Q I am a 25-year-old woman who has been trying to get pregnant for the last four years. I've recently been to a gynaecologist, who said my tubes are OK. He then told me to undergo surgery called 'endometriosis'. The cost will be $308,000, and I have been searching for a cheaper rate. Is this type of surgery really necessary?

A I'm afraid there has been a big misunderstanding between you and the gynaecologist.

You see, endometriosis is not a type of surgery. It is actually the name of a condition (a disease), which I presume he thinks you have.

Endometriosis is very common in over-25s. It's a disorder in which lumps of the lining of the womb grow in the wrong place. Every month, they try to menstruate. They cannot do so, causing intense pain. Also, these lumps may cause infertility.

In addition, endometriosis causes women to develop large, dark cysts (called 'chocolate cysts') in their ovaries. All in all, it is something that needs treatment.

What sort of treatment? Usually, doctors begin by giving strong painkillers and anti-inflammatory drugs. They may also pursue hormone treatment, with drugs such as norethisterone or goserelin.

Finally, it is often possible to treat endometriosis by carrying out surgery to cut out the diseased patches. This may be done with a scalpel (a surgical knife) or with a laser.

However, as your main problem is that you haven't got pregnant in four years of trying, before you undergo expensive surgery, I would suggest the following initial measures, none of which should cost you very much:

1. Make sure your man is fertile. Arranging a sperm-count test will cost very little.

2. Ensure you are actually ovulating, that is, releasing an egg each month. You can do this by plotting your daily temperature on a chart for several months. Or you can buy a do-it-yourself ovulation kit from a pharmacy.

3. Make sure that you and your husband/partner are having sex on the ovulation day each month.

4, Take advice from a nurse, midwife or doc about whether the two of you are having sex in the best position for conceiving.

5. Give up alcohol and cigarettes, and encourage your partner to do the same.

After doing all these simple, fairly cheap things, you should start thinking about having surgery. But you really need to find out whether you actually have endometriosis, and, if so, whether it is contributing to your fertility problems.

As there seems to have been a misunderstanding between you and the gynaecologist, I would suggest that you get a second opinion. Ask her to make clear to you just precisely what is going on inside your body. I wish you well.

Q Doctor, I am a 28-year-old woman. My fiancé has asked me to tell him how many guys I have had sex with. The true answer is about 16. Should I reveal this to him?

A Guys can become quite angry when they hear about previous lovers. Although I do not wish to encourage you to lie to your fiancé, I think you should try to give him a diplomatic answer, i.e., one which will not cause a fuss.

Q I had unprotected sex with my girlfriend last week. Our baby is now seven weeks old. Is there any chance I could have got her pregnant again?

A Yes, there is. But it is less likely if she is fully breastfeeding. She should do a pregnancy test in about a week's time. Don't take this risk again.

Email questions to saturdaylife@gleanerjm.com.

^Q Could you give me a good advice, Doc? I am a 30-year-old man and am thinking of getting married. But my girlfriend has pointed out to me that I am different from other guys in one respect. She has pointed out to me that in the 10 minutes or so before having sex, most guys produce some kind of sex fluid. My partner calls this 'the dewdrop'. I must confess that I have read a number of porn books and they mostly seem to talk about the guy producing a little thing like a raindrop when he gets excited. This may seem a trivial question, Doc, but it is not. Because I am probably going to marry this lady next year, I am beginning to fret that I might be sterile or infertile! If I am not like other guys, maybe I won't be able to have children. What do you think?

A Thank you for this interesting question. I hope I will be able to reassure you.

Let me first explain this 'dewdrop'. It is true that many men do produce a clear drop of fluid, or maybe several drops, before sex starts. Indeed, a lot of guys will secrete this fluid if they just start thinking about girls or about sex. Very frequently, they may find evidence of the dried-out droplet on the inside of their pants, and may even wrongly think they have a discharge.

I have had to reassure one or two young male patients who mistakenly thought they had caught a venereal disease, because they found evidence of this secretion on the inside of their pants.

Porn books and DVDs do seem to put an emphasis on the presence of this fluid. By the way, its medical name is 'pre-ejaculate' or 'pre-coital mucus', although many people call it 'pre-come'.

It is thought to be secreted by the prostate gland, and by some other small glands located nearby, and possibly by some located far inside the urinary pipe.

Now, let us look at the scientific facts. Rather surprisingly, about one-third of males do not produce any such fluid at all. Some people find that difficult to believe, but it is true in all age groups.

Around two-thirds of guys do secrete this little dewdrop. Research shows that, as a rule, it is only one clear drop, but in some quite highly sexed males, there may be several such drops, particularly if the man has been sexually excited for quite a few minutes.

It may well be that this secretion is nature's way of helping to ensure that the first moments of intercourse will be adequately lubricated.

Anyway, the point for you to realise is that about one-third of guys do not produce any pre-coital secretion at all. What this means is that you are normal. There is not the slightest reason to suppose that you are sterile.

I wish you well with your plans for matrimony.