Letters to the Editor-in-Chief

Since the start of this journal in year 2000, it has been possible for the general public to access the on-line version free of charge. As a helpline, readers have also been given the opportunity to make enquiries about matters of sexual health that is of concern to them. These questions and queries are discussed with the relevant experts and the replies are sent to the respective individuals. Here are a few chosen at random.

Q 1 Can you please advise me what is 'heavy growth of anaerobes gardnerella' and what causes it?

Reply: These are organisms often grow in "enclosed" areas because they require less air for their growth. This is less important than their management. They are not sexually transmitted. Nobody knows what causes them though they can be associated with contraceptive coils with tails, douching but in most cases they just occur. Treatment is often with a course of metronidazole tablets.

Q 2 I am 19 years old and have been sexually active for almost 2 years. I got my first period about 2.5 years ago, but have only had 4-5 since then. You can say that I have very irregular 'period'. Is it even possible for someone like me to get pregnant? I know I have gone through puberty, but I thought that everything in the female body had to be 'just right' for a pregnancy to occur. Also, is it possible that I am doing damage to my body by not having regular periods? Will this possibly cause infertility later?

Reply: In response to Q1 it is possible to get pregnant. For Q2 there is no damage to your body because you are not having regular periods. For Q3 it will not of itself cause infertility. See your GP or go to a Family Planning Clinic for further advice.

Q3. I missed my pill on Wednesday 28th February, and I took only one pill on the next day (I left Wednesday pill in the packet) as I couldn’t take a double dose. Then on Thursday I took my last pill of the month. I had been intending to carry on the pill without a break, but as I had missed a pill I thought I should have a period, to check that I was safe. Then I read on my pill packet last night that if a pill is missed in the last 7 days of the month then carry straight through without a break. I found out too late to take the next packet as I took it on Thursday and it is now Monday morning. My period hasn’t come yet, and it usually comes on the Sunday. What should I do? The last time I had sex without a condom was Saturday, and before that I used condoms.

Reply: If condoms are used at all times and no mishaps occur, then you are not at risk. As only one missed pill at the end of the pack, there should not be a risk but you should shorten pill free interval by 2 days (according to the information).
As you have had no period, you should get a pregnancy test done in case you were already pregnant (i.e. nothing to do with missed pill).

Q 4 I was wondering if you could please advise me. I am a clinical nurse specialist caring for patients with breathlessness and fatigue. They quite often express frustration regarding their sexual dysfunction. Do you know of any organisations that could offer some advice?

Reply: Thank you for your letter of enquiry. As you may know, sexual dysfunction in these people (men and women) will have many causes. The first thing to consider is the aetiology of their breathlessness and fatigue. These will include obesity, chronic obstructive airways diseases, damaged lungs etc. These need to be adequately managed. Secondly these people may get into a vicious cycle of fear of previous failure and frustration and this anxiety precipitates further poor performance. There are professionals and counsellors that can help you, especially in Andrology/Urology department.

Q 5. I had unprotected sex at the weekend, it was quite painful at the time and I have been a bit sore since. I had a bit of discharge on Sunday but not too much since. I am quite red and sometimes itchy. Could I have thrush or could it just be friction burns.

Reply: The best thing after an unprotected sexual intercourse is to have a check for sexually transmitted infections. Since you feel sore and had pain during the act, I shall suggest that you avoid sex and make an appointment with your nearest GUM clinic for tests. I suppose that your suspicion of friction burns or thrush is likely, but the best answer is to have a check up.

Q6. I think I have an STD, I have discharge from my penis and occasional blood. It is very painful when urinating, I seen my GP today but he didn’t even examine me. He said I need to go to a clinic, one problem is I am on Roaccutane for acne and I have my penis pierced and can't remove it. I don't want to go to a piercing place because of the constant smelly discharge, any ideas or advice and how long will it take to get an appointment because it is getting very painful and how long will it take to clear up and start having sex again.

Reply: The problem you have needs to be addressed immediately. You should make an appointment at your nearest Genitourinary Medicine (GUM) clinic as soon as possible. The facts that you are on Roacutane or that the discharge is smelly should not prevent your visit to the GUM clinic. You will be given a sympathetic attention. You should avoid sexual intercourse until your clinic visit.

Q7. In the last few months I have become sexually active. My partner and I were using latex condoms and KY lube. I have found since then that I am allergic to one or both. Since then we have stopped using both, not wanting to have reactions. The first time my partner ejaculated in me I experienced intense vaginal burning and swelling for about an hour to two after, even 12 hours later it was still unpleasant to walk. Since then we have learned that his seminal fluid has high acidity. What can we do? It's very frustrating to not be able to relax and go with the flow.

Reply: I agree with you that it is frustrating not to be able to relax and go with the "flow" You did not mention your age and the method of contraception that you are using. I assume that you are on the pill and that you do not have any other medical problem. While your partners ejacullum may be acidic, you should also realise that vaginal fluid is also acidic under normal circumstances. My suggestions are (excluding any sexually transmitted infections) - spend more time on foreplay; use hypoallergenic condoms for sometime. You can get these from any chemist. You may also consider a visit to your nearest Genito-urinary medicine clinic to discuss with the health advisor or see your GP.

Q8. My wife had an ileostomy (total) including removal of the rectum, last August. Although she's recovered from her ordeal, we cannot have full penetrative sex. One of the stitches (rectum) appear to be close to the bottom part of her vagina, Can anything be done to rectify this problem? We were not told anything about "pelvic floor restructuring" work, except that things "would be a bit sore for awhile"

Reply: Yes, something can be done to rectify the situation. If the stitch in the rectum is the major problem, your surgeon can look into this for your wife. However with regards to sexual activities you and your wife can learn to make adjustments. A visit to a gynaecologist to review the condition of your wife's front passage (vagina) i.e. elasticity etc. may be a start. Above all, don’t give up.

Q9. I am a 17-year-old girl and I recently discovered that I could feel a lump within the fleshy part of my left vaginal lip. It is not visible but if I feel around for it it's definitely there, it feels solid and somewhat moveable but it doesn’t seem to be painful. It has been concerning me and then today, I noticed a little hard spot appear on the surface of my right vaginal lip. It is smaller and is a little raised bump on the surface, not within the fleshy part like the other one, but I'm concerned that they're linked somehow? I really don't know what could be wrong with me and I'm really worried. I have had one sexual partner, who I'm still with, but he has been tested for STD's and has none. I have also been on the contraceptive pill for 5 months. I know you can't exactly diagnose without seeing me but please, if you could give me any suggestions of what maybe wrong, it would help me so much. I'm really worried that it's cancer.

Reply: The bumps are not likely to be cancer. Don't panic. They are probably due to follicles on your skin. Although you are on the pill, it is better for you to always use condoms in addition.

Q10. I am a young man of 26 years old. I have problems. Firstly my pubic hair has grown only on the genitals but has not grown on the chest or abdomen just like a man of my age. It has grown on the area between the testicles and anus. Am I normal? I am confused. Secondly I want to get circumcised but I have few worries. What is done to prevent erection of the penis after surgery? I am asking this because the organ will increase thus stretching the scar a little bit. I want to know the procedures for circumcision. Is it not painful?

Reply: The distribution of your genital hairs is normal. Not all men have hairs on their chest and abdomen. If circumcision is done, this should be done under sterile conditions in order to avoid infection, and you should have local or regional anaesthesia. If the operation is done properly, you should have no problem with erection.

Comments: I find myself obliged to extend you and your esteemed colleagues my best wishes and greetings. For your kind information I have recently noticed that some of the world's prisons and correctional institutions started distributing free syringes (to stop the inmates from using common syringes) among the inmates being addicted to narcotics drugs in order to prevent and control AIDS & HIV in the prisons.

In this regard I would like to know if this method is also used in the prisons of your country, and if yes please be kind enough to specify the effective and positive results of the method. Would you please also inform me if the above mentioned method (distribution of free syringes among addicted prisoners) would play an effective role towards the prevention of AIDS, HIV and contagious diseases in the prisons and correctional establishments. Statistical reports would also assist me in this field. While appreciating you in advance, awaiting your prompt reply, I remain.

Reply: Thank you for your letter. There is plenty of evidence to show that syringe and needle exchange reduces HIV, Hepatitis B&C spread. The obvious reason is that it prevents sharing of injecting equipment.

©2004 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough, UK
ISSN 1469-7556
http://www.sexualhealthmatters.com