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.
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.<
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.
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.
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.
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.
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.
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?
Quite often such stories make us emotional and indeed this is one of the saddest stories I have had in my medical practice.
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.
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.
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.
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.
How does this come about? What causes these Pelvic Inflammatory 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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”
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?
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:
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.
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.
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.
Qn; Lovely Jozey Gwaks “How are you Doctor? Iam asking, How long does sperms stay in the ladies’ body after sex?
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.
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.
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.
There is blockade of these pores or blocking the holes that are supposed to secrete the oil. This can be caused by three things
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.
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;
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.
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.
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.”
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.
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.
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.
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?”
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.
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.
QN. “My name is Godfrey. What causes red lips? And what can be used to prevent or treat it?”
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.
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.
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?”
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.
Tenesmus is a condition whereby someone feels like they want to defecate but when they go to the toilet they don’t do anything.
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.
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.
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.
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.
QN:”Naome Masogo” ‘’.Hi Doc,let me know what to do to conceive twins.”
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.
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.
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:
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;
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.
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 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.
"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?”
YES its possible to get a UTI sexually, but let first understand what a UTI infection is.
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.
“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?”
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.
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.
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.
This works for three years If you insert it, you can spend three years without conception.
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.