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1. A.V., Mangalore

*I am 31 years of age. I have lost interest in sex after having baby. My son is 3 years of age now. Can I  get the tips to get back the interest in sex like before.

** It is normal to have a decreased sex drive after giving birth. This feeling can last for months. But not for three years.Loss of sexual desire, known in medical terms as hypoactive sexual desire disorder (HSDD), is the most common form of sexual dysfunction among women of all ages. There are lot of myths and superstitions attached to this problem. To have a proper relationship and a happy family life, the couple should understand the problem, co-operate with each other and should seek proper remedy at an appropriate time.

 A recent study showed that nearly one-third of women aged 18 to 59 suffer from a lost interest in sex. Unlike men's main sexual complaint, erectile dysfunction, women's biggest sexual problem is caused by a combination of both mental and physical factors, which aren't likely to be cured by merely popping a pill.

Contrary to popular belief, frequency of sexual intercourse has nothing to do with sexual desire or satisfaction. But when a woman experiences a significant decrease in interest in sex that is having an effect on her life and is causing distress, then it's considered a problem of low sexual desire or HSDD.

Normally sexual drive declines naturally with age based on physiological factors. But sexual desire also encompasses interpersonal and psychological factors that create a willingness to be sexually active. Above and beyond sexual excitement, it is the sense of intimacy in the relationship that decide whether a woman  want to be sexually related with that particular person or not. Therefore, all of these aspects of sexual desire must be examined in order to determine the root of the problem.

Common causes for a loss of sexual desire and drive in women include:

Interpersonal relationship issues: Partner performance problems, lack of emotional satisfaction with the relationship, the birth of a child, and becoming a caregiver for a loved one can decrease sexual desire. 

Sociocultural influences: Job stress, peer pressure, and media images of sexuality can negatively influence sexual desire. 

Low testosterone: Testosterone affects sexual drive in both men and women. Testosterone levels peak in women's mid-20s and then steadily decline until menopause, when they drop dramatically. 

Medical problems: Mental illnesses such as depression, or medical conditions, such as endometriosis, fibroids, and thyroid disorders, impact a woman's sexual drive both mentally and physically. 

Medications: Certain antidepressants (including the new generation of SSRIs), blood pressure lowering drugs, and oral contraceptives can lower sexual drive in many ways, such as decreasing available testosterone levels or affecting blood flow. 

Age: Blood levels of androgens fall continuously in women as they age. 

Because a loss of sexual desire in women is caused by a combination of physical and psychological factors, it usually requires more than one treatment approach to fix the problem. Once the factors causing low sexual desire have been determined, potential treatment options may include:

Sex therapy and/or relationship counseling: Sex therapy is very effective for individuals and couples. Sexual dysfunction usually affects both parties in a relationship and should be discussed together or individually with a mental health professional. 

Changing medications or altering the dose: If the problem is caused by medications, a change of prescription or alternative therapies may be recommended. If an oral contraceptive is suspected as the culprit in lowering testosterone levels, a different formulation or no hormonal birth control methods may be prescribed. 

Addressing underlying medical conditions: Medical problems contributing to low sexual desire may require surgical treatment, such as the removal of painful fibroids or medication.

Testosterone therapy: Although no hormone or drug has been approved by the FDA to treat sexual problems in women, many gynecologists recommend off-label uses of testosterone therapy for women with low sexual desire to restore testosterone to normal (pre-menopausal) levels. 

You have to discuss this issue with your husband and he should understand that there is some problem which can be set right by mutual participation. Both of you can seek the help of a counselor to solve the problem. 

2.B.N., Mangalore

*I am 29 years and my husband is 40 years. Recently he underwent endoscopy surgery for kidney stone. After that he has lost interest in sex. He likes me a lot but not interested in sex. I want to get pregnant. 

** In most of the men the desire for sex gradually declines as they age, but it does not disappear. Endoscopy or any other type of surgery on kidneys should not affect the desire for sex. Let your husband talk to the urologist who performed the surgery about this development. There are some medicines available now which can re-kindle the desire in men if it is affected by non-neurological conditions. 

3. K.A., Bangalore

*I am 24 years of age and I believe that I am a homosexual as I get attracted to certain men and I never got attracted to any girl till date. I don't want to be a homosexual. Is there any treatment that I can undergo through and become normal.

** As you only have some sort of homosexual attractions, you can totally get rid off the problem by making some firm decisions. One of your priority tasks is to make constructive, positive changes in your habitual ways of behaving and relating to your environment. At first, you may have to take drastic measures to get your behavior under control. As you have not been  involved in homo-sexual behaviors, your job will be less difficult. 

Many people have to spend a great deal of time and energy undoing behavioral habits and addictions. You may be tempted to engage in homosexual activity thinking that if you were to experience it, you could "get it out of your system" and your fantasies could be put to rest. But this false illusion ignores the seductive power of sexual immorality.  Be strong and don’t give in to homosexual behavior. 

You will likely need to set boundaries to get your behavior under control. If you know you are susceptible to  homosexual  behaviors, you can decide to limit your access to places or conditions that might make it easy for you to go astray. Your attractions and sexuality are your own and you can set boundaries that define what you will do. As steward of your own sexuality, you are responsible for seeing that others do not use you in sexual ways and that you do not use them. In addition to obvious sexual actions, there are other areas to be avoided. Flirting, innuendo, and suggestive conversation show disrespect for the other person and are a form of manipulation and predatory behavior. 

Stay morally clean. This means that you keep a clean mind. Your thoughts will determine your actions, and so they must be controlled. It’s difficult to control those thoughts if you submit yourself to temptation. So you will have to carefully select your reading material, the movies you see, and the other forms of entertainment in order to have good thoughts rather than unwholesome desires. Never watch gay movies as they can be harmful for you.

The most important is to recognize your attractions and learn to deal with them on an emotional level without letting them develop into behavior. As you begin to see things in perspective, the temptations for sexual misbehavior will become less enticing and dwindle in number, and you will achieve greater mastery over your fantasies. You will be out of these attractions soon.

4. M.T., Mangalore

*I am 26 years of age. I have a problem. I work in gulf and my body gets heated a lot. So I masturbate daily while bathing. Is there any side effects if I masturbate daily. Any solution how to control myself. Please help me. Also I have a boil in my sitting place. Sometimes pus comes out and it is very painful. What may be done?

** There is nothing like body your age desire for sex and masturbation is common. There is no harm in masturbating as frequently as you can. 

Your other problem seems to be fistula in ano or a pilonidal sinus. Both these problems need surgical treatment. Consult a general surgeon now and decide about surgery if suggested.

5. M.D.F., Mangalore

*I am 32 years of age. I had a caesarian section about 8 months ago and now I have pain in my lower abdomen. It is not constant but it come & goes. It is more when I bend and work.

** It is difficult to opine whether the problem is related to caesarian section or not unless you are examined. You may consult your gynecologist for initial assessment. You might be referred to an orthopaedic surgeon if the problem is related to your spine.

6. R.D., Mangalore 

*I am 48 years of age. I have the problem of excessive sweating. During the hot season I feel  embarrassed to attend  any function because of my sweating my whole dress  becoming wet. I have done the complete medical checkup. My cholesterol is 245 and BP, blood sugar, uric acid everything within the normal limit. Please advice me some remedy to come out of my problem.

** Excessive sweating or hyperhidrosis is a clinical condition where parts of the body are sweating beyond the body needs. It is commonly an inherited condition. A segment of the sympathetic nervous system is responsible for this presentation. The sympathetic is an autonomous part of the nervous system on which we have no control. (The autonomous nervous system has two parts to it, the sympathetic and the parasympathetic. Those systems affect blood pressure, heart rate, anxiety level and many other functions) 

Commonly affected areas of the body are the hands, and feet. In smaller groups of patients the facial and armpit areas are affected as well.  Excessive hand sweating or as palmar hyperhidrosis is the most common form of excessive sweating.  Attempts to control this condition are numerous and they range from lotions, pills, herbal medications, bio feedback, electric currents (iontophoresis), and acupuncture etc and. to surgery. The benefits of these various modes of management are limited and in some they may not help at all.

In some centres endoscopic thoracic sympathectomy (ETS) is performed to relieve excess sweating in selected individuals. This operation is carried out in a relatively short period of time and the amount of pain and discomfort is limited. Benefits of the surgery are to be discussed with the surgeon before opting for it.

7. J.P., Udupi

*I am 25 years of age. I am feeling some uncomfortable, some air block issues kind finding in my scrotal sac for the past two weeks; am also getting pain as well,  especially at night.

** You may be having some inflammation of the parts related to testes. Consult a surgeon or an urologist.

8.S.L., Mangalore

*Is there any problem of having physical union with my husband who is diabetic; will it cause any harm to him?

** No. There is no problem at all. Some men with diabetes can have problems like low desire, erectile dysfunction etc. Many of these problems can be treated by the physician who treats diabetes.

 9. P.P., Bangalore

*I have the problem of bad breath. I do not have any tooth decay, cavity but my gums always bleed. I do regular check up with dentist and she told me that I do not have bad breath but whenever I talk to my family or my friends they say that I have a very bad breath. So please suggest what to do.  

** The problem of ‘bad breath’ can be of two types. In some of the individuals the bad breath is felt by the person himself and others do not get it. The other type is the one that you are having where others also feel it. In the former case consultation with a psychiatrist is required and in the later case proper evaluation might be needed.

The majority of bad breath problems begin in the mouth. Fortunately, treatment is very effective for people who have bad breath of mouth origin

Bad breath that is of oral cavity origin can be traced to a sulfur compound produced by bacteria. Dead and dying bacterial cells release this sulfur compound which gives the breath an unpleasant odor. 

Bacterial plaque and food debris accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices. Large amounts of sulfur compounds can be produced in this area, making it a frequent site of origin for bad breath. 

The tooth attracts bacteria containing plaque and if not cleaned regularly and thoroughly, this can result in large accumulations of bacteria which result in bad breath. 

People who have periodontitis often experience bad breath because of bacteria accumulating in areas that are not cleaned easily, such as deep pockets around teeth. 

Other reasons for bad breath (other than the mouth) are: 

infections, especially in the sinuses or lungs 

diabetes mellitus (acetone smell to the breath) 

malfunction of the liver 

disorders of metabolism (foul, fishy odor that comes and goes and may be difficult to diagnose) 

You may consult one more oral surgeon for a second opinion to assess the problem. If he finds that your oral cavity is normal, he might refer you to other specialists.

10. K.K., Mangalore

*I am 29 years of age, married for 3 years. I have not yet conceived. My husband works in rig and he comes home once in every 28 days. As I had not conceived we approached a Gynecologist last year. We had to undergo certain tests. My husband had got the semen analysis and he is perfectly normal. We had also done follicle study for IUI purpose, but my eggs did not rupture, the doctor gave some injection to me for the eggs to rupture, in spite of that the eggs did not rupture, then the doctor detected multiple cyst in both the ovaries, and told us that this could be the obstacle for the pregnancy, as per his advise underwent laparoscopy. 

Earlier I used to have severe pain in the abdomen during my periods. But after the laparoscopy I have no pain in the abdomen. I get my periods on 25/26/27/28 basis; sometimes it is on 25th day or on 26th day and it goes to 30 days also at times. I have regular periods. They last for 5 to 6 days. The doctor advised us to have relation on a regular basis, the follicle study was repeated, but again the same problem, the eggs grow but they do not rupture, in spite we did not give up, we used to maintain relationships during the fertile days. 

Again after 6 months we approached the doctor, he asked to get the x-ray done for the fallopian tubes, the tubes looked normal, except a small block on the right side for which the doctor said it is normal initially, later after a month he advised me to undergo one more laparoscopy. I am in a situation where I am totally confused, I do not know what the exact problem is with me, is there any remedy for the eggs to rupture, or is there any medication for the same? We are desperate for a child, please suggest us with a remedy, we are also thinking for going in for a second opinion with some other gynecologist.  I am married for 3 years now, and we have maintained physical relationship for 1 1/2 years since my husband is away for every 28 days.

** In such a situation it is always better to seek opinion from another doctor/consultant of the same specialty. It is quite natural for a doctor to have ‘tubular vision’ on a particular problem or the particular doctor might be hesitant to reconsider the diagnosis made by him/her. When the patient doesn’t get satisfactory solution for his problem or explanation from the doctor and the doctor suggests repeated tests, it is better then to opt for second opinion. It should be always remembered that the doctors are also humans and they make errors in their judgment.

But when one goes for a second opinion there is a problem in the commercialized medical profession of today; the patient might be advised to repeat the costly tests, there might be adverse comments on the previous consultant etc. Even then seeking a second opinion is not bad.

11. J.D., Mangalore

* We are in gulf. Our maid is suffering from chronic stomach aches and is continuously bleeding; I would like to know if she can be operated for this? How long she may have to stay in the hospital? It is very expensive for her to get treatment here – do you advise her to return to India for treatment?

** You have not given details of the consultations/tests your maid has already undergone. Whether she has pain abdomen or stomach ache? Where she is bleeding from? If she has pain abdomen and vaginal bleeding consult a gynecologist and if it is stomach ache then consult a surgeon. You can choose the place for treatment depending on the problem. Surgical treatments may relatively cost less in India and in some of the hospitals here they are done free of cost.

12. J. J., Dubai

I am 26 years presently residing in Dubai. I have read in your answers on quick ejaculation. You have explained that it is not a disease, this is his psychological problem or it is his thinking and there is no treatment for this problem. I am also having quick ejaculation problem. Is there any medical treatment for this problem?  Are there medicines to hold at least for ten minutes?  I am planning to marry this year...

** How are you sure that you have the problem of premature ejaculation? Is it during masturbation or premarital sexual ventures? One can not compare masturbation to sexual act. There may always urgency to ejaculate during masturbation. If it is in pre-marital sexual relationships, it can be due to anxiety. Many of the men ejaculate fast under tension due to anxiety, fear or guilt. If it is due to tension of pre-marital sex, then it might disappear in marital relationship with the wife. 

Premature ejaculation is not a rare problem even in married men. 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. 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 may help to some individuals. 

The men with this problem can consult an urologist for proper evaluation and treatment.

13. R. A., Mangalore

*I am 22 years of age. I have the itching problem since 4 years. Now I have burning in my penis head and it has colour changes like ash for just 3 months. I am taking treatment for the last one month. Still I have the burning in my penis head. Urine and blood reports are normal. 

** It appears to be due to fungal infection. You may consult a skin specialist for proper assessment and treatment.

14. R.M., Dubai

*I am 31 years old and presently working in Dubai, I am single. My problem is that I have small penis and frequently bed wet occurs due to small penis. I am hesitating to go ahead with my marriage as I would not like to end up with personal problems after marriage. 

** Even in the 21st century, men are always worrying about their penile size. It's not difficult to find out about the size of the average male member - there are lots of surveys on the internet and in scientific journals, and one can easily work out the average size ranges. But how reliable are these figures? The answer seems to be - not very! When you ask men to measure their own penis, they consistently get longer results than when doctors or nurses measure it! So, taking all the surveys, working out the average, and then adjusting the results in favour of those where measured by others the guys' penises, here are the most reliable figures: Average soft (flaccid) penis length = 3.3 inches (8.4 cm) Average erect length = 5.9 inches (15.0 cm).

In marital sexual relationship the size of the penis matters very little. Marital sexual act is not a mechanical union. There are lots of feelings that are involved and the size of the organ hardly matters for proper physical union. There is one more interesting thing is that most penises are very much the same size when erect. The man whose non-erect organ is smallish will usually achieve about 100 per cent increase in length during sexual excitement, while the man whose non-erect penis is on the largish size will probably only manage about a 75 per cent increase. In round figures, this means that the great majority of men measure between 15 cm (6") and 18 cm (7") in the erect position, with the average figure being about 16.5 cm (6 ½").

The size of the male organ can not be altered by any medications, local applications or even by plastic surgery. Men with small organ can perform as effectively as with the men having larger than average penis. 

There is no relationship between wet dream and size of the organ. A wet dream is an erotic dream that is so intense that a guy ejaculates in his sleep. Nocturnal emission is one of the ways the body gets rid of semen build up, so it usually doesn't happen during periods of masturbation or sex play. Although wet dreams are most common among teenage guys, many men also have nocturnal emissions as adults. Some guys never have wet dreams, but most do. Dreams or no dreams — both are normal. 

During sleep, from time to time, our bodies enter periods called REM, or rapid eye movement, which last from a few minutes to a half hour. During these sleep periods, guys experience several erections, and girls experience vaginal lubrication. If a dream during REM sleep is very arousing, the sensation of an erect penis pressed against a mattress can lead to erotic dreaming and ejaculation in guys. Wet dreams are very common during youth and they gradually disappear once normal sexual activity is started after marriage.

15. A.S. Kuwait

*I am working in Kuwait, I have nervous problem, when I talk to my manager, supervisors or any other higher person my hands getting cold and start  shaking and I  find it difficult to talk, if I know the answer for there question still I can not answer because of nervous problem. If there is any function I hesitate to attend it, because I lose my confidence in front of them. But when I talk to my friends and co-workers I don’t have this kind of problem. What can be done?

** You require counseling from a trained counselor. This problem can be gradually controlled. Trained counselors are available in major cities and you can get their help.

16. L. D. Udupi. 

* I am 48 years of age. I have the disc prolapse at L4 -5 level. I was treated with epidural steroid injections twice. I had noticed improvement. But as of now the problem has re-surfaced and I can't walk much or stand long.

**Epidural steroid injection is one of the methods to reduce the inflammation due to disc prolapse.  It does not eliminate the problem in all the cases of disc prolapse. Along with the injection you might be advised to modify your activities, reduce the weight, certain exercises to build the muscles of the back. If the problem has resurfaced consult the neurosurgeon/ orthopaedic specialist who had treated you earlier. A small percentage of patients with disc prolapse may require surgical removal of the disc.

17. J. P., Dubai

*I am 30 years of age. I am married for 4 years and having a son of 3 years. My problem is that before coming to Dubai I used to get my periods after 15 days and it was for just one day. I had my scanning done in Mangalore. It was reported normal and I was informed that the problem was due to hormonal changes. I was given hormones for 3 months.  I came to Dubai and completing the three months course, there was no problem for a month but it started again. I had scanning again in Dubai and the result was normal. But from past 2 months it is bleeding within 10 days of my periods. This time it exceeds to 6 days and I am scared because there medium pieces of blood. Please let me know what can be done? I have put on weight after coming to Dubai. I had a normal delivery. Can I have a second child?

**It appears that the hormonal imbalance has not set right. You may have to consult the specialist again and continue the treatment till the periods become regular. You may not conceive when you are on hormones. 

18. A. A. Mumbai

* I am 28 years of age. Though I can ejaculate properly in the initial intercourse, I do not ejaculate if I try within half an hour; it requires at least two hours to have another ejaculation. I have the habit of masturbation. Is it required to consult a doctor? Will it affect my married life?

** During ejaculation the seminal fluid that is stored in the seminal vesicles is forced out. It takes some time for the seminal fluid to fill again.  The duration required for this is age related. In younger age it might get filled fast and in older men it might require days. The frequency of intercourse also might be related to it. This is not a problem and is not related to masturbation. It will not affect your married life. Except during the initial period of marriage, most of the men are able to have sexual act not more than once in a day. As the age advances the frequency gradually reduces, for example a man who is having sexual act once in a day at the age of thirty may be able to do so once in three days when he is forty.

19. M. D'S., Mangalore

I am 27 years of age. I am having hypothyroidism and am taking supplement. I will be getting married next year and would like to start a family. I would like to know if the fetus will be affected in any way and what are the chances of the baby being defective. Is there any herbal remedies you can recommend?

** Hypothyroidism is a state where the thyroid hormone level in the body is less than the normal and you are on supplement to correct the deficiency. If you regularly take the supplement, get your blood analyzed to maintain the level of thyroid hormones you are like any other individual having normal thyroid hormones. As long as your thyroid levels are maintained you will have normal pregnancy and the child should be normal. The key in dealing with your thyroid condition during pregnancy is close monitoring of your TSH and T3 and T4 levels and compliance with your treatment regimen. A pregnant woman with hypothyroidism should have her thyroid function checked during each trimester. In particular, it's known that the thyroid hormone dosage requirement can increase in the early part of pregnancy due to the increased estrogen levels of early pregnancy.

Untreated hypothyroidism can cause serious problems for an unborn child, so many experts recommend that all pregnant women be tested for thyroid function during the pregnancy. Every woman treated with thyroid hormone who anticipates becoming pregnant or is found to be pregnant should have her thyroid hormone levels monitored more closely. Some woman may need to have their dosage of medication increased by as much as 50% during pregnancy. Thyroid medication is safe to take during pregnancy.

As you are planning for pregnancy immediately after the marriage, it may not be advisable to change the system of medicine to control the hormone deficiency. I do not think there are effective herbal remedies for hypothyroidism.

20. J.S., Mangalore

* My daughter matured in last August. She is just 13 years of age. She got the periods for about 7 to 8 days. Slight discharge continued for about a month and then it stopped. I have consulted a doctor who assured me that it was normal and she would not get any problems. Is it so? 

** The incidences of irregularities, excessive or prolonged bleeding is normal at the onset of menarche. After the onset the periods might disappear for some time. If you have any doubt you can consult the gynecologist again or get a second opinion for assurance.

Dr. Edward Nazareth

Dr. Edward Nazareth

Dr. Edward Nazareth: Born December 28, 1958. Dr.Nazareth holds medical degrees - M.B.B.S. (1982 Mysore Medical College, Mysore), D.Ortho (1986 Mysore Medical College, Mysore) M.S.(Ortho.) (1987 Mysore Medical College, Mysore).

At present Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Fr. Muller’s Medical College, Kankanady, Mangalore-575 002.

He is a resident of Kankanady.

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