Q Doctor, I am a 48-year-old woman. My sex life has not been too good recently. Is it true that it would improve a lot if I went on that hormone replacement therapy (HRT)?
One of my friends says that the HRT turned her into a real hot sex bomb! Is that a possibility, doc?
On the other hand, I have a next friend who says that it is now known that the HRT is real dangerous, and she has advised me against it.
So I would be grateful for your expert advice. Kindly note that I am getting real bad 'hot attacks' in which I pour with sweat and feel dreadful.
A The subject of HRT is an important one for many women and their partners.
Why is HRT needed? It is because in most women, the natural output of female hormones falls off quite suddenly at the menopause, or even before it.
The results of this fall in hormone production can be quite dramatic. They may include:
Distressing sweating attacks.
Equally distressing 'hot flushes' (or 'hot flashes'), in which the face feels as if it is suddenly filled with hot blood.
Itchy feeling under the skin.
Dryness of the vagina making it difficult to enjoy intercourse or 'love play' without severe discomfort.
It is often claimed that the drop in female hormone levels can produce other symptoms, like depression, anxiety, crying attacks, low feelings and other emotional difficulties. This may be so, though it is a little difficult to prove.
What is certain is that the MAIN symptoms of the menopause - that is, excessive perspiration, hot flushes and vaginal dryness - respond extraordinarily well to a course of HRT. In many women, the menopausal symptoms vanish within a matter of days after starting to take the hormones.
In the case of vaginal dryness, it may well be necessary to take those hormones vaginally in order to return the sex life to normal. As I have stated before in this column, that is done by giving the hormones in the form of a gel, cream or pessary (which is a little vaginal tablet).
So HRT is real good at getting rid of menopause symptoms, including restoring the vaginal to its former moist and healthy state. Many couples feel that it has given them back their sex life!
However, these days doctors feel that HRT should NOT be taken for year after year, until the woman is far into her 60s or 70s. It should be used SHORT-TERM only.
Why is that? This is because of the major research which was done a few years ago - research which showed that HRT carried more dangers than doctors had thought.
What dangers? HRT is associated with the following things:
Increased risk of deep vein thrombosis (that is, clotting in the leg veins). Increased risk of womb cancer. Increased risk of breast cancer. Increased risk of ovary cancer.
Increased risk of heart attacks. Increased risk of strokes.
However, I must say that the increase in risk is not all that great. Also, the danger of womb cancer can be greatly reduced if the doctor makes sure that she gives the patient a form of HRT that contains two hormones instead of one.
Nevertheless, expert opinion these days is that women should only take the minimum effective dose of HRT for the minimum period of time.
In your case, there is no doubt that your 'hot attacks' would respond well to HRT. But I would recommend that you only take it for six months or a year - by which time the tendency to these attacks may well have gone.
HRT cannot possibly revolutionise your sex life, as your friend has suggested. So you are NOT going to become some sort of 'hottie-hottie' or sex bomb.
But if you are suffering from vaginal dryness and soreness, the HRT probably WILL help you greatly - though you may well have to use the hormones vaginally, rather than taking them by mouth.
QA most embarrassing event has happened to me, doc. I am a man of 32 and I plan to marry this summer. Unfortunately, when my fiancée was giving me that 'oral sex' yesterday, it seemed like she accidentally bit me.
As a result, I am bleeding from that little 'string' structure which is on the underside of my organ.
What must I do?
A Do NOT have any kind of sex until this cut has completely healed. Otherwise, it will keep on bleeding.
The little 'string' is called the 'fraenum' or the 'fraenulum'. It is very sensitive - and very liable to injury. Teeth and finger-rings are the most common causes of these wounds.
If 'the string' gets cut by anything, the best immediate first aid is to apply some Vaseline, and then press firmly on the bleeding area with cotton wool. But what I would like you to do now is to have a doc check out this wound, in order to make sure that everything is OK.
QI am 58, and last week I had to do an X-ray of my back. To my distress, the report said that everything was OK - except that there was 'a little arthritis'.
Does this mean I am going to be crippled by the arthritis, doc?
A No, it does not. It is a little-known fact that by the time you approach the age of 60, nearly everyone has slight traces of a type of arthritis on their X-xrays.
This will probably never progress any further, so you can quit fretting.
QDoc, I am a 26-year-old woman and I have had several lovers. I have never had a pap smear.
Do you think it is time I took one?
AVery definitely! Any adult woman who has ever had sex should take regular smear tests. These will make sure that you do not die from cancer of the cervix. Don't delay.
QTo my horror, I found yesterday that I was passing blood in my urine. Why, doc?
A Don't be scared. This symptom usually indicates an infection in the urinary 'piping' - though it can have more serious causes.
So please try to consult a doctor tomorrow. Most importantly, take a specimen of urine with you, in a completely clean container. Good luck.
QI am a woman of 33. On a trip to the United States last year, I somehow got persuaded into lesbian sex.
Could that give me any kind of VD, doc?
A Sex between women can pass on sexually transmitted infections, but the risk is less than it is with heterosexual ('straight') relationships.
Nevertheless, there is so many venereal diseases around that I feel you would be wise to have a check-up from a doctor, including lab tests.