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MENSTRUAL PERIOD PAINS

Different types of periodic pains, causes of periodic pain, treatment and how you can get rid of them at your home I mean the home remedies for periodic pain.

Menstrual periods are supposed to be a normal occurrence for each and every woman. However most women experience abdominal pains during their menstrual periods. This is so unpleasant that it at times causes stress and depression especially in the young girls who are just starting their menstruation. It can also lead to low self-esteem and loss of jobs at times. Just imagine yourself communicating to your boss that you failed to attend work because of periodic pain. Therefore we need to address this issue in this article.

Doctor explains

Pain during menstruation or what we call in science dysmenorrhea is abnormal. It is absolutely abnormal for someone to feel pain while undergoing their menstruation. Actually menstruation is supposed to be fun for most women, but most of them receive very unpleasant pain. This pain can be in the lower abdomen or what we call the pelvic region but some women can also feel it at their back and that is what we call radiation of the pain. And at times this pain can also be referred or it can radiate to the thighs. And someone feels pain in the thighs, they feel pain at the back, they feel pain in the lower abdomen, this is what we call dysmenorrhea.

This kind of pain or dysmenorrhea is categorized into two. There is what we call primary dysmenorrhea or primary period pain. And then secondary dysmenorrhea or what we call secondary periodic pain. Let us look at each and every category we are talking about.

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1.Primary dysmenorrhea.

This happens to a woman whereby you are feeling pain during menstruation but there is absolutely no damage to your pelvic organs. What do I mean? In the pelvic we have the uterus, the ovaries, the fallopian tubes and so many other structures? So if those structures have a problem, then you can experience abdominal pain during menstruation. But if they have no problem at all they are all normal and a woman goes on to experience pain during menstruation, we call that primary dysmenorrhea. This pain is so characteristic that it usually starts actually when a girl is starting menstruation, usually they start getting the pain from that particular time until adulthood. And also this pain mostly radiate to the back. And these pains are also associated with heavy bleeding. You will find that the woman is having heavy blood and then they will have that menstrual period. What causes this? Because we have seen that there is no absolutely abnormality in the pelvic organs the uterus, the tubes, everything is normal. So what is causing this pain? There is a friend of ours called prostaglandins, prostaglandins is one of the chemicals secreted by the body. And you find that these people with primary dysmenorrhea secrete high levels of prostaglandins during that period, and prostaglandins cause or stimulate the contraction of the uterus of the endometrium. You will find that the endometrium is contracting and then after contracting of course the person will feel pain. How will this occur? During contraction there is constriction or narrowing of the blood vessels that are supplying or blood vessels of the endometrium or the blood vessels of the uterus. So when these blood vessels are narrowed it means that less blood is going to supply the endometrium. So because less blood is supplying the endometrium, it means less oxygen is reaching the muscles of the uterus. When there is less oxygen reaching the muscles of the uterus, the muscles will pain and this is the same pain people feel and that is what we call the cardiac pain. If we look at the explanation of that cardiac pain you will find that it is the lack of oxygen that is causing the pain, the same thing is applied here in the uterus that someone will feel the pain because of the reduced supply of oxygen and this is coming from increased levels of prostaglandins, increasing uterine contractions, reducing or narrowing the blood vessels, thus reducing blood supply to that part and thus reducing oxygen to that part and the person will have pain. And this is what we call primary dysmenorrhea. I told you in the beginning that most of these women also have heavy bleeding. So the same thing will happen, because you are having heavy bleeding especially with the clots, the uterus has to contract in order to eliminate or to push out that clot or push out that blood. And in the process of contracting the uterus or the uterine muscles are again going to constrict the blood vessels. When the blood vessels are constricted, thus less blood supply to that area. When there is less blood supply to that area, remember in our science we said that red blood cells carry oxygen. Therefore if the blood vessels are reduced, blood supply is reduced, it means oxygen is also going to be reduced in that particular area, and therefore you are going to feel pain.

Risk factors of getting Primary Dysmenorrhea

There are some risk factors for getting primary dysmenorrhea. What do I mean by risk factors? I mean that if you possess any of the following, there are high chances that you get primary dysmenorrhea.

  • Family history of primary dysmenorrhea. If in your family there is someone or your parents and so on have been having primary dysmenorrhea it means you also have a high chance of getting this dysmenorrhea.
  • Another issue is early menarche. What do I mean by early menarche? Ladies or girls who begin menstruation early especially girls who begin menstruation at nine years, ten years, or what we call below 11 years, they are at a very high risk of getting primary dysmenorrhea.
  • People who smoke.
  • And then lastly is obesity. I have not read anywhere where obesity is important for human health. So here it comes, it is also one of the risk factors for getting primary dysmenorrhea.
Secondary dysmenorrhea.

2.Secondary dysmenorrhea

This is whereby there is an underlying pathology in the peripheral region what do I mean there is an abnormality in the pelvic organ. So we said that in the pelvis we have the uterus, the fallopian tubes, the ovaries, and so on. If any of those structures has an abnormality or if any of those structures is sick, then a woman can experience pain during menstruation this pain is also characteristic in such a way that at times they even feel pain even before a week prior to menstruation? So that pain can happen at any time though it intensifies during the menstruation or during the menses.

So what can really cause secondary dysmenorrhea?

  • Number one and the major cause, above 80 percent of women with secondary dysmenorrhea have endometriosis. And what is this animal called endometriosis? Endometriosis is a condition whereby the underlining of the uterus implants itself somewhere else. What do we mean here? If you look at the uterus, the uterus has a space inside, I guess everyone understands our uterus or the womb. It has a space inside so the membrane that underlines that uterus inside is what we call the endometrium and it is this endometrium that bleeds during menstruation.
  • Actually during the menstruation when the egg is not fertilized, the underlining of the uterus will be shed off and this is where menstruation comes from. I mean this is where messes or blood comes from. That is menstruation. Now what happens when this underlining of the uterus or the endometrium is implanted somewhere else for example outside the uterus, in the ovaries, or just in the pelvic cavity? What would happen? The time someone is supposed to bleed will come and therefore that person will bleed. Bleeding will occur outside the uterus. And when bleeding occurs outside the uterus there is no way it can be eliminated because normally when there is bleeding in the endometrium or in the inside the uterus blood will be propelled or will be pushed out through the cervix and then someone undergoes menstruation like you see.

    But now when bleeding happens outside the endometrium for example in the ovary, in the tubes, or even outside the whole structure. And it happens in the peritoneum somewhere there, then blood will be there and it has no way it can be eliminated out and that will cause pain. Therefore endometriosis is one of the major and main causes of secondary dysmenorrhea. I guess you have understood me. I have said that endometriosis is whereby there is implantation of the underlining of the uterus outside the uterus and when that happens there will be bleeding outside the uterus and that bleeding outside the uterus will cause that discomfort or pain.
  • Another cause of secondary dysmenorrhea is Adenomyosis. Adenomyosis is like a friend to endometriosis. What happens in adenomyosis? I am sorry my friends these terms are really big but I will try to explain them. Adenomyosis is whereby the underlining of this uterus is now implanted within the uterine muscles. When we are looking at the uterus we say the uterus has three layers. It has that membrane which is outside or the muscles that are outside the uterus, then there are muscles in between, and then muscles inside. So there is that layer outside the layer in between and then the inner layer. So at times in some people find that, the underlining of the uterus, the endometrium will implant itself in the middle of the muscles of the uterus. And when this happens of course bleeding will occur in the middle of the muscles inside the muscles and when breathing occurs inside the muscles again severe pain is going to occur during your messes.
  • What else can cause secondary dysmenorrhea is ovarian cyst. I discussed about the ovarian cyst and I guess if you would like to get more about the ovarian cysts you can check one of my articles concerning ovarian cysts. These ovarian cysts are one of the causes of secondary dysmenorrhea. PIDs. These Pelvic inflammatory diseases I also discussed about this but they can also cause secondary dysmenorrhea.
  • There are also what we call polyps. Polyps are like growth within either the uterus or at the cervix or anywhere in the pelvic region those polyps or the growth or the masses can cause dysmenorrhea which is secondary.
  • And lastly I will talk about fibroids. We talked also about the fibroids, I will not expound them if you would like to know more about the fibroids again reach out to one of my articles you will understand what fibroids are and how they actually cause secondary dysmenorrhea.

Remedies that can be used to calm the pain.

But now most importantly we would like to know how you can help yourself. We are looking at the self-help, home remedies. What you can do if you have this condition whether it is primary or secondary but mainly it should be the primary. The primary, there are many things we can do about it but for the secondary you need to go to the hospital and they treat the cause. Because we have seen that for secondary dysmenorrhea, there is absolutely an underlying cause. There is a pathology within the pelvic organs like endometriosis, adenomyosis, PIDs or any of those infections and so on. So if you have any of them, then you need to go to the hospital get treatment of course dysmenorrhea will go away. But if it is a primary dysmenorrhea this one will have no control, you will not do anything about it. There is no disease known that you can treat. So what are you going to do? You are going to do something at home in order to get relief.

  • Number one we recommend exercise. Do some exercise actually this has shown that leads to production of endorphins. Endorphins are like feel good hormones. I do not know if you understand this. When you do exercise they stimulate production of endorphins and endorphins are those hormones in the body that make you feel good. So even during that kind of displeasure, feeling that pain, the endorphins can act in a way that there is no pain and you feel good. So exercise can help. You can do some yoga, you can do jogging, you can do some good exercise and then you can have relief of that pain.
  • What else you can do is to use warm water. You can get warm water, you can either drink it, and some people put it in the bottle or another in a container and then just massage it in the lower abdomen.
  • Something else you can do is to take a position that is comfortable for you. There are some positions that are really good that are helpful for someone for example they bend if you bend upwards or you bend in front like you see in this picture, if you have that pain and you take that position some people will feel some relief now.

If all those ones cannot work for you, then we have got the next step and that is the medication you can buy some medicines, there are over-the-counter medicines called NS-Aids. These are non-steroidal and inflammatory drugs. Examples of these drugs are ibuprofen, Celecoxib, Diclofenac those medicines can help you to reduce that pain. Why? Because NS-Aids will act on, remember we talked about the main cause of this primary dysmenorrhea is the excessive production of prostaglandins you remember. So what these NS-Aids will do is to reduce or to inhibit the secretion of prostaglandins and when these the prostaglandins are reduced of course the pain will also reduce and it will go away.

So you can take painkillers or those painkillers we are talking about. Ibuprofen is one of the commonest NS-Aids used. So you can use ibuprofen or what you people call Brufen you can use a Diclofenac, you can use Celecoxib, you can also use Mefenamic acid. Mefenamic acid is a little stronger than the above. There is also Trancinamic acid and so on. So when you are using those NS-Aids you should also remember that they are not good or they are not supposed to be used in some conditions. For example if you have ulcers then NS-Aids are not a go area for you. People with bleeding disorders, if your doctor told you, you have a bleeding disorder, you have such kind of disease, if you have asthma. Then ibuprofen or those NS-Aids may not be good for you and therefore you should also first seek advice from your doctor before you use them.

Now if the pain persists after using your ibuprofen you have used the Diclofenac or a combination, by the way if you also get a combination of ibuprofen or a combination of Diclofenac with Paracetamol or what most people call Panadol. If you get that combination it can be better off for you to get relief of that pain.

But if the pain fails, if it persists then you need to go to the hospital and get more advanced painkillers because we have what we call the analgesic ladder. If we use the NS-Aids and they are not able to work, we can go to other painkillers like the opioids and so on. We can even reach the level of Pethidine. I have received several cases whereby you give all those painkillers and they fail to work in this individual and we end up with even those higher painkillers like Pethidine.

Some other medicines that can be used to stop this pain are the oral contraceptive pills actually if you use the other analgesics and they really do not work for you then we can opt for oral contraceptive pills but will of course use these contraceptive pills in a person who does not want to give birth in the near future. So how will they work for you? These Oral contraceptive pills stop ovulation. And when ovulation is stopped of course the prostaglandins will not be stimulated and when prostaglandins are not stimulated of course you do not have this pain.

WHY SOME ONE TESTS HIV NEGATIVE YET THEY ARE POSITIVE (REASONS FOR FALSE NEGATIVE AND FALSE POSITIVES). HIV WINDOW PERIOD

Why should someone test negative for HIV when they are actually positive? Can someone transmit HIV to the partner when still in the window period?

Qn: Hi Dr Uthuman, am Herman N. I did an HIV test before marrying my wife and we both tested negative. However, four months later when we went for antenatal care, she was found positive while am negative. We both agreed to separate but I remained taking care of her because she was carrying my baby. What surprises me is that yesterday after 4months of separation, I tested positive yet I never had any other affair. Am very confused and worried. Why did she test negative yet she was positive and how did I acquire HIV four months later after separating with an HIV positive person?

Answer from the Doctor.

Quite often such stories make us emotional and indeed this is one of the saddest stories I have had in my medical practice.

  • “These are rare circumstances that we often come across. It is not surprising that such a scenario, our friend found himself in such shoes. It is very possible that he by the time these two people did the HIV test one of them must have been infected. Though when somebody gets an infection there is what we call a window period. A window period is the period it takes the HIV virus from the time it gets into your cells, to the time when it starts making other new viral copies, making new viruses. And this period can range from three months to nine months” Said Dr Kamoga Samuel an HIV expert from The Aids Support Organization (TASO) in Uganda. So this is the period it takes to make new copies of the virus and the body to start responding by producing antibodies against the virus. Antibodies are our defense cells that fight against the virus.
  • When this HIV comes into your cells it goes into dormancy and brings its genetic material, inserts it or puts it into your body cells, and then it first keeps quiet. So that period when it has entered to the time when it starts now making viral copies and gets detected into the blood that is what we call Sero-Conversion in science. Therefore, before sero-conversion, the virus is inactive and the body may not have realized that there is an enemy within the body to start producing soldiers to guard the fight the enemies. And when you look at some of these tests that commonly are used, they test the antibodies.

    They test the presence of soldiers against the HIV virus. Therefore, it can so happen that if I got an infection today you test me tomorrow I will be negative because in the body, there seems to be no activity. Now my reader I think this is really going to be very challenging for all of you because you can be positive yet tested negative it is very possible. So please always take caution!

    So here there is a very big point someone is in their window period can they spread the virus? YES! Actually this is one of the times when the virus is highly multiplying into your body and therefore if you had unprotected intercourse with a person who is in her or his window period you can contract the virus therefore you are not safe.

  • Secondly, if somebody has been already HIV positive and has been on treatment over time frequently without defaulting or missing their doses for some time, it means that the virus is getting almost wiped out of the body. Because drugs stop the virus from producing viral copies and as time passes by the body reaches a stage where it feels as if there is no infection because all these copies have been wiped out. Therefore the HIV antibody test will show negative results but remember the infection is still in your body because its DNA is still there. So if this person stops taking the medicines, it again starts making more copies and the results will turn out positive again.
  • In such a scenario it happens that if this lady was already on treatment and this gentleman did not know and they used the HIV test strips determine, stat-pak (HIV antibody tests), there are chances that you can get a false negative result.

    One of the tests that you can use to confirm whether somebody is having some HIV viral material in his or her body or not, is called DNA. The HIV RNA PCR or HIV DNA PCR. That is the test you can use at any time to confirm either presence or absence of viral HIV material in your body.

    Actually DNA PCR is also the same test we do for testing children who are below 18 months. If the child is still 18 months and below, we do not use the usual tests we use the DNA PCR. And I think you have seen various children they are getting dry samples or getting blood from their feet ,from their toes and that is DNA PCR.

    Way forward

    It is very important to note that for HIV, you are negative as at that time when you were told that you are negative. That is why its encouraged that after doing the first test and you are negative wait after like three months just like the way this gentleman did and repeat the test. Because he says in his question that after four months he tested and he was found positive. Meaning that there are things I get from this kind of scenario and a question in that it seems this lady when she got married to the gentleman she stopped taking medicines because now they were together she feared to be known that she is HIV positive just as we said earlier, that now the virus now started again making copies in the body making more antibodies so when they went back for a test it was positive. That one tries to make anybody understand that when somebody takes his or her medicine consistently regularly very well for some time the body reaches the point as if there is no infection when truly there is an infection and therefore in this situation you can test falsely negative but you take any time off medicine even if it is just two weeks and you repeat the test it will be positive.

    Conclusion

    In my conclusion I would say that there are two possible reasons why this lady tested negative in the first place when she was positive. One, either she was taking her ARVs and or two, she was in her window period. Then the reason why she tested positive after a few months is that probably the window period had expired or she stopped taking her ARVs because she was with a new partner. And then the gentleman testing negative on the second time after having affairs with this woman is the reason could be that he was also still in his window period and he tested positive four months later when the window period had expired. And therefore, this is an advice to everyone. Before you marry this beautiful person this handsome man you want please test them not only once but twice or three times in a space of three months, to be very sure that you are taking the right person of your choice. And lastly it is not a good idea to separate with your partner because the partner is HIV positive it is always good to go to your counselor. The counselor will counsel you will talk to you about how to stay with your partner when you are discordant.

PELVIC INFLAMMATORY DISEASES AND INFERTILITY EPISODE 3

How infections cause infertility? Causes, Signs and symptoms, Prevention and possible treatment of Pelvic Inflammatory diseases.

Today we are talking about Pelvic Inflammatory diseases. Every time am talking about Pelvic Inflammatory diseases I even get insane. Pelvic Inflammatory diseases are one of the major causes of infertility in the world. Most women have failed to get pregnant, most women are being called barren, because of Pelvic Inflammatory diseases.

What are Pelvic Inflammatory diseases?

Pelvic Inflammatory diseases like the one sound PID, comes from the word Perfect Inflammatory Diseases, what some people call infections. What are these diseases? Lets look at the reproductive system of a woman. So this disease or these infections affect the reproductive system and that is the Vagina, the cervix, the uterus, the Fallopian tubes and the ovary.

Causes of Pelvic Inflammatory diseases

How does this come about? What causes these Pelvic Inflammatory diseases?

  • Most of the Pelvic Inflammatory diseases are caused by Sexually transmitted diseases (STIs). Sexually Transmitted diseases are the biggest culprit here, is called gonorrhea. Gonorrhea is one of the main causes of Pelvic Inflammatory diseases and it is an STD. Actually I have seen several people passing around, you find someone in town saying “You know my doctor said I have infections". "My doctor said I have Pelvic Inflammatory diseases" my friend you are talking about sexually transmitted diseases because 90 percent of the Pelvic Inflammatory diseases are caused by STDs. The gonorrhea and chlamydia of this world. And how does someone get these diseases?
  • Of course your partner has an infection or your partner has an STD, like chlamydia or gonorrhea. You have live or any protected sexual intercourse and you acquire it. At first it will not affect directly the Pelvic Inflammatory diseases parts or the uterus, the fallopian tubes to become a PID. They will first of all be sexually transmitted diseases there are the STDs which will be affecting only the vaginal area. However if this infection, this gonorrhea, the chlamydia is left untreated, because some of them actually we shall look at the signs and symptoms, some of them may not even get you may not even get the symptoms. So if they are left untreated, they can ascend. So Pelvic Inflammatory diseases are as a result of ascension or the ascending of infections into the upper centers of the reproductive system. What do I mean? If you have gonorrhea or chlamydia and it is not treated, it will travel. It will move. The bacteria will move and reach the uterus, the bacteria will move and reach the fallopian tubes and even the ovaries. And at the end of the day you will have a PID. Same applies to the chlamydia. So these Pelvic Inflammatory diseases are mainly sexually transmitted.

  • Actually some of them are transmitted by you yourself. How? You have a PID, you have some small infection maybe bacterial Vaginosis or chlamydia or the gonorrhea, but it is still within the vulva or the V area. The vagina. What is going to happen? You women, most women do not know how to wash themselves. This issue called douching. You will find that a woman is trying to put two fingers inside. They dip both fingers inside and is trying to scratch and remove I do not know what. And they spend even a lot of time someone is putting fingers there to remove dirt. That is not the best way of managing the hygiene of that area. You are not supposed to put the two fingers because actually when you put the two fingers when you fix your two fingers there, they are the ones going to transmit this infection. Probably, the bacteria or germ may be around the vulva or the vagina area and then when you put your fingers you wll get the infection and push it onto the cervix. And when it reaches the survival area, of course it will be able to move. And therefore what I usually tell the ladies that come to me, I tell them not to wash like that. What do they do? Just wash outside or wash with all your four fingers. Where the four fingers do not reach. Do not go there. Do not try to fix your fingers inside there because at the end of the day you may even cause injuries. Actually somebody told me "you know doctor I first clean myself, I wash myself with a detergent, maybe with a sanitizer and then I put my fingers there". However much or whatever soap you use to wash your hands, your hands will still remain or your fingers will still remain with germs. They will still remain with bacteria and it will be you yourself to transmit or to transfer those bacteria into the higher centers of the reproductive system and then you end up with a PID.

Signs and symptoms of Pelvic Inflammatory diseases.

How will you know that you have a PID? What I want you to understand and you must be very cautious is that some women do not get symptoms of these Pelvic Inflammatory diseases. Actually a PID comes, you have it, but you are not seeing any sign and symptom and maybe probably the only sign you will get, will be the complication of this PID. Probably one year, two years, you are not getting pregnant you are/ not giving birth. It can be a sign for you and when you go to the hospital they will tell you, you have Pelvic Inflammatory diseases.

  • Most women will experience lower abdominal pain. Actually this is one of the cardinal signs or symptoms of Pelvic Inflammatory diseases. Women have lower abdominal pain, they feel pain in the groin region.
  • Secondly is dyspareunia. What I mean by dyspareunia is pain during sexual intercourse. Actually this is one of the major signs. If you have experienced pain during sexual intercourse you should run to your doctor and find out if you have a PID.
  • Some people have vaginal discharges. The discharges can be yellow green and so on. And that is a sign of a PID.
  • Other people will have frequency of urination (increased urination habits), pain during urination and so on. Those are symptoms of a PID plus other symptoms.

How will the doctor confirm that you have a PID?

A doctor will do an examination called VE or a vagina examination. And this examination will be able to elicit tenderness or pain on your cervix. The doctor will try to touch or to trickle your cervix and if you feel pain it will be a very big sign for him that probably you have a PID.

Secondly, is that of course by examining or looking at those discharges, it can also be assigned to us that you have a PID.

And also we can decide to do an ultrasound scan but with a scan that really is able to visualize all to look at a PID very well which is a trans-vaginal ultrasound scan, and that is the scan we put down, you know these usual scans we put a probe, I think most of you have gone to scans, we put a probe just here on your belly. But for the trans-vagina we put the probe down and we are able to look at the tubes and so on. There are several features on the ultrasound scan that can probably or predict that you have a PID. But largely most Pelvic Inflammatory diseases are diagnosed by your signs plus the features or the signs the doctor will list.

How does this PID cause infertility?

When you get a PID for example your uterus is irritated, the endometrium you have got an endometritis or you have fallopian tubes that are inflamed, there is a lot of water around here. The tubes are inflamed, the tubes are solid what will happen is that of course they can heal, when they heal they will heal with scars there will be scar formation. And when there is scar formation, you remember what I told you about the fertilization, how the egg is supposed to move and meet the sperm. How is this sperm going to swim to reach the egg which is which will be here when there are a lot of scars here. So what is going to happen is that the sperm will stop here and the egg is around here so meeting will take place and fertilization will not occur. Same applies to an egg which may be in the ovary and fails to be propelled or to reach this end where fertilization is supposed to take place and at the end of the day you will have infertility. Fertilization will not occur.

Secondly is that the tubes can be swollen. They can be swollen to an extent that they block the entry of this sperm into the region where it is supposed to carry on the fertilization and of course infertility will come from there.

And another complication which is very dangerous is ectopic pregnancy. What do I mean? In case this sperm manages to swim and reach this egg, fertilization occurs and the zygote is supposed to move this zygote will remain at this place or it will move a little bit and fails to come for implantation into the into the uterus. So when this zygote remains in the fallopian tube you will end up with an ectopic pregnancy. And I told you the other time that an ectopic pregnancy or a pregnancy that is inside the fallopian tube cannot reach term. Because this tube is very small and it is not expansive like the uterus. The other time we say that the uterus is expansive. However small it is, when the baby grows bigger, the uterus also expands and grows bigger but this tube will not expand to that extent and therefore when the baby grows to about two months, three months, in most cases it may not even reach three months, the tube will rupture. And this is an emergence. This is one of the major obstetric emergencies or gynecological emergencies we have in hospitals. So it will burst and issues will come. Therefore, even when this sperm survives an ectopic pregnancy can not. Therefore these Pelvic Inflammatory diseases can lead to infertility in that way.

How can Pelvic Inflammatory diseases be treated?

Very simple. This is not some disease that really scares the medical professionals. It does not. The only thing is when it comes and you are not aware. But once you get to know that you have a PID it is just like eating a piece of cake. Because after testing, after doing the swabs, you have confirmed that this is gonorrhea, this is chlamydia, this is Trichomoniasis, this is any of the microorganism causing the PID the treatment is there. Antibiotics! Simple antibiotics. Depending on the severity you can either get IVs or injections or just capsules to swallow. If it is chlamydia a drug called doxycycline is just enough. We just give that drug for around two weeks and it will clear. So if it is any other depending on the bacteria we are suspecting or we have confirmed then you can get antibiotics either by injections the Metronidazole of this world, the said Ceftriaxone, Levofloxacin, Ciprofloxacin all those are some of the antibiotics that can help us in managing this PID therefore treating this PID is not an issue.

The big issue is failure to recognize that it is a PID. And also treating it when it is already late. Because you can come to the hospital when it has already formed the scars and therefore yes you treat the infection the bacteria will die however, the scar will not go away and it can lead to infertility even when the disease is treated. So therefore the most important thing is understanding how you can prevent this.

How to prevent Pelvic Inflammatory diseases.

Because I told you the highest percentage of Pelvic Inflammatory diseases are caused by sexually transmitted diseases therefore, my friend condoms are there. Let us use protection, use condoms if you are not sure of your partner. People who are using multiple sexual partners they are at risk of getting these Pelvic Inflammatory diseases. You are a lady there, but you have someone who buys for you clothes, another one pays for your transport, another does the hair, the makeup, the nails, someone else pays for rent, you are at this risk of getting a PID because you are using several men several partners and they are also using several other partners and that is when we come to multiple sexual partners with multiple sexual partners. You have like three or four but one of the guys one of the third person is always having like three or four. You are a candidate my friend. You are a candidate. Therefore, if you are in such a category, try to use protection so that you do not get these Pelvic Inflammatory diseases.

And another thing is avoiding that douching we talked about. I told you that it is you that transmits this infection. You may find it is a simple infection just in the vulva. But you put your fingers there, fix them deep and they reach the cervix. When they reach the cervix of course they will ascend into the uterus, into the fallopian tubes and the ovaries and at the end of the day you have a PID. Therefore adopt safe methods or safe ways of washing yourself and I said that because some of you quote me that our doctor said we should not wash ourselves. So you go on. No!! Wash but the way you should not go further. Do not go deep inside there. Where your fingers do not reach, you should not reach there. So in other words when you are washing yourself put your four fingers there, all of them so where they do not reach do not also go there because you are invading an area you are not supposed to go. And if some of you will say but doctor we shall smell no way! How to prevent Pelvic Inflammatory diseases Because I told you the highest percentage of Pelvic Inflammatory diseases are caused by sexually transmitted diseases therefore, my friend condoms are there. Let us use protection, use condoms if you are not sure of your partner. People who are using multiple sexual partners they are at risk of getting these Pelvic Inflammatory diseases. You are a lady there, but you have someone who buys for you clothes, another one pays for your transport, another does the hair, the makeup, the nails, someone else pays for rent, you are at this risk of getting a PID because you are using several men several partners and they are also using several other partners and that is when we come to multiple sexual partners with multiple sexual partners. You have like three or four but one of the guys one of the third person is always having like three or four. You are a candidate my friend. You are a candidate. Therefore, if you are in such a category, try to use protection so that you do not get these Pelvic Inflammatory diseases. And another thing is avoiding that douching we talked about. I told you that it is you that transmits this infection. You may find it is a simple infection just in the vulva. But you put your fingers there, fix them deep and they reach the cervix. When they reach the cervix of course they will ascend into the uterus, into the fallopian tubes and the ovaries and at the end of the day you have a PID.

Therefore adopt safe methods or safe ways of washing yourself and I said that because some of you quote me that our doctor said we should not wash ourselves. So you go on. No!! Wash but the way you should not go further. Do not go deep inside there. Where your fingers do not reach, you should not reach there.

So in other words when you are washing yourself put your four fingers there, all of them so where they do not reach do not also go there because you are invading an area you are not supposed to go. And if some of you will say but doctor we shall smell no way!

Actually let me tell you this. This system has its own way of cleaning itself. Let us ask ourselves several times we wash our faces and eyes but has any of you ever opened the eye lid and then you try to wash deep inside the eye, no you do not. But at the end of the day the eye does not get dirty. The eye is already clean the globe or the eye is always clear. We only wash outside where these four fingers reach is where we wash and that is for the eyes. Same applies to this precious this prestigious system, it can clean itself it has that mechanism of propelling the dirt and so on to get out without your involvement. You only need to apply little and some of you put some you are not supposed to put any detergent just use plain water and wash outside and all that area where the four fingers can reach. Because at the end of the day this system can propel, can bring its own blood. Blood can come from here during menstruation. Is it you who picks it from there? No! For you, you just put your sanitary towel and wait for it to flow. And therefore it has its own mechanism. It is mechanism of eliminating all that you think you are eliminating. Therefore by avoiding this kind of douching we have talked about, you will be able to reduce the risks of transmitting these infections from the vulva area to the higher centers of the productive system and thus you will be able to avoid or prevent yourself from getting Pelvic Inflammatory diseases.

INFERTILITY EPISODE 2 FIBROIDS

What are fibroids, causes, treatment and how you can prevent fibroids?

Fibroids are one of the leading causes of infertility in women and we are in our second episode about infertility. In the last episode we discussed generally about infertility, where we looked at how a child is formed, how fertilization occurs, how the child is formed, how the child is kept in the mother’s womb, and how birth occurs normally. And we also looked at areas where problems can happen for someone to fail to conceive and that is infertility. So in this episode we would like to specifically look at one, diseases that can cause infertility, and that is fibroids.

What are fibroids?

Again when we have to look at the reproductive system of a woman. We talked about the uterus as the area where: Sperms swim through to reach the egg, as the area that keeps the baby, and the area that also contracts to push the baby out. When we are looking at fibroids, we want to understand these things.

A fibroid is a mass, call it a swelling that is found in the uterus. This swelling is not a cancer and that’s why in science we call it a Benine tumor or a Benine swelling. Because it’s not cancerous. These swellings can range in size, there are those they can begin from a size of a rice grain to a size of a fist and even more. These fibroids have different types and we get types according to where they have grown or which part of the uterus the fibroid has grown.

So we have what we call the Sub-Seroso fibroid. This fibroid grows just like at the outer lining of the uterus. You don’t need to know about those terms, you just mind about where the fibroid is. So this fibroid is just at the outer lining of the uterus.

We have another fibroid or another type of fibroids called the intramural. The intramural is found just within the muscle, when you look neither outside nor inside, you will not see it. But it is just within the middle of the muscles and that is an intramural fibroid. We also have the Sub-mucoso fibroid or a fibroid that is found within inside the lining of the uterus. So usually the doctors will tell you, you have a fibroid and this fibroid is sub-seroso, this fibroid is intramural, this fibroid is submucoso. Just know when they say sub-mucoso, it means your fibroid is inside the lining of your uterus. When there is an intramural, it means it’s in the middle of the muscles of the uterus. And when they say it is sub-seroso, it means it’s just outside the outer lining of your uterus. So those are different types of fibroids.

Now someone wants to know. What causes these fibroids? What happens? Why should someone get fibroids?

I want you to understand that the cause or the main cause of fibroids is generally not known. Doctors don’t know what causes fibroids. However there are some researches which have been done, and they are pointing towards some factors that can lead to the formation of fibroids. However generally because you find someone with a fibroid, and you look for any cause among the possible causes and there is none yet someone has a fibroid. And therefore we call that idiopathic. Meaning that largely the cause of fibroids is not known.However most people that have had fibroids have the following factors and therefore most researches confirm or most researchers believe that the following are the causes of fibroids.

  • Prolonged exposure to estrogen. In the other episode we talked about two hormones progesterone and estrogen. These two hormones progesterone and estrogen work like co-wives. These two hormones work like one is in the government and the other one is in the opposition. What the other one does is the reverse of the other. Progesterone is a hormone of pregnancy and when someone conceives, during that period, they have high levels of progesterone. And therefore when there are high levels of progesterone, the levels of estrogen go low. It’s like almost someone has no estrogen. In very little amounts you will find it there as compared to progesterone. When someone delivers, the level of estrogen will go high, and progesterone will go low. These two hormones work antagonistically. One is the opposition and the other is the government. So when you are pregnant, the levels of progesterone are high. But once you give birth, progesterone goes low and then estrogen shoots. When you get long exposure to estrogen, for instance people who take long to produce. Someone enters their 30-35years and so on without getting pregnant just know that you are now a culprit or you’re becoming a candidate for a fibroid. Because your progesterone levels are low and then estrogen is high and the uterus is exposed to high levels of estrogen and therefore you may end up with a fibroid. And that’s why for all people with fibroids, when you look at their histories you’ll find that they have spent a long time without giving birth.
  • Another risk factor is that those people who begin menstruation early at around 8years.And then they take long to get pregnant, 30-35years hence being exposed to high levels of estrogen and low levels of progesterone. Therefore they are candidates for getting fibroids.
  • So what happens exactly? For someone to get a fibroid because of long prolonged exposure to estrogen or to high estrogen levels. I said progesterone is a hormone of pregnancy. So when progesterone is there, there is pregnancy. Someone is pregnant. When progesterone goes away, and you now have estrogen, someone doesn’t have a baby. So what will happen is that the uterus will demand. When time passes the uterus will feel like it should have a baby, the ovaries will feel like the baby should be there. And therefore there is going to be a hormonal interplay there. And then there will be a communication and the uterus will want to have a baby, therefore the uterus will form a doll. The uterus will not form a real baby, but it will form a doll. It’s like when you don’t have a child, you can have a teddy bear. So this uterus is also going to form a teddy bear and it will grow like a baby. Therefore when there is something, the uterus will feel like there is a baby inside. And that is how people end up with fibroids.So that is the major factor for someone to get fibroids.

  • Secondly these fibroids have been linked to genetic causes. And there are some people with genes that can lead to formation of fibroids in their body. And that’s why fibroids are hereditary. You will find that a certain family, some people are getting fibroids when the mother had a fibroid, the daughter and the grandchild is having a fibroid, so you find that the fibroid is running through the families.
  • Another risky factor for getting fibroids is age. We talked about when someone is about 35years.When you are above 35 years, remember there is that long exposure to estrogen for all that period of time and if its coupled with non-child birth or not getting pregnant, then at the end of the day you may end up with the a fibroid.
  • Other factors include vitamin D deficiency. People with vitamin D deficiency are also culprits or their candidates for getting fibroids.

Signs and symptoms that you may have a fibroid.

Actually most of these fibroids are asymptomatic. This means that someone cannot realize that they have them. Most of them actually around 80% of them come unnoticed. Someone spends with a fibroid a period of five years and he’s not aware that the fibroid is there. Actually most of these fibroids are incidental findings .Someone comes with something else or with another disease, you do an ultrasound scan, and you find a fiber already there. However those that have signs and symptoms, the following can happen to a person with a fibroid.

  • Lower abdominal pain. These people get low abdominal pains. That is pain below the umbilical region. Secondly, which is also the most common, is prolonged and heavy bleeding during menstruation. These people also can have inter menstrual bleeding. Whereby someone bleeds in between their cycles.
  • So if you see such signs you have some lower abdominal pain, inter menstrual bleeding and heavy prolonged bleeding, it should prick into your mind that probably you may have a fibroid and you may need to go to the hospital for a checkup.
  • Other signs come as a result of increase in size of the fibroid. When this fibroid increase in size, it causes pressure symptoms and people will now present increased micturition whereby every time someone wants to go and urinate. That can be a sign of fibroid that the size has increased hence causing pressure symptoms. Constipation, lower back pain and so on can be some of the signs of a fibroid.
  • If you have a fibroid, because we’ve said some of them are symptomatic, you may not get to know the signs and symptoms. What should you do? Go to the hospital and one of the easiest tests that will be done is the imaging and that is the ultrasound scan. When an ultrasound scan is done, it can see a fibroid. Very easy you don’t need to struggle because you know an ultra sound scan is non-invasive and painful so you’ll be able to detect whether you have a fibroid or not. There are also x-rays like an HSG,Hystero pendulogram that is an x-ray where they first introduce a dye and that can also be able to visualize or to indicate you that you have a fibroid.

Now another major question should be, are these fibroids treatable? Can I treat them?

Yes! Fibroids can be treated by the following.
  • Medical treatment but also the surgical treatment of fibroids. If you look at the medical treatment because we generally believe that prolonged exposure to too much estrogen in the body for a long period of time can lead to formation of these swellings of these fibroids. Now if you’re giving a medicine for fibroids you have to target the estrogen level. And therefore largely we are using Hormonal intrauterine contraceptive devices. What we call an IUD that is hormonal bearing. It contains a hormone called progesterone. So it’s a slow releasing hormone. Progesterone is released in the body slowly and it can be able to treat a fibroid.
  • Largely also we use a gonadotropin releasing substances or products or agonists. Those agonists can be able to also reduce and shrink the size of the fibroid.
  • There are several other treatments to use, you can use family planning pills, the progesterone only pills because if you look at these oral contraceptive pills or these oral family planning pills. Those tablets you swallow for family planning are of two types. There are those they tell you, this one can be taken by anyone. But again they say, if you are breast feeding, you are not supposed to take this. So it means there are two types of contraceptive pills. The progesterone only pills and those are the pills we give to breast feeding mothers and there are also these other pills that have both the yellow and then the brown color. So if you have a fibroid we may advise you to take the other white pills those that are progesterone only. We call them POP(progesterone only peels) the one that is taken by a woman who is breastfeeding or a lactating mother. So those pills can also be able to shrink the fibroids. Why? Because they contain progesterone. And I told you progesterone is an opposition leader versus the government which is estrogen. When you introduce progesterone in the body, it will lower the levels of estrogen and therefore it will suppress the growth of this swelling.
  • Largely these swellings may not go off or may not go away completely with medical treatment. And therefore they may require a surgery. Therefore this requires a discussion between you and your doctor to look at very many factors such as; the size of the fibroid, the type (where is the fibroid), fertility intentions (do you want to have more children or you don’t want to have more children?).So after looking at that, then you can decide on the other medicals I have talked about or the surgery. What surgery can be done? We call it a myomectomy. What we mean by myomectomy, we just cut below the umbilicus, and we make a very small incision, we go to the uterus, examine it to look for where the swelling is, and remove it. We just cut it out, stop the bleeding and then you get fine. That’s is called a myomectomy.

However there are those swellings that are really too big, and they have occupied almost the whole entire area of the fibroid. And also depending on the type, whether it is especially the intramural. These ones which are in between the muscles also considering other factors that you may discuss with your doctor and your family, we may decide to do a hysterectomy. This can be a subtotal or total.By hysterectomy we mean removing the uterus. And that can be either removing a small part of the uterus and that is what we call the subtotal or the whole of the uterus. But I told you this will depend on your individualized talk with the doctor.

So someone may be asking how this fibroid is causing me not to get pregnant.

Just assume that there are fibroids here. Multiple of them or just one fibroid. How is implantation going to occur? Because remember we said that after fertilization, the baby has to come and implant or it attaches itself on the wall of the uterus. How is implantation going to occur amidst these big swellings? So that how you can end up with infertility.

Secondly, these swellings can interfere with the movement of sperms. Imagine sperms have been deposited and they want to pass through, they want to swim. How will you pass through this area (uterus with fibroids)? Which is full of swellings at the end of the day, the sperm may not be able to reach the Ova and therefore fertilization may not occur. Therefore these swellings, or these masses make the conditions unfavorable for the sperm to propel or to swim to reach the ova and they can also make conditions unfavorable for the zygote or the baby which has been formed to implant in this area and that’s how a fibroid also causes infertility.

How can you prevent fibroids?

  • By bearing children .Don‘t take long without getting pregnant. That is one of the issues you should look at.
  • Use some hormonal contraceptive pills especially if you know you are at risk of getting these fibroids because we’ve talked about the risk factors.
  • Also we have talked about the hormonal IUD. You can use it if you really see that you are in that category of people that can get fibroids. However still before using all this we are talking about, have a good talk with your Doctor. Let you have an advice because yes I am talking about a hormonal IUD as far as fibroids are concerned, but it also has its own side effects and that’s why you will find that largely people prefer copper T IUDs.
  • Thirdly, if you would like to prevent yourself from getting fibroids, keep a normal weight. I didn’t talk about it in the risk factors but obesity is one of the risk factors of getting fibroids. Because when you are obese there is increased secretion of estrogen in your body thus being exposed to getting fibroids? Therefore keep normal weights, do workouts, exercise.
  • Take a lot of vegetables and fruits to increase your vitamin D and vitamin C in your body.

INFERTILITY EPISODE 1

What is infertility? What causes infertility and what can you do to get rid of infertility.

Qn: Miss Oluwadamilola Onasanya “please help me doctor, have been married for about 8 months and been expecting fruits of a womb but all to no avail. What will I do?”

Gloria Eskine “ Dr. Please I always go close to my husband while am unsafe for the past 3 years now, but still I have not been able to conceive. So please help me with it because am worried. Thank you”

Answer from the Doctor.

News of child birth bring happiness and joy in our marriages and relationships. However it can be so devastating for a couple to fail to get a child or what some people call the fruit of a womb. And in most times surprisingly people will blame the woman for this calamity which may not be completely true because even the other gender can be infertile. There are many flaunting questions about child birth. They want to see how they can get the fruit of a womb. But let’s first understand what infertility is?

What is infertility?

Infertility is a condition whereby you fail to get pregnant when you are staying with your partner, having sexual intercourse and unprotected for at least three times in a week for a period of one year. What do I mean here? I receive several questions like the ones we have seen previously. People asking about infertility, “I met my partner last month but up now I’m not getting pregnant”, “I met my partner three two months ago I am not getting pregnant” and someone will even tell you “I meet my partner once in a year but I’m not getting pregnant ,doctor I’m so worried”. That may not be infertility. That may not suit the definition of infertility. So for you to say that am infertile or someone is infertile, we must satisfy these three conditions:

  • You must be meeting your partner at least three times in a week.
  • When you meet your partner, you must be having live or unprotected sexual intercourse.
  • The two conditions above should stay for a period of one year.

If it’s less than one year we may not call it infertility. However, if it’s six months, we can call it sub fertility. And therefore when you reach six months and you’re not getting pregnant, then you can start on with the investigations though we shall not confirm that you are infertile.

What causes infertility

Infertility is not only for women and this is where the public goes wrong. Most people think when someone is not giving birth or when the family is not getting a child, the whole family or relatives will gang up against a woman especially in our African culture. They can chase her from her marriage because she’s not getting pregnant .Infertility can be caused by two factors and that is the male and female factors.

In this first episode we would like to look at generally, how infertility comes about in women. Let’s look at the reproductive system of a woman where we have the vagina, cervix, womb or uterus, fallopian tubes or oviduct, ovary and the Ova. So all organs make up the reproductive system of a woman. For you to understand infertility, you must first of all understand the system. Each of these parts has its own function. It has a role it plays as far as reproduction or child birth is concerned.

  • Lets start with the Vagina: the most important reason as to why we have this part for reproduction is that it receives the sperms .Once you have sexual intercourse the sperms are received from this part. This part has a conducive environment and I guess you know it’s acidic in nature. So this condition is conducive for the survival of sperms in this area.
  • Cervix : this is a narrow path that comes from the vagina into the uterus. First of all it allows sperms to pass through and enter into the uterus, and secondly, when someone conceives, this cervix closes so that the baby doesn’t pass through or to stop a miscarriage or an abortion. And also when it’s time for someone to give birth or for parturition, the cervix will open for the baby to get out.
  • Womb or uterus: this is the area where the sperms pass. They swim through this area when they are going to the fallopian tubes, and also this part acts as an implantation site. When the baby comes, it implants here and the baby grows from this area.
  • Then another part is the fallopian tube. This fallopian tube or what some people call the oviduct is the area where fertilization occurs.
  • Lastly are the ovary and the ova and these are the eggs. This is the area where the eggs are or manufactured from.

So what happens for fertilization to occur? And before we even look at the reproductive system, this is what makes reproduction go on smoothly. However there are some other factors or some other structures that are invisible. There are structures you cannot see but they are also part and parcel with reproduction. What are those factors?

We have the hormones and the brain. Take an example that this is a vehicle. That vehicle cannot move unless there is fuel for those that use fuel and or there is a driver for those that use drivers. So if this vehicle is not having a driver or fuel it will never move and the same applies to the structure of reproduction. You cannot conceive when the two that is the hormones and the brain are not in place. So what happens?

We have the brain who is the driver. What it’s going to do is to send a signal. The signal being sent is the hormone. For example a hormone called follicle stimulating hormone, it will be sent to the ovaries, telling the ovaries to manufacture or to cause maturation or to make one of the eggs or two to mature or grow very fast. And that is the follicle stimulating hormone. It is the fuel that is sent by the brain. So when the hormone grows very fast and it matures, then the brain will also send another signal and that is the luteinizing hormone to cause the egg to move.

So what will happen is that this egg will move and it will reach the point called the Ampulla which is found in the fallopian tube. And this is the time when we say the woman is ovulating. Actually I have heard stories of women telling me that they even feel some pain when this egg is moving and it may be true because there are some people that receive ovulatory pains. So this egg has moved on to this area which is ampulla. Now what’s going to happen, you are going to have sexual intercourse today and the sperms are deposited in the vagina. So sperms will now swim through the cervix, they reach into the uterus, they will swim and one of them will fertilize this egg. So once fertilization has occurred, the next step is going to be formation of a zygote and that’s the baby.

So the baby is going to be formed from this area. After the baby is formed at this place called the ampulla, it’s going to be propelled or be move into the uterus. So once the baby is moved back into the uterus, it will now have implantation which is the attachment. This baby will attach itself or adhere, onto the walls of the uterus. What this uterus will do is to feed or provide nourishment, blood and so on to this fetus so that it can grow. Secondly, this uterus is also expansive. The more the baby grows the uterus will allow it and will expand so that the baby can keep there and that’s why the women will have those front humps, they will have big bellies because the uterus is expanding as the baby grows.

Now Mr. Brain also will send a signal here, and it will send another hormone called progesterone. This is what we call the hormone of pregnancy. It is the hormone that babysits or it is the person that babysits this fetus while still in the womb. It keeps telling this fetus “please don’t cry, don’t get sick don’t get out “therefore progesterone is going to keep this baby in the uterus. And now I told you this is a vehicle so we are moving.

Most people know that people deliver at the ninth month, so we have a destination our vehicle is moving because there is a baby everything is okay.The driver and the fuel are there. So what is going to happen is that when we reach our destination, what the driver does, is to put the leg off the accelerator, and then press the brakes. So what the brain is going to do is also to remove its feet from the accelerator and that is to withdraw slowly this progesterone. Because I told you progesterone is the hormone that keeps this baby into the uterus. Therefore ,when you remove it ,it means the baby will get out. But the baby is already grown and wants to get out, therefore the brain will take away progesterone slowly and will now bring other two hormones and that is the break. It will bring Oxytocin and Prolactin hormones. Prolactin will go to your breasts, and start secreting the milk. Because the brain is aware that we are about to give birth and the baby will need breast milk. Therefore Prolactin will start secreting milk. Because the baby is no longer going to be feeding through the uterus.

Another hormone which is secreted at last time during labor is the Oxytocin. What it will do first is to open the cervix or to dilate the cervix so that the baby can pass through. Secondly is to cause contractions and that is what you call the labor pains. The labor pains have to be caused here so that the baby can get out and therefore that is how someone will give birth. That is exactly what happens for you to give birth. This is the normal system.

Therefore what will cause infertility is any abnormality onto any of these parts of the reproduction system. There can be an abnormality somewhere or the brain or the fuel and those are the hormones. So which abnormalities can occur? In this episode we are looking generally at what causes infertility and in other episodes we shall look at each of them.

  • If the vagina is not conducive enough, for example if it’s not acidic enough, it is highly alkaline, every sperm that will be deposited here will die off. It will not even reach the level of the cervix and therefore someone won’t be conceiving. Your vagina is not conducive for the sperms.
  • Next is the cervix especially for those who have a lot of miscarriages. Every pregnancy you get ends up a miscarriage. Two months, three months you are bleeding. It’s the cervix. What is happening to the cervix? It opens anyhow, uncontrollably, the cervix is loose and not thick enough, it’s not long enough thus incompetent. Therefore the babies just get out.
  • Another factor is the uterus or womb. There are some people with a uterus which is slippery. It is too thick and when the sperms come, they cannot swim. The environment is not good for the sperms to swim through. The uterus is infected. It is having endometritism and inflamed. The uterus has masses or what we call masses, swellings like fibroids and cancers. This kind of uterus cannot be able to propel or to allow the sperms to pass through to the fallopian tubes. Again even if the sperms find their way of going to the fallopian tubes and fertilization occurs, the baby will not implant. The baby will come but it doesn’t have where to attach itself and therefore, it will be a miscarriage.
  • Actually there are some people who get miscarriages after just one week of conception and this may not be noticed because there may not be bleeding. There is fertilization that has taken place but implantation has not occurred. It is like someone who takes emergency contraceptive pills which stop implantation from occurring but you don’t see any bleeding because it’s not a real abortion. So problems of the uterus can cause someone not to conceive.
  • Another problem can be the fallopian tubes whereby they may be blocked. So what is going to happen? When the egg comes, it cannot pass through. When the sperms come, they cannot reach the egg hence fertilization will not occur. Another issue, there may be adhesions. What we call adhesions are like scars in the fallopian tube. The egg is not able to pass through the fallopian tube very well. When the sperms reach the fallopian tubes they just stop somewhere there because the edges are ragged they cannot swim very well and even if they manage to swim when you have adhesions and fertilization occurs, remember after forming a zygote, it has to pass through and comes to the uterus. So it the edge is not smooth enough, there is no proprietary action, then this fetus will remain in the tube and thus people getting ectopic pregnancies which is very dangerous. And that is the baby that cannot survive beyond three months. Therefore the procedures will be done and the baby gets removed. All those are causes of infertility.
  • The other issue can be on the ovary and the ovaries. You may find you don’t have ovaries. The ovaries may be there but there are no eggs. Naturally it happened like that. So you cannot conceive without the ovary or the ova.
  • And the other factor can be the other structures we are not seeing. We talked about the hormones or the fuel. Your hormones may have a problem; you have low level of required hormones. You know when you are driving a car and the fuel gauge shows red, you can’t not go further. The follicle stimulating hormone is low; therefore the eggs are not matured. And when also the luteinizing hormone is not there, then ovulation doesn’t occur. The eggs are mature, everything is mature but the egg doesn’t move to fallopian tubes and remember the sperm will not swim until it reaches the ovary hence fertilization will not occur.
  • Lastly another problem can be the brain. The main structure in the brain is called the pituitary gland. If you have a problem with the pituitary gland, it can have a tumor or there are very many diseases that can attack this gland. And if it has a problem it will not make those orders. It won’t send signals to the hormones.

NUMBER OF DAYS SPERMS SPEND IN THE WOMAN’S BODY

How long do sperms stay in the woman’s body.

Qn; Lovely Jozey Gwaks “How are you Doctor? Iam asking, How long does sperms stay in the ladies’ body after sex?

Answer from the doctor.

This is quiet an interesting question from Jozey. First of all you have to understand that sperms are manufactured from the tests. From the tests they are transported by vas deferens into the Urethra. Of course the urethra is found in the penis and that is the way through which sperms can be ejaculated. Now once sperms are deposited into the woman’s body. Their survival will depend on mainly two factors i.e. The cervical mucus and also the PH or acidic nature of the vagina.

Actually in a single ejaculation, a man can release over 100million sperms. However only one sperm has to fertilize the egg. Therefore, some of these sperms are killed before they reach their destiny and one of the factors that can lead to the death of these sperm cells is the high acidic nature of the Vagina. So with all those obstacles to answer your question, a sperm can survive in the woman’s body for up to five days .However if the sperms are outside the woman’s body or they are outside the body they can only survive for 20minutes.

Actually we’ve seen people who say “I did a fore play but my wife conceived, I did not penetrate her”. You find someone saying “I withdrew. I dint deposit the sperms inside but she conceived”. What happened?

Now when you withdraw, at times you deposit the sperms or you put the sperms just around the thigh area or around the vulva. Now those sperms can navigate, they can negotiate their way and enter the vagina. If the 20 minutes have not yet passed and the sperms are still viable, the woman will conceive.

In a nutshell sperms within a woman’s body will take up to five days and outside the body will take up to 20 minutes. And outside the body will take up to 20 minutes.

PIMPLES OR ACNE

What causes Acne? How you can treat them, prevention and the Dos &Don’ts of Acne.

Qn: Hello Dr Uthuman, I have had pimple since my high school. Tried green tea and several other home remedies without improvement. What is wrong with me? Am I going to remain like this? Anyway, please help me get rid of these things.

Answer from the Doctor

Pimples or what some other people call acnes are one of the most common skin diseases or conditions in the whole world. They not only affect the cosmetic beauty of your skin, your face but also lowers some one’s self esteem. And can also pose a danger to your health.

Today we are talking about pimples. But before we talk about pimples we need to look at the skin. The skin contains pores call them holes. They are like holes and these holes contain a gland and a hair. The gland am talking about is the sebaceous gland. This gland releases all secretes oil onto the hair and finally onto the skin. This oil is actually onto the skin. This oil is actually the one that makes your skin moist, soft and smooth. So our skin requires this oil.

Causes of pimples.

There is blockade of these pores or blocking the holes that are supposed to secrete the oil. This can be caused by three things

  • Excessive oil production.
  • Too excessive bacteria onto your skin
  • Dead skin.

Therefore in summary we can say that pimples are caused by excessive bacteria on your skin, excessive oil production and lastly excessive dead skin. So let’s look at the risk factors for developing pimples.

These are the factors of which you have them; they can expose you to getting pimples.,

  • Hormonal changes. If you are undergoing the condition that involves a lot of hormonal interplay, you’ll be exposed to getting pimples. For example people in their puberty stage. Actually most people develop pimples during the puberty stage, and some of them, if they are left untreated they continue up to their adulthood. And if you treat them, some of them really get fine.
  • Other pimples develop pimples during pregnancy. When they get pregnant, they develop those pimples because of the hormonal interplay that happens during that period. Other people develop pimples during menstruation, same thing that happens in puberty, pregnancy and so on.
  • Other people who are exposed to pimples are people that eat foods or diet rich in sugars. Examples are bread and chips. People who eat a lot of chips are also prone to getting pimples. Therefore if you really want to get rid of pimples, one of the steps is to reduce intake of such foods.
  • Some pimples are hereditary. By hereditary I mean they pass through families. You find the whole family or the whole generation has pimples and those are very dangerous.
  • Some people get pimples because of anxiety .When some people go under stressful conditions, they lead to production of those hormones that can lead to excessive production of oils and then pimples will develop.

How do we treat pimples?

Before you even look at treating that pimple you have developed, I want you to look at these points very critically. Never scratch your pimple, never pop, never pinch or even touch your pimple except if you are applying the medicine. Why? Because the moment you scratch it, you pop it or you irritate it and cause inflammation which will lead to the swelling of that part where the pimple is. Therefore even if we end here, never scratch your pimple.

So what is the goal of treatment? When we are treating these pimples, we look at;

  • Reducing excessive oil production in your body
  • Reducing the swelling because some people develop pimples and then swell that particular area or even swell the whole of that structure. So therefore we look at reducing the swelling in that area.
  • Treating the infection if any.
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The treatments available are in topical formulations and tablets which can be swallowed.

These include;

Retinoid drugs; theses are drugs that contain retinoic acid and these drugs are in formulations of gels, lotions and creams. An example of them is Adapalene, so when you go to the pharmacy, ask for a drug or a cream that contains retinoic acid. So how are you going to use that cream? Apply it at least three times in a week. That means if you apply it today, don’t apply it the next day but apply it the following day. So three times in a week and then the skin will have gotten used to the cream or drug, now you can apply it daily for the following weeks until the pimples clear.

Secondly are the antibiotics. Commonly the antibiotics we use are Clindamycin, Erythromycin and Doxycycline. When we are using these antibiotics, we combine them with a drug called Benzyl Peroxide. This drug helps in reducing the swelling of this pimple and therefore when you apply these drugs. Actually when we are giving you these drugs or when you are taking drugs for pimples, you don’t take just a drug in isolation. So you combine these drugs, the retinoid and an antibiotic or plus a drug called Azelaic acid.

Azelaic acid is also available in creams and gels. So if you go to the pharmacy, ask for a cream or a Gel called Azelaic acid it can be in different brands but as long as you find a brand which contains 20% of Azelaic acid, that is the best brand or best drug to take. And Azelaic acid is the best treatment to give to pregnant women, because the other retinoid and the antibiotics; the Doxycycline of this world we’ve talked about are contraindicated or they are not supposed to be taken when someone is breast feeding or when you are pregnant .This is because they can pass through those vessels and then reach the baby.

Another drug can be Dapsone. As long as you find a tube or a cream that contains 5% of Dapsone. Buy that cream, use it, it will also reduce the swelling.

Some other drugs that are available for preventing, stopping or treating this acne are oral contraceptive pills. These pills are the common family planning pills we use. So if you don’t have a problem with family planning you can use these drugs. They can also help in the other way round. But if you want to have children and you don’t have any program of stopping or having a space, then you don’t use these oral contraceptive pills.

Lastly, another drug is Anti-androgen drug. For example the Spironolactone; this is the same drug we use in liver failures. People with liver failures, which have also got an effect or a complication of swelling of the Abdomen. We use the same drug to trap or to reduce the fluids that are in the Abdomen. So this same drug can also be used to remove those fluids in the pimple.

So the treatment we’ve seen above can be applied from home, but there are some medications or therapies that can only be applied from the hospitals and these are called Hospital-based therapies. They include drainage and extraction, chemical peel, steroid injections and light therapies. These are procedures which can only be done in the hospital. Therefore if you’ve applied or tried the above tropical, tablets and they have failed, you can go to the hospital and try those therapies.

But the most important thing is to know how you can prevent or you can avoid getting pimples or acne.

This goes to mostly ladies. Avoid oil based makeup products. I understand that makeup is part and parcel with women beauty, however when you’re choosing your makeup products, make sure that you choose those wakeups that have less oil or that have completely no oil. Those will work for you and they won’t be able to cause Acne or pimples on your skin.

Another issue which is sleeping with makeup. Its a wonder that some women sleep with makeup. So this is something that needs to be avoided. When you are going to sleep, Please wear off your makeup or clean off your makeup so that you don’t provide a good environment for pimples or Acne to develop.

Another thing is to stay hydrated. Take a lot of water, plenty of water at least 3liters a day can work for you. Those are six cups or six mugs of water. But people who get dehydrated you know; Dehydration causes stimulation of hormones that lead to production of oils and when excess oils are produced, of course you know what happens is the eruption of pimples or what we call Acne.

The other thing which is not easy to avoid is stress. But try as much as possible to avoid stress because its one of the factors that stimulate the growth of pimples.

Lastly, avoid junk foods. We shall talk about them several times. People like eating chips, people like eating junks and those are one of the foods that expose you to getting pimples.

Something else you need to understand, when you have a pimple, there are signs you should look at that should force you to go to the hospital. If you see any of these signs, it means you should rush to the hospital for medical attention. Difficulty in breathing , fainting, swelling of the face, the lips and the tongue, these signs should warrant you to go and seek for medical attention because they can cause some emergency.

Also another sign I have talked about is throat tightness. Sometimes pimples can cause tightness of the throat and someone is not able to breathe very well, they may end up fainting and so on. You should go to the hospital for medical attention.

In my conclusion I would like to demystify the myth and the misconception about pimples or Acne. There are some people who link acne to hygiene. They go on and say people who are dirty, people who don’t bathe, people who put on dirty clothes are exposed or are at risk of getting pimples. There’re also those that claim that eating chocolate or chocolate based products can cause acne. This is not right. It is not scientifically proven that those two items can cause acting or can cause pimples.

RECURRENT MISSCARIEGES

What causes recurrent miscarriages or what we call recurrent abortions? How you can get rid of recurrent miscarriages?

QN “Mackline Fortune” “Hello Dr Uthuman, Iam 35years old but I have had five miscarriages in a row. I have only one child who is 12years now. My worry is whether I can ever give birth again, Dr, I have been taking several herbal drugs for many years but nothing has changed. What do you think is the problem and what can I do because I am about to lose my marriage.”

Answer from the doctor.

Childbirth is one of every woman’s desire on planet Earth, actually news of pregnancy is a shared happiness to a family. However it devastates when a woman loses her pregnancy and furthermore it adds an injury to the wound when the next pregnancy is also lost and the next, the next and the next and that’s what we call recurrent miscarriages. This brings agony and causes emotional breakdown to the family.

Recurrent miscarriages or recurrent spontaneous abortions is a condition where by a woman loses her pregnancy one after the other. Like we have seen in the question where this lady lost five pregnancies consecutively, is what we term as recurrent miscarriages.

Causes of recurrent miscarriages

  • Genetic cause. When we talk about genetic causes, we are talking about chromosomal abnormalities. During fertilization, a woman contributes 23 chromosomes and a man also contributes 23 chromosomes. When I talk of chromosomes I mean the body or the human make. When making that fetus, the man will contribute 23 and the woman will contribute 23 and those are called chromosomes. So if those chromosomes any of them has an abnormality, they will end up making a fetus or zygote which is abnormal and when is abnormal, the body will try as much as possible to eliminate it because it has either less or more of the genetic material. And actually, this chromosomal abnormality accounts for about 30 to 60 percent loss in the first trimester.
  • Another cause is the Rhesus factor incompatibility. What do we mean by rhesus factor incompatibility, when you go to the hospital for blood group testing , they usually give you results with blood group O,A.B or AB. However on those O,A,Bs they usually put a plus or minus. That plus or minus indicates the rhesus factor status. So some people are rhesus factor negative and others are rhesus factor positive. How does this become a problem? If a man’s rhesus factor is positive and a woman is rhesus factor negative, the offspring or the baby is going to be rhesus factor positive. What is going to happen? The first pregnancy will have no problem at all. However in the second pregnancy, the mother’s body is going to detect the rhesus factor positive as a foreign material or foreign body or as an attack on its body and therefore the mother’s body will eliminate this child immediately and that is what will cause a miscarriage or a spontaneous abortion.
  • Thirdly is hormonal imbalance. By hormonal imbalance we are talking about fertility hormones. When you look at the fertility hormones we have the Progesterone, the luteinizing hormone, the estrogen and so on. However, here we are mainly focusing on progesterone and luteinizing hormone. First, progesterone is a hormone of pregnancy .it’s the hormone that keeps the baby in the mother’s womb. In conditions where the human body has low levels of progesterone or very high levels of progesterone, the woman is going to end up losing the baby.This condition is called Hypo-progestenaemia and this is whereby a woman has low levels of progesterone and this will lead to elimination or losing this pregnancy.
  • The Uterine structural abnormality. If you look at the woman’s uterus, it has the body of the uterus which is spacious, it has enough space for implantation of the fetus after fertilization. A septate uterus or septum of the uterus happens when there is an infolding either from the fundus or from the sides of the uterus. There is a muscle which enters into the uterine cavity. When there is that infolding of the uterus, it will reduce on the space for implantation and therefore if the fetus fails to implant or if the fetus fails to attach itself onto the mother’s womb, it will be eliminated and hence become an issue of abortion or a miscarriage.
  • Incompetent cervix: Many women lose their children or lose their pregnancies because of incompetent cervix. A cervix is supposed to close or it’s the mouth that closes the uterus. If the cervix is incompetent, it means it has weak muscles and therefore these muscles cannot keep the uterus closed and when the uterus is not closed, the baby will automatically be eliminated from the uterus and this actually also accounts for higher percentages of recurrent abortions in many women in the world.
  • And another issue on the uterus are the fibroids. Women with fibroids tend to have miscarriages. Why? Because like I told you, the fundus or the body of the uterus is supposed to have enough space for implantation which is a process whereby after fertilization, the egg or this fetus is supposed to come into the womb or the uterus and implants itself or attaches itself on the walls off the uterus. So if this wall of the uterus has the swelling, the baby will not be able to implant or attach itself onto the walls of the uterus and therefore a woman will end up losing that baby.
  • Other causes can be infections. Infections like Herpes simplex virus, Chlamydia and Rubera. Rubera is what most people call the Germany measles. These infections affect fetal development and therefore they can lead to loss of pregnancy.
  • Environmental factors especially people who drink marijuana, tobacco and alcohol. These items also affect the fetal development. And when the fetus is affected its life is not progressing well, it may end up being lost.
  • lastly but not the least are the blood clotting diseases. These are like Systemic Lupus Erythromatosus. It is termed as SLE, these ones affect the blood flow to the placenta and also cause clot formation and when clots are formed around the placenta, there is deprivation of oxygen and nutrients to the fetus. When this fetus is not fed well, it is not being given nutrients, it is not receiving enough oxygen. It will be affected in terms of development and therefore it will be lost.

How to get rid of recurrent miscarriages

To you all our readers out there facing an issue of recurrent miscarriages, you may not be interested in all these causes, you don’t need to know them, What you need to know is what is exactly affecting you and bringing miscarriages. And how are you going to deal with that? Is by doing investigations.

For example you will go to the hospital, do a blood group test. Go with your partner, check your blood group and Rhesus factor if you find that you have different rhesus factor status, it means that’s where the problem is and therefore you start with that .

For example if you lady you have a negative status, you will be taking a drug called Anti D. it’s like a vaccine. You will take it when you give birth on your firstborn, you will take that injection within 72hours.After that when you conceive another pregnancy, you will take that injection again on the 28th week ,this is like the seventh month .Therefore you will be rest assured that you will have your baby and after giving birth to that particular baby, you will have to take another injection of Anti-D within 72 hours or within three days.

  • Secondly if the problem is hormonal imbalance, they will take your blood and do fertility hormonal assay to find out exactly which hormone has a problem. The main culprit is usually progesterone and If you have low levels of progesterone, there are drugs or what we call hormonal replacement therapies that can be taken and you increase your progesterone levels. These are drugs like Duphastone and so on. They are many drugs which can be used to boost your progesterone

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    You will also be required to take a high Vaginal swab, this means taking a high skin of your inner vaginal wall to check for infections like Chlamydia the Simplex Virus Infections. And once we find any of those ones we will give you treatment. For Chlamydia it is just a matter of taking Doxyclin capsules, antibiotics and so on and you get fine.

    Another issue you have to do is imaging or an Ultra sound scans and so on. These ones look at the structure of your uterus. They will discover if you have fibroids and if you have fibroids, you will go to the hospital and according to its size it will be managed. Either surgically or with tablets that can make it small or it disappears from your womb.

    If the ultrasound scan finds out that you have a short cervix and thus an incompetent cervix, You will have to do a Cervical Cerclage. This is whereby we suture or we tie your cervix. Remember with cervical incompetence you have a cervix which is loose, it has weak muscles and therefore they cannot close the uterus or womb thus an abortion. Here we are going to get a suture or call it a thread, pass it through the cervix and tie it. We close the uterus literally and when it is closed you will have your baby until term when the suture is removed and you deliver your baby.

    Lastly you can do Karyotyping. This can be done if you are suspecting an issue of chromosomal abnormality. Remember I told you about genetic abnormalities contribute a very big percentage of recurrent miscarriages. So by Karyotyping you will be able to identify whether you have a problem with your chromosomes.

  • VASECTOMY

    What is vasectomy?, Can a man make a woman pregnant after vasectomy?

    QN;“Clare” “I am pregnant yet my husband did vasectomy, he has failed to take care of me until I give birth and he does a DNA. How can I be pregnant yet my Husband did vasectomy?”

    Answer from the doctor

    For clarity let’s first understand what Vasectomy is. This is a procedure done on a man not to produce again. So it is a permanent method of family planning done by men. Who does this procedure? It is bold men who feel they have produced enough, they don’t want and any more children. Those are the men who undergo Vasectomy.

    The way it’s done is very simple. This procedure takes 5-7minutes. What we do is usually make a puncture or a whole onto your scrotum. The scrotum is what some people call the eggs of a man where we make a small incision or small puncture, we enter inside, we get the first deferens tube. Be reminded there are two tubes. There is a tube responsible for transporting semen, and there is a tube that also transports sperms. So when we are doing this procedure, we only look at the tube that transports sperms. And that’s the tube that we cut and tie. After that, someone will have done vasectomy.

    When you do this procedure, you need to know that its irreversible. There are many researches that have been done to see how to reverse this procedure but the success rate is really very low. So when you do vasectomy be sure you don’t want to produce again.

    So how did this woman conceive, because she is sure that she didn’t have an affair with any other man. What happens is that All family planning methods are not 100% there is usually a small chance of getting pregnant again.

    When you do a vasectomy you are told to wait for at least three months or use a condom because in this time, someone can be having sperms that are active which have passed beyond the tying. So if you happen to have unprotected sexual intercourse it is possible to impregnate a woman.

    Apart from that, there might also be a surgical mistake or the procedure was not made properly by the surgeon who did it or they were not tied properly.

    There are also scenarios where by the tubes naturally recanulate and sperms can find their way through hence someone being able to impregnate a woman.

    Doctors’ advice

    In this situation therefore the husband can undergo a sperm analysis or semen analysis to see that whether there are other viable sperms within semen to clarify whether its this man responsible for your pregnancy or wait for a DNA test when the baby is born.

    RED LIPS

    How normal lips look like, What causes red lips? How we can treat or prevent red lips.

    QN. “My name is Godfrey. What causes red lips? And what can be used to prevent or treat it?”

    Answer from the Doctor.

    The normal color of our lips ranges from pink to brown and actually these lips are very important to the body. They not only provide the beauty of the face, but also protect the teeth from harsh environment conditions.

    Actually we should understand that the lips provide a very important role during chewing. And they also aid in spoken languages. Check on your self if you can mention letter B, M or P without using lips, so it becomes quiet very hard for you to mention those letters without using lips. So lips are very important in spoken languages.

    They also help us during the unspoken languages for example, when you are expressing yourself during sadness, happiness and so on. You know how you can look. Lips can provide that expression for you.

    They actually act as sensory organ for food, before you put food in the mouth. And that’s why we find that when babies are crying, they usually put some soup on the lips and you find them licking the lips. That is the sensory mechanism the lips are giving to the body.

    And lastly lips act as a sexual organ. You understand that during Kissing, any human being can be sexually aroused.

    So what can turn these nice-looking pink brown lips to become red? Most people actually may look at a person with red lips and think about the person having HIV. This is not completely true.

    The following are the causes of red lips.

    • Trauma; Actually some people get red lips because of excessive chewing. When you chew a lot you get inflammation of the lips which is called Chilitis and inflammation of the lips will lead to redness of those lips.
    • Also people with dentures that are poorly fitting can cause inflammation of those lips and they become red.
    • Some people have allergy to certain chemicals for example the lipstick and many other chemicals, the lotions and so on. When you apply them on to your face, they can redden the lips.
    • Infections. These can cause reddening of lips and the examples of infections that can cause reddening of lips are the fungal infections, the Candida of this world, the bacterial infections and viral infections. With viral infections that’s where we come up with HIV/Aids, it can lead to inflammation of lips and become red, but it is not entirely only the only one that causes reddening of lips. Human simplex virus or what they call HSV, this is also an infection which can be acquired via sexual route. Is also one of the factors that can lead to redness of lips.
    • Another cause of redness of lips can be leukemia. These are blood cancers and this condition is called leukemia labialis.
    • Then lastly it can be as an issue of genetic predisposition when someone has a mutation in some genes, thus can end up having red lips.

    Can red lips be treated?

    This depends, some red lips can go on their own, they are self-limiting, and can disappear on their own.

    However if they bring issues like difficulty in breathing, swelling of the lips, difficult in swallowing, high body temperature or fever plus an altered mental status, you can now have treatment for them.

    The treatment depends on the cause. If it’s an allergy, stop applying that lipstick or stop applying that detergent or a lotion on your body then it will go. If it’s a bacteria, go to the hospital treat the bacterial infection. It’s easy, you know how they check for bacterial infections in blood and so on. Take swabs so you can get treatment for that. If it’s a viral infection, the same thing.

    Most viral infections we give tropical treatments. We give you a tube you can apply and therefore red lips can disappear. If it’s a viral infection, same thing. Apply or you take medicine for that particular virus.

    OVARIAN CYSTS

    What are cysts? How do you know that you have a cyst, what are the causes of cysts, how can you treat cysts and what are the complications of a cyst, can you be pregnant with a cyst, can you menstruate with a cyst?

    QN: “Jemimah” “hello doc Iam 28years old, went to the hospital yesterday and I was told I have a cyst on my tubes. First is it curable, and can I become pregnant?”

    Answer from the doctor.

    A Cyst is a thin walled soft mass which is filled with fluids or semi fluids. It’s actually like a polythene bag which is filled with water. It is very soft and with a thin layer. These cysts can be found all over the human body. However in the interest of this question we will talk about cysts found in the ovary, fallopian tubes and those cysts found in the pelvic organ. So we need to understand what causes or what brings about these cysts.

    Causes of cysts.

    • Infections. Most of cysts are caused by infections especially Pelvic inflammatory diseases or PIDS that are not treated, poorly treated or that are recurrent or when they persist in the body they may endup forming cysts.
    • Hormonal imbalances especially during menstruation or ovulation.
    • Some other cysts occur during pregnancy especially in the early life of pregnancy and their role is to support this early pregnancy until the placenta is formed. They don’t usually persist after the formation of the placenta. However, if they persist until the late pregnancy , they can be removed during delivery.

    Signs that can show that you probably have a cyst.

    • Most women have lower abdominal pain. Pain that occurs just below your umbilicus. This may be one of the suggestions that you have a cyst.
    • The dyspareunia.This means pain during sexual intercourse and this usually happens during penetrative sex.
    • Abnormal vaginal bleeding.
    • Others signs come up as a result of the progression of this cyst and when this cyst becomes big it causes pressure symptoms. This means the cyst compresses on some other structures in the pelvic region for example the bladder and the rectum. When it compresses the bladder you will have increased frequency of micturation or increased frequency of urination. And once it compresses the rectum(big intestines in the body) you will have Tenesmus.

    Tenesmus is a condition whereby someone feels like they want to defecate but when they go to the toilet they don’t do anything.

    What to do to overcome a cyst

      You must first undergo some tests. You will do some blood tests like the CBC and so many tests when you go to the hospital.

      You will also need to do a scan to confirm the presence and the size of the cyst. However what you should understand is that most of these cysts will resolve on their own. Actually they will go away without any treatment. But those that persist without treatment, they really require to be treated.

      There are two modes of treatment for cysts namely;

      • The medical treatment. This is given in cases whereby the cause is really known for example, if you have infections, the PIDs, you will have to take antibiotics and once these infections are treated, then the cysts will go away.
      • Then for hormonal issues you’ll be able to take contraceptive pills. Your doctor will discuss with you and see the medicines they can give you to treat these cysts.

      • The surgical treatment. There are cysts that can’t go away either on their own or by medication and require a surgery.
        • What are the indications of surgery?

          If the cyst is large especially cysts about 5cm.However when I say 5cm don’t go to your doctor and tell them you know for me they told me when this cyst is about 5cm I should go for surgery,NO,you must discuss with this person because there some other factors that should be looked at before a decision is taken.

          Another issue is a persistent cyst where this cyst may happen this month, treated it with antibiotics, three months later another cyst in the period of one year you have four cysts, then the cyst may also require a surgery. But this also depends on the discussion you’re going to have with the doctor.

          There are also those cysts that are so painful and you cannot bear the pain, these cysts may also require a surgery.

          Lastly, hemorrhagic cysts. These are cysts that bleed. Someone has severe per-vaginal bleeding, it may require a surgery. But all in all it requires a discussion with a doctor to come up with the right decision.

          The choice of a surgery to be done should also be done based on fertility intensions. This is whether this woman still want to give birth or they produced and no longer want more children.

          Types of surgeries that can be done.

          • Cystectomy: This means removing the cyst and leave everything else that way it is.
          • Oophorocystectomy. This is a surgery whereby we remove this cyst plus also the ovary. This is because most cysts are attached on the Ovary and the Fallopian tube. So sometimes you my remove the fallopian tube and ovary and sometimes the tube its self.
          • Lastly a TAH(Total Abdominal Hysterectomy) can be done whereby we remove the whole uterus. So this really requires you to have an individualized talk with a doctor. And this will depend on the severity and massiveness of the cysts.

          In conclusion therefore to our friend Jemimah and to all our readers, someone can conceive, can continue their regular menstruation with a cyst. However, it depends on a type of a cyst and its severity. So you need to go to the doctor and have several examinations, get checked to understand your prognosis.

    HOW TO GET TWINS.

    Factors that can contribute for you to having twins, what can you do to have twins? And, how you can take care of your pregnancy if you have twins?

    QN:”Naome Masogo” ‘’.Hi Doc,let me know what to do to conceive twins.”

    Answer from the Doctor

    Having twins is a very hot debate in our communities out there. You find two people resembling and you can easily tell that they are twins but there are those that do not actually resemble. Someone will tell you that they are twins and it will be a hot debate out there in our villages. So let’s first look at the types of twins.

    There are two types of twins namely;

    • The identical twins
    • The fraternal twins

    What are identical twins.

    These are twins called the monozygotic twins. When you hear mono it means one and zygote means the young baby in the mothers womb. What happens for identical twins to be made?

    The mother produces one egg during ovulation which is fertilized by one sperm. After fertilization, this zygote is divided into two. Therefore you will have two babies in the womb within one placenta and with the same genes. And that’s why the identical twins actually resemble and are normally of the same gender. Actually you will never find identical twins of a different Gender.

    The fraternal twins

    These are twins that science calls non identical or di-zygotic. This means that, during ovulation, the mother produces two eggs which are fertilized by two different sperms. Therefore you will have two babies in the uterus in different placentas. They can be of the same or different genders. Actually there is no any special genotypic difference from the other siblings.

    There is usually not much you can do to have twins but there are some factors that can contribute to having twins namely:

    • Family history of having twins. If there is history of having twins especially on the mother’s side, there are other chances of you having twins. And the chances actually increase more when you your self you are a twin.
    • Age: Women who are above 35 years stand high chances of having twins compared to there counter parts. Reason being, these women have reached there premenopose stage and during this stage there is hyper stimulation of the ovary leading to the production of more than one egg. And if more than one egg is produced, there are higher chances of conceiving twins. These kinds of twins are usually non identical or fraternal twins.
    • In vitro fertilization: There are circumstances where a woman cannot have fertilization with in her uterus. There are women that cannot produce eggs, and there are men who cannot impregnate their women. Therefore what we do is to assist them in fertilization. In this process we get an egg from the woman and a sperm from the man and the two are fertilized from the test tube and after some time transplanted into the woman’s womb. In this situation most experts implant two embryos and if both embryos grow of course you will have a twin pregnancy.
    • Taking Fertility Drugs: these drugs stimulate the Follicle stimulating hormone and the luteinizing hormone in your body. If you take these drugs, they are going to hyper stimulate the ovary where it produces more than one egg. And if more than egg is produced, you will have the fraternal twins.
    • Height: there is a research which was done by Doctor Gary Steinman in USA, he found out that tall women stand higher chances of having twins compared to their short counter parts.
    • Breast feeding: We all know that breast feeding is one of the natural family planning methods. However research has shown that women who conceive while breast feeding have higher chances of giving birth to twins as compared to the other number. Actually the research that was done showed that 11.4 women who conceived while breast feeding gave birth to twins. What’s not true about getting twins.

    There are a lot of myths that people think when you do the you can have twins. Which is not true because there is no research that has proved them right. And these include;

    • Taking folic acid daily
    • Drinking or taking dairy products
    • Sex styles

    Signs you are pregnant with twins.

    • Hyperemesis gravidarum .This means excessive vomiting. It’s understandable that during the first three month of pregnancy, there is usually some nausea and vomiting. However, if the vomiting is excessive, one of the causes of excessive vomiting is carrying a twin pregnancy. Therefore this should ring into your mind that probably you have a twin pregnancy.
    • Having a big belly as compared to the gestation age because there is usually the size of the belly your supposed to have in comparison of your gestation age. But if it happens to be bigger than your gestation age you should probably know that you are having multiple babies.

    To confirm this you need to do an ultra sound scan. The scan will be able to show you that you have more than one baby and you need to prepare for this.

    How do you prepare for a twin or multiple pregnancy.

    If you discover that you have more than one child in the womb, you will need to visit the hospital frequently more than the person who is carrying one child because this is a risky pregnancy. In most cases we advise women to deliver only in the hospitals because these babies are precious and they really require special attention by experts. This is because at times they even require cesarean deliveries because sometimes you find some having their heads down and others up. Therefore advised to have proper antenatal care to ensure safe delivery.

    FAMILY PLANNING METHODS

    What are the questions you should ask yourself before using any family planning method, Categories of family planning and who can use family planning.

    QN

    : “Cathy” “Doctor I am still a teenager. Can I use family planning?” “Mathew” “Can I use family planning when also my wife is on family planning?”

    Answer from the Doctor.

    Such kind of questions need to be verified. There are three questions you need to ask yourself as an individual, couple or as a family.
    • When are we going to have the first child? That’s what we call planning. You plan for it and its family planning or contraception that can answer this question.
    • When are we having the next born? After having the first born, you need to know when to have another child and that’s what we call spacing. This question can also be answered by family planning.
    • When are we stopping to have children?
    • Who can use family planning?

      Family planning is for every one who can conceive and everyone who can impregnate a woman that’s to say every woman of a child bearing age. Every woman that undergoes menstruation can still conceive therefore can use family planning. For a boy/man that has experienced wet dreams can impregnate a woman therefore likewise can use family planning.

      Categories of family planning methods.

      • Short term methods. These are methods that work for days, weeks to four months. These include the family planning pills, condoms and injectables.
      • Long-term methods These are methods that work for years that’s to say 1 year to 10 years and these include; implants and IUDs
      • Permanent methods: These include vasectomy and bi-lateral tuba ligation

    URINARY TRACT INFECTION (UTI)

    What is a UTI, Can it be transmitted sexually? signs you have UTI.

    Qn

    "Madinah" “ A few days back I went to the doctor and I was told I have an infection called a UTI. Is it possible that I got the UTI from my cheating boyfriend?”

    Answer from the doctor

    YES its possible to get a UTI sexually, but let first understand what a UTI infection is.

    What is a UTI?

    A UTI is a Urinary tract infection. This tract is a path way for urine beginning from the kidneys. Kidneys are two body organs found in the abdomen almost at the back. They manufacture urine which is transported to the bladder by the ureter. A bladder is like a store for urine before its remitted from the body. From the bladder it’s moved outside the body by the urethra and that’s what we term as urinating.

    So UTI is caused by a bacteria although there are other micro organs that can cause a UTI but mainly its caused by a bacteria called E.coli even thou there are many others but E.coli is the mainly implicated.

    The urethra of a man is found in the penis so the urethra is embedded in the penis and for a woman the urethra is found slightly above the V. Therefore in case a one partner has the bacteria in the urethra, it’s very easy during sexual intercourse to transmit it from one urethra to another if not with protection. So that’s the way a UTI can be transmitted sexually.

    Secondly there are bacteria that are normal in some body areas called normal flora. However, if are moved from one body area to another they become germs and cause a diseases. There is some Bactria around the valve outside the urethra. So during sexual intercourse, these bacteria can be dislodged into the urethra which would cause a UTI.

    SIGNS THAT YOU HAVE A UTI

    • Lower abdominal pain
    • Frequent urination
    • Pain when urinating.

    CONTRACEPTIVE IMPLANT

    What is an implant, how does an implant work,Types of implants,catagories of people adivised not to use implants and side effects.

    Qn

    “Hi doctor am Bridget I have a two months baby and I would like to use an implant but I hear people say it can move and disappear in the body. Is it true?”

    Answer form the doctor.

    It is not true that an implant can move and disappear in the body so whoever wants to use an implant Bridget and other people, be assured that it cannot move or disappear in the body. But lets first understand what an implant is.

    What is an implant?

    An implant is a small rod or stick that is put underneath the skin of your arm which helps you not to conceive if not ready to have a child. It’s a type of a hormonal family planning method which means it uses hormones to do its activities in the body to stop pregnancy. It releases an external hormone called Etenegesterol and Levonegesterol which resembles a body hormone.

    Hormones are like internal mechanisms that connect different activities in the body. These two hormones the Etenegestrol and levonegestrol resemble the body hormone called progesterone.

    How does an implant work in the body?

    First of all we should understand how a woman gets pregnant. We have the womb, what we call the uterus and we have fallopian tubes. The fallopian tubes are the ones that connect the uterus to the sac(ovary).So for conception to occur, once the sperms are deposited in the vagina, they have to swim through the cervix, passes the womb to the fallopian tubes where they meet the egg from the ovary and then fertilization occurs. After fertilization, the baby will be moved to the uterus and it will grow from there until the woman gives birth.

    An implant thickens the mucus on the cervix to prevent sperms from passing through the cervical passage whole for sperms to swim further to the womb.

    Secondly it stops ovulation. Ovulation is the movement of the egg from the sac to the fallopian tube which makes it hard for someone to conceive.

    Types of implants commonly used

    • An implanon.
    • This works for three years If you insert it, you can spend three years without conception.

    • Jaddelle
    • . This can take some one for five years without conceiving when inserted but still some one can take it out at the choice of time.

      Categories of people advised not to use implants

      • It’s advisable not to use an implant if you are obess having 75kgs and above.
      • People who have hormonal imbalances
      • People who have vericose veins on the body.( investigations should be done before using an implant)
      • Some of the side effects of implants.

        • Inter-menstrual bleeding. Where some people bleed in between their menstrual cycle.
        • Heavy bleeding during menstruation.
        • Headache and dizziness after insertion.
        • Mood swings over time.
        • Obesity
        • Conclusion

          An implant can not disappear from the body, but due to fatness which makes the skin flaps down wards it might not be easily seen thus you need to find an expert to detect where it is.