1.J.R., Mangalore

*I am 31 years of age and been married for 2 years. I am a juvenile diabetic since the age of 10. As there are issues going on in our marital life, we are postponing the pregnancy. My question is if we postpone is it possible to get pregnant later and will the child also develop diabetes? And incase we chose to delay pregnancy for later stage would there be any risk involved ? My sugar level are in good control now.

** As the age advances, the fertility in women gradually declines. Starting at about age 32, a woman’s chances of conceiving decrease gradually but significantly. At 30, the chance of conceiving each month is about 20%. At 40 it’s around 5%. The risks of pregnancy and birth complications – and caesarean section – increase with age. Complications related to pregnancy are higher when a woman conceives for the first time after 30. Older women are more likely to have a baby with birth defects or genetic abnormalities. A woman over 35 is nearly 2.5 times more likely than a younger woman to have a stillbirth. By age 40, she is more than five times more likely to have a stillbirth than a woman under 35. For a woman aged 40 the risk of miscarriage is greater than the chance of a live birth.
The most important precaution before and after conception is to keep the diabetes under control. Your diabetic status has to be constantly monitored and blood glucose levels should be kept under control for a healthy pregnancy and normal baby.

2. P.A., Dubai

*I am 29 years of age. I got married recently; my problem is my foreskin is very tight and due to this problem I have problems in sex. I am planning to apply some steroid cream. Is it fine or I have to go for surgery?

**If the tight foreskin is interfering with your marital act, it may be better to get opinion from an urologist or general surgeon. Steroid cream may not help.

3. B.F., Mumbai

*Is schizophrenia curable? My wife is a schizophrenic patient for the past 35 years and on medication.

** At present, there is no method for preventing schizophrenia and there is no cure. Minimizing the impact of the illness depends mainly on early diagnosis and, appropriate psychosocial treatment and medication.

‘4. S.A., Dubai

*I am a girl of 12 years. I want to increase my height. My height is 148 cm. Could you please suggest some solution?

** The height of any individual is predetermined and there are no simple ways to increase the height. You are now 12 years and there are minimum 6 years of growth left and during the growing period you will get the maximum height as decided by your genes. Normal healthy diet and simple exercises to maintain good health are all that is needed to attain the height.

5. R.D., Mangalore

*I am 27 years of age and I have the problem of hemorrhoids. I have a external hemorrhoids on the opening of the anus and it is irritating me a lot and I do not feel like sharing it with my family members. What need to be done?

** All the hemorrhoids(piles) do not require surgery. Most of them can be managed by medication and diet habits. You may consult a general surgeon for assessment and advice.

6. J. P. Kuwait

* What are the chances of contacting HIV through mouth to mouth kiss?

** Open-mouth kissing is considered a very low-risk activity for the transmission of HIV. However, prolonged open-mouth kissing could damage the mouth or lips and allow HIV to pass from an infected person to a partner and then enter the body through cuts or sores in the mouth. Because of this possible risk, it is recommended against open-mouth kissing with an infected partner.
HIV is not transmitted casually, so kissing on the cheek is very safe. Even if the other person has the virus, the unbroken skin is a good barrier. No one has become infected from such ordinary social contact as dry kisses, hugs, and handshakes.

7. R.S., Mumbai

*I am 30 years of age. I am planning marry in another two months. Recently I had my semen analysis which showed very low sperm count. (Sperm count: 1.8 millions/ml; Motility: active: 20% sluggish: 10% non motile: 70%) I met a gynecologist who advised about 6 ayurvedic tablets per day and he also advised me to eat lot of fruits and vegetables. Now my question is what is the reason for such a low sperm count? Does masturbation leads to low sperm count? (I used to masturbate 4 or 5 times a month for 10 years). Will this affect my sexual life? Is there any ways to increase the sperm count? Do I have to follow any new life style? Do I have to undergo any surgery?

** The major cause of male infertility usually is a sperm problem. In many of the men the exact cause for low sperm count can not be detected. Normally in nine times out of ten, no amount of testing helps to find the cause and this is labelled as "idiopathic oligospermia". Modern research has shown that the reason some men have a low sperm count maybe because of a microdeletion on the Y-chromosome. This is an expensive test, which is available only in research laboratories at present. It is known that varicosity of the veins around the testes (vericocele) can precipitate low sperm count. The low sperm count is not related to physique, general state of health, diet, sexual appetite or frequency. Masturbation has nothing to do with sperm count or motility. While not knowing the cause can be very frustrating so is the treatment. The medicines prescribed to you are ayurvedic and their exact role in increasing the sperm count or motility is not established, however there may not be any harm in using them.

The low sperm count has nothing to do with libido or sexual drive. It does not affect the sexual life at all. Sometimes men with low sperm count find this difficult to understand. The reason for this is that the testis has two compartments. One compartment, the seminiferous tubules, produces sperms. The other compartment, the "interstitium" or the tissue in between the tubules (where the Leydig cells are) produces the male sex hormone, testosterone, which causes the male sexual drive. Now while the tubules can be easily damaged, the Leydig cells are much more resistant to damage, and will continue functioning normally in most men with low sperm count. As the sex drive and act is dependant on hormonal levels and not on sperm count, even with zero sperms the man can have normal sex life.

It may be better to consult an urologist to know if there are any treatable causes. If vericocele is the cause surgery can help.

8. L.L., Mangalore.

* I get severe headache during sex that I cannot continue at all and it will remain for at east 4-5 days. What might be the reason?

** Sex related headaches are not common. The types of headaches associated with sexual activity come in different varieties. There's the dull pain that seems to come from the head and neck contractions during sexual activity. There is another type that seems to occur during a change of posture. And then there is an intense orgasmic migraine, pain that generally hits fairly suddenly at the time of orgasm. This is the most common of the sex headaches.

The pain usually doesn't last very long, though it may last for several hours. Researchers believe that the headache may be triggered by the exertion of sexual activity.

Headaches are usually not doing any serious damage, but occasionally they can be a sign of something serious or even life threatening. Any headache if it is getting worse, suddenly different, repeating, or new then a neurologist has to be consulted. The same advice goes for headaches associated with sexual activity and orgasm.

9. S.m., Kuwait

* I am 27 years of age. I have been suffering from slip disc since I got married and it is almost close to two years and the pain still continues. I just want to know is it safe to plan for a kid? If I conceive will this hurt me more?

** There is difference between what generally presumed as slip disc and exactly the problem of prolapse of the intervertebral disc. Intervertebral disc prolapse at the lumbar region is more commonly seen in men than women and it is an acute episode. Slip disc is associated with severe pain in the back, pain radiating down in the lower limb with sensory and motor deficit. Sensory deficit can be parasthesia, numbness or frank anaesthesia in particular regions of the lower limb. Motor weakness can be difficulty to inability to lift up the great toe or other toes. Rarely bladder and bowel movements may be affected.

What is generally believed as slip disc is chronic back ache where the pain is located in the back with occasional radiation down in the lower limbs but without sensory or motor deficits. You are probably having chronic lumbo-sacral strain or in simple terms chronic back ache.
You may consult your gynecologist and if required take opinion from an orthopaedic surgeon about the back pain. Exact cause of the pain may be evaluated. If the backache is due to chronic strain at the lower back no active treatment may be needed except physiotherapy and back strengthening exercises. This type of back ache is not a contraindication for conception or for delivery.

10. M.F. Saudi Arabia

*My age is 23 years; Height 6.1 feet and I weigh 110 kgs. How can I reduce my weight?

** Some one has compared body weight to balance in the savings bank account. To increase you have to deposit more and to reduce you have to withdraw. In our body the same principle works. However here deposition is easy and withdrawal is difficult.

The food contains the substances that finally form the energy in the body. The energy is measured by a unit known as ‘calorie’. Some food items like meat, fat produce more calories and others such as green leafy vegetables produce less calories. The calories are required for normal body functions like breathing, digestion of food, walking etc. The calories are also required for our daily work. If you do sedentary work (such as the office work, routine household work) then the amount of calories you require are much less. If you do physical exertion or hard work then the calories requirement is more. Many of us eat the food that produce large amount of calories, but we do very little work to use them. The extra calories thus produced in the body are finally stored as fat and it increases our body weight and disfigure us.

To reduce the body weight you have to reduce the quantity of the calories you intake. The amount of food intake has to be reduced and the food should be such that it produces less of calories. The food items like cheese, ghee, oil, meat and meat products are to be reduced. The diet should contain more of vegetables. The overall quantity of food intake has to be reduced gradually.

Regular exercises such as walking, swimming, bicycle riding help in burning the extra calories that is stored as fat. These are to be started and followed regularly. It may take long time to lose the weight.

For weight reduction or even for general health exercises like jogging or running are not advisable. It is always better to have brisk walking on a level ground. If there are facilities you may even opt for swimming. You may start to walk with moderate speed for about 20 minutes per day initially. Gradually increase the duration as well as the speed and you may have to walk for minimum of one hour per day for minimum of five days in a week.

11. J.D’s., Mangalore

* I am 28 years of age. When I was small my parents had consulted a doctor because they had felt that I had no opening at my vagina. The doctor had told them that it was there and had no problems. I do not find any opening and if I try to put the finger it hurts. I find some extra skin at that region. Can I marry and have children?

** It appears that you are not aware to find the opening of the vagina or you may be having thick hymen. As the doctor has examined you when you were a child and found it normal, it should be normal and the opening must be there where it has to be. If there were no opening you would not have got your periods, (I presume you have normal periods). If you have still doubts consult a gynecologist.

One of the causes for not finding the opening is imperforate hymen. The imperforate hymen is at the extreme of a spectrum of variations in hymenal configuration. Variations in the embryologic development of the hymen are common and result in fenestrations, septa, bands, micro-perforations, anterior displacement, and differences in rigidity and/or elasticity of the hymenal tissue. Hymenal variations are rarely clinically significant before menarche. Due to imperforate hymen, during the onset of menarche the menstrual flow can get collected inside and can cause pain. This is rare.

12. J.C., KSA

*My family recently started complaining that they are disturbed by my snoring style. I am snoring loudly immediately once I am sleep. I also have another problem, I get a horrible and scary dreams. I get up from the sleep because of this and I feel tired and scared to sleep again anticipating dreams again. This happens at the very beginning of sleep not later. What shall I do?

** Snoring is one of the common problems of sleep. It can be due to variety of causes. In most people, it 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. The surgical procedure will depend on the location of the tissues contributing to snoring.

Dreaming is a hallucinatory experience that occurs during sleep. Dreaming, a common and distinctive phenomenon of sleep has since the dawn of human history given rise to many beliefs, fears, and conjectures, both imaginative and experimental. There are volumes of books written about the meanings, importance and interpretations of dreams. Modern psychiatrists believe that dreams have no significance. There are no methods or medications to alter the pattern of dreams or dreaming altogether. Though there is no need to give any importance to dreaming, here are a few suggestions which might help you to a certain extent:

• Make sure you get plenty of sleep every night; someone who is sleeping deprived is more likely to dream more and or talk in sleep.
• Reduce the stress and anxiety levels.
• Keep to a regular schedule of going to bed and getting up at the same time.
• Don't eat a heavy meal right before bedtime.
• Read some smoothening reading before you go to bed may be a few versus from the Holy book.
If you wish, you may consult a psychiatrist to rule out any other associated problem. However, dreaming is not an illness

13. P. P. ,Mangalore

*I am male of 23 years have problem of less hair on face, arm pits and chest. I also feel sex organ not fully developed. What is the problem? Should I consult endocrinologist?

** If you have secondary sexual characters like growth of pubic hair, development of moustache and beard (even if they are scanty), occasional erections, night falls or wet dreams you are normal. The scanty hair is not unusual in normal men and you might get them later on. However you may consult an endocrinologist for assurance.

14. S. M. Dubai

*My son is 7 years and has started stammering since 1 year. When he wants to tell something, the words are not coming clear. He drags the words. On phone also the words doesn't come clearly so he avoids talking on phone. Somebody recommended consulting a speech therapist. We are in Abu Dhabi and I am unable to get one here. Is there any way that I can try teaching him from Home to improve his speech? One strange thing I note in my son. He sings very well and recites his studies very well without stammering. He is interested to go in for many activities but is pulled back due to his stammer.

** Stammering is a common speech problem. A stammerer knows precisely what he wants to say but cannot, for the moment, say it because of an involuntary repetition, prolongation or cessation of the speech sound. Like all other physical actions, the act of speech is the result of neuro-muscular coordination which involves the transmitting of electro-chemical messages from the brain to the appropriate muscle groups. For every one of us (non-stammerers and stammerers alike), this neuro-muscular system sometimes trips and fails especially during moments of inadequate emotional control. For the stammerer, this 'tripping' occurs much more frequently than it does for normal speakers. Whenever he faces what he perceives as a 'feared' situation, the stammerer adopts a mind-set which triggers off spasms of speech-blocks. Such fears can also center on certain speech sounds or even certain people.

Actually, all stammerers have periods of fluency when they are emotionally relaxed but revert back to dysfluent speech under stress. Answering the roll call in class, speaking on the telephone, talking to someone in authority, speaking in a group, attending a job interview, etc. are some such pressure situations which might cause an increase in stammering behavior.

One more of the unusual facts about stammering as you have noticed in your son, are that even the severest stammerer can sing fluently without any speech blocks. This is because when we sing a song, we know exactly when to say the words and there is no ambiguity in our minds about this timing. In conversational speech however, we cannot bank on any such cues but as normally fluent speakers, most of us do not need these cues. However, without these cues, a stammerer's speech becomes disoriented, because of his 'wrongly tuned' neurological speech-timing system. He experiences difficulty in maintaining a smooth forward flow of words in the sentences he speaks. Frequently repeated, these instances of stammering arouse fear in the mind of the child who stammers. With growing years, these fears keep snowballing until the stammerer begins to experience tremendous frustration, anxiety, shame, embarrassment, even guilt every time he opens his mouth to speak. He begins to recoil from speaking. The smirks on the faces of his listeners which his speech sometimes elicits do nothing to help his self confidence. In every other respect, except speaking ability, the stammerer is a completely normal human being, as good or bad as the rest of us. In fact most stammerers are sensitive and intelligent.

Stammering is predominantly a 'male' condition (80% of all stammerers are male) and it usually affects the first-born male child. A significant majority of stammerers (65%) have a family history of the disorder; usually the father who stammers or speaks at a rapid rate. Nearly always, stammering starts before the child is 5 years of age. If left untreated, it peaks in severity around the age of 10 to 18 years and then begins to stabilize or fade away as the stammerer grows older.

Speech is one of our body's strongest habits and stammered speech is also a habit. Stammering is not a disease and therefore, it cannot be treated through medicines. The stammering child or adult has to be helped to develop a new, more fluent manner of speech through an intensive re-orientation program which focuses on modifying his physical manner of talking as well as changing his mental attitude towards the problem. Speech therapy is available in several centers in major cities in India and abroad. You may have to try to locate speech therapists in your place. I do not think you can do it at home at your own unless you are a qualified in speech therapy. Other than speech therapy, yoga and meditation might really hold the key to solving the problem of stammering.

15. B.R. Mangalore

* I am 27 years of age. I am having the problem for conceiving a second child. My first child is 6 years of age. We have been trying for more than one year now. My periods are normal. I had a surgery to remove a lump from my breast about two years ago. Does this have anything to do with the present problem?

** The surgery to the breast has nothing to do with conception. Breasts are no way related to conception or pregnancy. They only increase in size during pregnancy due to the effect of hormones. Like in all other mammals, in humans also the breasts are needed only to feed the young ones after birth till they are able to take other feeds or food.

16. D.M., Mumbai

*My daughter is 7 years of age and she has been advised to use spectacles for constant use from the age of 3 years. She always gets sty on her eyes one after the other. She also gets itching in her eyes every time for which doctor says it is allergy because of pollution and prescribes eye drops. What could be the reason for sty? Is it because of heat in her body? Can I soak coriander in water and put it in her eyes? Will it help anyways?

** A stye (medical name Hordeolum) is caused by the bacterial infection, in the sweat or oil producing glands at the base of the eyelashes. It is not related to heat inside or outside the body. The infection produces swelling with pus which gives rise to a painful red lump at the eyelid edge. As well as being painful, vision may be affected by the swollen eyelid pressing on the front of the eye. In some cases the infection may become more widespread affecting the whole of the eyelid area. Hordeolums are usually on-off occurrences, but repeated episodes of this particular infection may indicate that a person is generally unwell or rundown.

This type of infection can occur for no particular reason. The bacteria which causes it, is staphylococcus aureus which is found normally on the human skin. Normally it is harmless, but sometimes it enters the body and causes infections such as boils and abscess.

Many Hordeolums/Styes simply burst themselves and cause no further problems. If necessary, when they first occur and to speed up their
removal and ease the pain, a hot compress ( clean cotton cloth like hand kerchief dipped in comfortably hot water and squeezed well) held over the affected area for 15 to 20 minutes, three times per day is usually very effective. Sometimes a physician will prescribe antibiotic eye cream, such as for persistent infections.

This type of eye infection can be easily spread and so hands should always be washed after touching the eyelids. As your daughter is also having allergic problem of the eye, she must be repeatedly rubbing the eyes with hands which she might not be able to wash every now and then.

You may try to locate what exactly is the cause of allergy and help your daughter to avoid that. You may also teach her to use a clean hand kerchief to rub the eyes when itching is unbearable instead of bare hands. The coriander water may not solve the problem.

17. S.K. Mumbai

* I am getting engaged to a person who is having psoriasis. Is it safe to marry him, what about my married life?

** I feel you have to have some basic knowledge about psoriasis and then you take a decision about marrying the person whom you are engaged.

Psoriasis is a noncontagious common skin condition that causes rapid skin cell reproduction resulting in red, dry patches of thickened skin. The dry flakes and skin scales are thought to result from the rapid build up of skin cells. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

Some people have such mild psoriasis (small, faint dry skin patches) that they may not even suspect that they have a medical skin condition. Others have very severe psoriasis where virtually their entire body is fully covered with thick red, scaly skin.

Psoriasis is considered a non-curable, long-term (chronic) skin condition. It has a variable course, periodically improving and worsening. Sometimes psoriasis may clear for years and stay in remission. Some people have worsening of their symptoms in the cold winter months. Many people report improvement in warm climates, or with increased sunlight exposure.

The exact cause remains unknown. There may be a combination of factors, including genetic predisposition and environmental factors. It is common for psoriasis to be found in members of the same family. The immune system is thought to play a major role.

Psoriasis is currently not curable. Research has shown it to be non contagious from person to person. One cannot catch it from anyone, and it does not pass to anyone else by skin-to-skin contact. You can directly touch someone with psoriasis every day and never catch the skin condition. Although psoriasis is not contagious from person to person, there is a known genetic tendency, and it may be inherited from parents to their children. It does tend to run in some families. Now there are effective medicines that can control the disease. Dermatologists are the specialists who are experts in treating psoriasis.

It has no bearing on sexual life or reproduction. It does not affect the longevity or generally has no effects on other organs of the body.

18. J.P., Bangalore

* I am 27 years of age and my husband is 50 years. He has diabetes. He has problem of erection and hence we can not have proper intercourse. We are married for 6 years and have no child yet. He has consulted some specialists but the problem remains the same. How can I get a child?

** Your husband has to consult a neurologist and find the cause for erectile dysfunction. If the neurologist opines it is due to diabetes and can not be set right through medication, you may seek the help of any fertility specialists who might guide and help you to get a child from your husband artificially.

19. R.J.F., Mumbai

* Now I am 40 years. When I was 23, I had visited a call girl and next day I got itching on sexual organ and I took some medicine from local RMP doctor, and from the day onwards if I eat fish, chicken within a hour I get itching and red rashes there, so I stopped those items. If I travel long 2 days the itching will reappear. What can be done?

** You are probably having some allergic reaction or fungal infection. Consult a skin specialist and take proper treatment. The problem is unlikely to be a major sexually transmitted disease and may not be directly related to your visit to a commercial sex worker some 17 years ago.

20. F.P. Mangalore

*I am getting married this year, I am 32 years old, and my fiancé is 27 years old. Recently she has developed fibroids, its less then 1.5mm in size, (she consulted with the doctors) She gets heavy irregular bleeding and abdominal pain. Now what precautions we can take to avoid the pain?

Are there any medicines available for fibroids? Is there any problem for pregnancy and sexual life?

** Even the small fibroids can cause the problem if they are inside the uterine cavity. Small fibroids inside the musculature of the uterus (known as intramural fibroids) or on the surface of the uterus are normally harmless.
The irregularity in periods and pain during the onset of bleeding is normal and may not be related to fibroids. However if the quantity of flow is excess, consult the gynecologist.

Pain during periods (dysmenorrhoea) is again not unusual in those women who have not delivered. Over the counter painkillers such as ibuprofen and paracetamol often help to relieve period pains. There are also painkilling tablets available that contain the drug, hyoscine that may help prevent the muscle contractions. One can get the prescription for these drugs through the doctor.

Moderate physical exercise can also be helpful for relieving pain, and may help prevent period pain. Many women find a hot water bottle held to the abdomen or back is comforting. Self-heating patches or heat packs that can be warmed in a microwave are a convenient alternative.
If these measures do not provide enough relief, or if period pains are interfering with daily life, then it’s best to see a gynecologist. A gynecologist can usually diagnose period pains easily and several treatment options may be discussed.


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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