herpes -- are categorized into two types: herpes type 1 (HSV-1, or oral herpes) and herpes type 2 (HSV-2, or genital herpes). Most commonly, herpes type 1 causes sores around the mouth and lips (sometimes called fever blisters or cold sores). HSV-1 can cause genital herpes, but most cases of genital herpes are caused by herpes type 2. In HSV-2, the infected person may have sores around the genitals or rectum. Although HSV-2 sores may occur in other locations, these sores usually are found below the waist. Most people get HSV-1 (herpes simplex type 1) as an infant or child. This virus can be spread by skin-to-skin contact with an adult who carries the virus. An adult does not have to have sores to spread the virus.

Herpes simplex viruses spread from person to person through close contact. One can get a herpes simplex virus from touching a herpes sore. Most people, however, get herpes simplex from an infected person who does not have sores. This is termed as “asymptomatic viral shedding.” Most people get genital herpes from HSV-2, which they get during sex. If someone has a cold sore and performs oral sex, this can spread HSV-1 to the genitals and cause herpes sores on the genitals. 

Symptoms of herpes simplex virus typically appear as a blister or as multiple blisters on or around affected areas -- usually the mouth, genitals, or rectum. The blisters break, leaving tender sores.

Once a person becomes infected with a herpes virus, the virus never leaves the body. After the first outbreak, the virus moves from the skin cells to nerve cells. The virus stays in the nerve cells forever. But it usually just stays there. In this stage, the virus is said to be dormant, or asleep. It can become active when the person has physical or mental stress.


10.V.S. Mumbai

*I am 24 years of age. I have got white dotted patches above my reproductive organ where hair grows. Sometimes it used to itch. But now its not itching but patches are clearly visible

**Unless examined, it is not possible to opine what these patches could be. You may consult a dermatologist for proper assessment and treatment.


11. R.P. Kuwait

*How the snoring is developed? What are the ways by which this can be cured or suppressed? Is there any medicines to stop snoring?

** Snoring is one of the common problems of sleep. It can be due to variety of causes. It is most important to stress that snoring, in most people, is due to multiple factors, each playing some part in the snoring process. Factors which are important in this regard include narrowing or blockage of the upper airway passages through anatomical or injury reasons. It can be also due to congestion of the soft tissues of the airways, e.g. smoking, alcohol, acid reflux from the stomach affecting the throat tissues, obesity, ageing and hormonal factors. 

Noises can result from a narrowing of the nasal passage, which generates a whistling noise. The vibration of the soft palate (or roof of the mouth) causes the fluttering vibration sounds.

In most of the people the problem of snoring is just ignored and no treatment is opted. Sleeping in supine position (on the back) can reduce snoring. If the problem really bothers then consultation with an ENT surgeon may be advisable. Depending on the severity of the problem surgical corrections can be done. Surgical assistance may include nasal, palatal or tongue and neck surgery. The surgical procedure will depend on the location of the tissues contributing to snoring.

Nasal surgery may include improving the nasal airway by straightening the nasal septum (mid line nasal cartilage partition), shrinking the lining tissue of the nose, particularly where this has been troubled by allergy or by the removal of nasal polyps. Previous nasal injury involving the external nose and the nasal septum may require correction.

The flapping of the soft palate in snoring may be assisted by palatoplasty involving either high frequency radiowave or laser surgery. Newer procedures for more severe forms of snoring including radiowave shrinkage of the back of the tongue as well as procedures to bring the tongue tissues forward may be of assistance in selected cases.

Because snoring is a multi-factor medical condition, repeat or additional operations may be required as part of the management plan. Not all patients can anticipate 100% control of snoring although the majority of patients do have useful improvement. 


12. P.F. Mumbai

*I am 24 years lady and I have a serious problem about marriage. Last month I inserted my middle finger into my vagina.  It was 4th day of my periods and there was blood on my finger. Was my hymen damage at that moment or the blood that was from my periods? Will my husband get doubt about my virginity if I do not bleed again during our first night. Do you advise me to consult gynecologists to repair the hymen?

**Hymen is a thin layer found on the exterior of vagina. It is just at the entrance and not deep inside. The hymen is thin layer and may rupture without doing anything. Many girl children are born without an intact hymen. In some of the women, the hymen may break as they grow without any particular reason. This is specially so in individuals participating in sports activities, doing heavy exertion work. Therefore broken hymen has no significance. Even an intact hymen may break during first physical union without showing any signs such as bleeding. Hymen is no more can be considered as a sign of virginity.

If you have an intact hymen it may rupture even by fingers. Physical examination is normally not done to test for the intact hymen, as the broken hymen does not tell anything. You need not consult the gynecologist for that. Many virgins have broken hymen, so do not worry about it. There are no surgeries available to repair the broken hymen.

The blood found on your finger on the 4th day of the periods is most likely from the menstrual flow.

Except by physical examination, there are no tests to make out the intact hymen. There is a myth that intact hymen alone results in bleeding at first sexual encounter. Though intact hymen normally tears at first sexual union, the tear does not always results in bleeding or pain as believed by many.  We have a myth that intact hymen is the proof of virginity and its tear at first physical union is indicated by bleeding. Partial penetration is possible without breaking the hymen. Therefore intact hymen can not be a proof of virginity. Bleeding at intercourse is again not a sign of virginity.  In many of the virgins there may be no bleeding at first physical union. Similarly forceful physical union even in a woman who is not virgin may result in bleeding due to tears or abrasions. Bleeding at physical union has no relevance as far as the virginity is concerned.


13. H.D. Mangaluru

*I am 45 years of age. I have hyper pigmentation on face; it looks as if my face is burnt could you please suggest remedy?

** You have to consult a dermatologist to find the cause for hyper pigmentation. Do not apply any medication unless you are advised by a specialist. There are effective medications for the problem.


14. G.R., Bangalore

*I am 35 year old married lady.  I have 8 year old baby and we have planned to have only one child.   I was using Copper T from 9 years, and I changed 3-4, giving gap of 1 month in between.  Recently I conceived again and I aborted that, now again I want to put a Copper T, but my doctor is suggesting that it is not good to have Copper T in this age, it may cause cancer.   Is it is true?  I asked her about taking tablets, she informed me, it was also harmful, and she advised me to undergo tubectomy. Please help me what should I do.  I do not want to go for tubectomy now; I want to put Copper T for some more years? 

** There are no reports of loop being the cause for malignancy. At your age, you can safely go for a loop. Most known complications of the loop are intolerance, bleeding, pregnancy, infection, perforation etc. Loop is relatively the safe and best method for spacing the child birth compared to many other methods including pills. 

The contraindications for the use of the loop are:

Unexplained, irregular, or abnormal uterine bleeding 

Severe menstrual cramps or heavy periods 

Known or suspected cervical or uterine cancer. 

A history of endocarditis (heart inflammation), rheumatic heart disease, or the presence of artificial heart valves 

Problems with blood-clotting 

Reduced immune response (sometimes brought on by steroid treatment) 

Previous pregnancies while using an IUD 

A history of IUD expulsion from the uterus 

Non-cancerous tumors underneath the muscle surface which may increase bleeding, or a very thin cervical opening 

A copper allergy or Wilson's disease (excess copper in the body) 

Anemia 

As you had conceived with loop in situ once before, there are further chances of conception about which you should be careful.

You may consult some other gynecologist for a second opinion. 


15. H. J., Ahmadabad

* I am 29 years. I was on Clomid for 5 days after that the doctor did ultra sound scan he told me I got two eggs with good condition. On 12th day he did IUI. And the day after IUI, I am feeling more different in my activities even I have loss of appetite; my mouth is very watery with metal smell. I got frequent urination, abdomen pain, mood swings and also had difficulty in getting sleep. Is it because I conceived? 

** The symptoms expressed by you are not related to pregnancy. Pregnancy can not be made out by any definite symptoms soon after conception. The commonest early sign of pregnancy is a missed menstrual period; but this will be not less than two weeks after conception. The definitive confirmatory test of pregnancy is the ‘urine test for pregnancy’. It can be positive even in the first week after a missed period. If the period is delayed for some other reason, it can be confirmed by simple urine test.

There are many tests designed to test pregnancy as soon as a missed period. 

A pregnancy test is done with a small sample of urine. The test looks for evidence of HCG, or human chorionic gonadotropin. This is a hormone made in the body only after an egg has been fertilized by a sperm cell to start a pregnancy. HCG can be found in the urine as early as two weeks after conception (that is almost immediately after a missed period). 

Most urine pregnancy tests are sensitive enough to find even a small amount of HCG in the urine. There are a few situations that may cause a negative pregnancy test, even though the lady is pregnant. They are:

* If testing too early in the pregnancy. One has to wait at least for a week.

* If the urine is not concentrated enough. Especially very early in pregnancy, it is best to test a sample of urine from the first urination of the day.

* If there is a problem with the pregnancy. A tubal pregnancy may not cause a positive test result. 

Other than a missed a period, the other signs of pregnancy are nausea, vomiting and breast tenderness.

The problems expressed by you may be due to some medication. If you are not on any particular medication, these can be psychological.


16. J.P., Pune

*I am 30 years of age and my wife is 24. We are married for 3 years. About 6 months ago my wife had miscarriage and after that we have been trying for the baby for the last 5 months.  After various tests the doctor has opined that my wife was not ovulating, my wife was put one duphastron -m 2 tablet a day, from the 11 day of the cycle till 25th day. We have taken it for 2 months, this month she was taking Fertyl-M 25 mg table twice a day for five days. Will she conceive?  

** As your wife had conceived once, there is every chance that she would conceive again. The medications are to facilitate ovulation. Even a normal and healthy lady may not ovulate in every cycle. The medication advised by the doctor is to correct this problem. The woman may not conceive in the very first month after starting the treatment. So be patient and follow the advice of your doctor.


17. F. F. Kuwait

*I am 35yrs old married; I have two kids. First one is son & second is girl. I delivered two months ago. Since I do not want more children I tried to go for operation but could not do it here as it is expensive in gulf. I have decided to do it when I go down to India. But till then I would like to take pills to be safer. Since my baby is just 2 months old & I am still feeding her, I would like to know whether good to have pills right now. I had asked my doctor & she advise me to take certain tablet as long as I feeding my baby and after that she would change the tablets. But I have not started that tablet because I have some doubt that if I take that tablet it would affect my child? Whether my breast milk will be reduced? 

** As you are breast feeding, oral contraceptive pills should not be taken. It may be ideal not to take any hormone preparations when the baby is on breast feed. You may go for loop insertion. Normally the loop is inserted soon after a menstrual period. As you are feeding the baby you may not get your periods for three to six months. Till then your husband may have to use condom during physical union. Once you start your periods the loop can be inserted. Normally the loop once inserted is effective as long as it is in the uterus. The loop once inserted  normally can be retained for three years. Anytime it can be easily removed. However you may consult a gynecologist to know if there are any definite contraindications in you for using loop.


18. S.K, Bahrain

*I am a lady of 23 years and am married for past 1 year.  I have a son of 7 months. After my delivery, I have the problem of white discharge, which is quite more, and because of which my body smells and that the smell is horrible. Because of that I am loosing weight and also not so comfortable to fulfill my husband at times.

I consulted doctor both here and in India and they gave me a tablet which has to be inserted in my private part at night. But my problem is that that tablet does not suit me. I feel it makes me bleed and I am afraid to use it future. What suggestion do you give me?  Should I continue with that tablet as I am scared? Will such thing happen by using that tablet or is it my imagination? 

** You are probably having a condition known as vaginitis. Vaginitis is described as an inflammation of the vagina characterized by a discharge, odor, irritation of the vaginal wall and itching. The most common agents are bacterial vaginosis, trichomaniasis and candidiasis -more commonly known as a yeast infection.  Bacterial vaginosis is the most common cause of vaginitis among women of childbearing age.  When bacterial vaginosis occurs it is due to a change in the vaginal environment.  

The primary symptom is an abnormal, odorous, vaginal discharge.  The fish like odor typically is more prominent after sexual activity.  Often times the cause for this type of infection is unknown. Currently the only way to determine a positive test for bacterial vaginosis is through a test of the vaginal fluid.  Antibiotics are used to treat the problem.  If ignored, this can lead to chronic pelvic inflammatory disease which can often lead to infertility and tubal pregnancies.  

The doctor must have diagnosed a fungal infection known as candidiasis for which antifungal pessaries are used. These are normally well tolerated and do not cause bleeding. Vaginal candidiasis is a common problem in certain women. Women are susceptible to infection if the body is under stress from poor diet, lack of sleep, illness, or if she is diabetic, taking antibiotics, or is douching too frequently.  Symptoms include vaginal itchiness and soreness, and a thick, cheese-like vaginal discharge.

Those who are at most risk are women with a new sexual partner, who have had multiple sexual partners, practice douching, or use an intra-uterine device for contraception. Since vaginitis is most closely associated with sexual activity it was found that those women who are not sexually active are rarely affected by this bacterial infection.  

Steps to prevention include the use of condoms, limitation on the number of sexual partners, reduction of douching, use of all prescribed medication even if signs and symptoms no longer are apparent, wear clean cotton panties to allow for absorption, and reduce the use of scented feminine products

You may take a second opinion from another gynecologist and have a proper assessment of the condition.


19. G.L. UAE

*I am 25 years. I am working in UAE since 4 years. I got married 4 months ago. I was having regular monthly cycle, but for the past 42 days there are no signs of periods. I don't want to get pregnant for at least 2 years. We are not using any contraceptive methods. Will you please give some advice to avoid pregnancy? 

** If you had regular periods and if there are no other causes for a missed period, it is most likely that you are pregnant now. You may confirm the same by simple pregnancy test. If you are pregnant, it may be better to continue with the pregnancy rather than opting abortion. There are no tablets with definite and safe abortificient action. Few of the tablets available in some part of the world are not used widely because of their side effects. These tablets instead of causing abortion might result in defects in the baby. Only other option left is going for medical termination of pregnancy. It is method in which mother kills its unborn, helpless child!

And, why? Just that mother does not want it! Just think over this. You are killing a baby whom you have not seen. The baby is so helpless—no one comes to its rescue!

You may be having your own reasons for not having a baby so soon. You do not know what God’s plans are for you and your family. He might be blessing you with a well talented child. Accept His gift. He will definitely show the means by which you can bring up the child. I agree there will be difficulties initially, but they will be rewarded later. If you are truly worried about the job, just analyze for whom you are earning? Is it not for your family? Is it not for your children yet to born? 

Do you know good percentage of women fail to conceive after an abortion? It is not rare. If this occurs to you?

Accept the present pregnancy as God’s gift for you and continue with it.

After you deliver the present child, opt for a definite method of family planning to space the arrival of second child. It is always better to plan the families and maintain a healthy gap between the children, than going for abortion.


20. A. K. Kuwait

*I do not want to conceive now.  What are the safe days for having physical union?

**In calendar method of family planning, 10 days preceding and 10 days following menstruation are considered as safe period for physical union. This may be effective if the woman has regular periods, the duration of each cycle should be equal and more than 28 days. 

Normally a healthy woman with regular periods will have ovulation on the 14th day preceding the day of onset of menstruation. Two days preceding it and two days following it are termed as the ‘window of fertility’.

 Window of fertility is the most likely period of ovulation and it is commonly advised for infertile couple to make use of, the chances of conception are better in this period. Most of the couple is advised to practice this at least 6 months before opting for costly tests of infertility and artificial methods as treatment. The incidences of conception are more if physical union is regularly performed during window of fertility. However this is not a guaranteed method. 

But the calculation regarding the fertile period (5 days) is not always true. It varies from woman to woman. This is due to variable survival period of sperm in female genital tract after intercourse as well as the survival of egg after the ovulation. So in theory, middle 2 weeks are fertile and 1st and last weeks are 'Infertile'. Having said that, even if you follow this safe period (1st & last week of your cycle), this method has high failure rate. This is because, apart from reason mentioned above (survival time of egg and sperm), also there is large variation of ovulation timing in each cycle. Therefore this method is not normally recommended for effective family planning. Infact the safe period can be highly unsafe. 


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