Doctor's advice - Haunted by yeast

Q.  I am 25, and I have a concern regarding yeast which that I hope you will be able to help me with. I have been having yeast infections in the vagina for years now. Each time it happens, I go to the gynaecologist and I get medication. Then it clears up. But it quickly returns. I did some STI tests, but they came back negative, and I am HIV-negative. I did a Pap test, and they found no cancer cells - only what they called 'abnormal bacteria'. They did not specify anything else. This yeast problem is really distressing. It itches, and the only time I get ease is when I douche. I know douching is wrong, but I can't think of anything better to do. Incidentally, when it flares, there is a thick, white discharge, sometimes like clumps. Could you give me some info as to what is causing it?

A.  Sorry to hear about all the trouble you have had. It certainly does sound as though you keep getting yeast infections. However, there is one other possibility, which I will get to at the end of my answer.

But first, let's talk about yeast. This is the name which is used in Jamaica for the condition which docs call candida or monilia. It is also known as thrush.

Vast numbers of women get it. The symptoms are as you describe: intense itching, and a thick, white discharge.

There are two ways of treating it: The first is with pessaries (which are vaginal tablets) and creams. The creams and the pessaries most commonly contain an anti-yeast drug called clotrimazole, but there are alternatives.

The other way of treating it is to take a capsule orally. This capsule contains the drug fluconazole. There is another product which can also be taken orally - itraconazole. It is only used occasionally.

Some docs will give patients both oral and vaginal medication at the same time, and that is often effective. But in your case, the infection just keeps on coming back after treatment. Why?

The commonest reason is that the woman is being reinfected by her male partner. He might well have no symptoms at all, though he may have experienced a little soreness and itching in the region of the foreskin.

Anyway, when you suffer another flare-up, you should not only take the treatment yourself, but also insist that your partner is treated, by using anti-yeast cream, several times a day for five days.

There is one other possible reason for the fact that you keep on getting yeast attacks. A lot of women with early-onset diabetes are very vulnerable to yeast, so I would advise you to take a test for diabetes.

Finally, may I turn to the question of your recent smear test (Pap test)? I do not understand why the lab reported 'abnormal bacteria', especially as yeasts are not bacteria. Next time you go to the gynaecologist, ask him to explain this test result for you. There is a chance that it indicates that you also have something called bacterial vaginosis. This is common, and is easily treatable. Good luck.

Q.  Dear Doc, I am a 19-year-old male. For the last six months, I have been dating this girl, who is 25. She really loves me, and I love her too. In fact, she decided that she wants to have my baby. So I have now got her pregnant. Do you think it's OK to keep ejaculating inside her? Could having sex with her affect the baby?

A.  In the past, it was thought that sex during pregnancy was dangerous. But experts no longer believe this. So unless the young lady's midwife or doctor has said she should not have sex, it is OK to continue.

Q.  I am worried about the force with which I ejaculate. The fluid seems to me to travel only about six inches. Is this OK, Doc? Some of my friends say that it should travel several yards.

A.  Six inches is perfectly healthy for a young man. After all, the entire point of ejaculation is simply to deliver the sperm into the woman's cervix which, during intercourse, is very close indeed to the tip of the guy's penis.

Your friends may not actually be lying because occasionally seminal fluid does travel over a yard in the case of some young, highly sexed males. It is claimed on the Internet that a German called Horst Schultz was able to ejaculate 18 feet 8 inches (or 5.7 metres), but frankly I do not believe that.

Q. Although I am a 42-year-old woman, I am in love with an 18-year-old man. He is a university student. We love each other very much. But one thing is missing to make the relationship complete: we do not have a child. I gave him permission to have an outside child, but he has refused, saying he does not want to hurt me. I think I am still fertile, as I have my cycle every month. Could I still get pregnant, and what are the risks at this age? If it is too risky, what are our options?

A. I have altered a couple of details of your email to prevent you from being recognised. Female fertility falls off very sharply after age 40, but the fact that you are still having regular cycles does suggest you may well still be able to conceive.

There is a special test which tells you how many eggs (ova) you still have left, but it is enormously expensive, and you would have to go to the United States or England to obtain it.

More practically, you can buy a simple ovulation kit from any large pharmacy. These products are very useful. By testing your urine each month, around halfway between the menses, you can find out whether you are ovulating, and also pinpoint the best day to have intercourse.

As to the risks of being pregnant at your age, there is no doubt that the dangers to the health of both mother and baby are somewhat increased. But these dangers are not insuperable.  My main concern is that for the babies of mothers over 40, the risk of Down's syndrome (trisomy 21) is greatly increased. For instance, at age 44, it is one in 35. If you think that the risks of pregnancy are too great, your only other option is adoption.

Q.  Is there any medication that will make a guy's organ straighter?

A.  I'm afraid not. If you really think yours is bent, check with a doc.

Q.  I am a bisexual male, and last month I had sex, but the condom burst while in my bottom. What should I do?

A. You must go to a doc or clinic and have swabs taken from the bottom and the penis, and send them to the lab. You may also need blood tests. Do not delay.

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