Dear doc:Help!I'm afraid of giving birth ...

Q. Doctor, I am 26 years old and have been sexually active since I was 17. I have a huge fear of giving birth.

My vagina is extremely tight. I haven't had sex recently, because I am single. I also do Kegel exercises.

I would want to have a child eventually, but I don't know how I am going to do it, because I have heard that childbirth is terrible and I just dread it.

I seriously don't think I could push out a baby, but I don't want to grow old without having a child.

A. You wrote to me last week about your fear of Pap smears, and today we turn to your fear of the pain of childbirth.

This is not unreasonable! We have to face the fact that giving birth is usually very painful - there is no point in pretending otherwise. Since the beginning of time, women have had to undergo considerable agony as they struggle during childbirth, delivering a child that weighs six, seven or eight pounds, through a fairly small aperture.

Some females do complete their labour with very little pain, but they are in the minority.

On the other hand, since anaesthesia was invented, things have been a lot easier for mothers, and the advent of good painkilling drugs has also made a tremendous difference. In addition, epidermal injections have helped a lot.

I do not deny that the pain of labour is bad, but it is survivable. And once it is over, most mothers are very happy with what they have achieved.

As it relates to you, I wonder why you are so very fearful of childbirth? When you were very young, did your mother or other relatives stress to you that it was agony? Did people tell you that you were going to experience tremendous pain? That kind of a remark does tend to 'condition' a girl to fear the process of giving birth.

Also, have you had any other experiences that made you fearful of anything to do with your vagina? Were you ever raped, or 'interfered with' sexually?

I know that you are afraid of Pap smears. And you also think that your vagina is 'extremely tight', though I don't know what evidence you have for this. Did some past boyfriend say it to you?

I am also puzzled by the fact that you are doing Kegel exercises. These are generally done in order to tighten the vagina. It is very unusual for a woman to do them when she has not had any children, especially if she thinks that her vagina is already tight.

Summing up, it is clear that you have an unusual degree of anxiety about childbirth. The first thing I think you should do is to talk to a number of women who have recently given birth and ask them to tell you what they experienced. You may be surprised at how positive some of them are.

Secondly, I think it would be a good idea if you had a course of (say) six sessions with a good counsellor or therapist. She could help you explore your feelings about your vagina and about childbirth and help you to achieve some peace of mind. I wish you well.

Q. Doctor, my wife is three months' pregnant. And I find that suddenly I do not want to have sex with her. It is almost as if I have lost my nature - but I do love her.

She is getting very frustrated, and wants me to have sex with her. She complains that she 'has not had an orgasm for weeks'. I would be really appreciate your advice.

A. You may be surprised to hear that some men actually like making love to pregnant women. But you are the opposite! You clearly cannot cope with the idea that a woman who is pregnant is sexually desirable.

And there are men who do share your viewpoint. They have grown up with the idea that pregnant women are in a sort of separate 'compartment' from other women, and that it is not right to want to have intercourse with them.

I think you should have some counselling sessions to try to sort out these feelings. By the time you finish the sessions, your wife's pregnancy would be over! But you need to get the problem fixed.

What I propose is this. Begin by talking to your spouse, and explaining to her how you feel. Stress that you still love her and that you want her to be happy.

Next, I think you should offer her some way in which she can have the orgasms that she badly wants. I suggest that the two of you set aside some time for a few quiet, romantic sessions in which you cuddle and where you use love play ('foreplay') techniques to let her climax. As I am sure you know, you can do this with your fingers or your mouth. An alternative would be to employ a vibrator.

I do hope that you can successfully get her to understand your problem. At all costs, you must reassure her that you are not 'scorning' her and that she is the woman you want to be with.

Q. Dear Doc, I am a 25-year-old female who has always had what I would call a normal cycle.

However, this year I have had menstrual cramps, but on one side only. I became very concerned and visited my family doc. He gave me a thorough check and a Pap smear, and he said that all was well, but I am still concerned.

Why do I only have cramps on one side of the belly? Should I visit a gynaecologist for a second opinion?

A. I tend to agree with your family doc. I think that this is only an unusual type of menstrual cramp. But one thing you could try is just going on the Pill for a few months and seeing if that gets rid of the pain. If it does, then that would suggest that this is just an uncommon form of period pain.

However, if you can afford it, there would certainly be no harm in getting a second opinion from a gynaecologist.

Q. Hi, Doc. I am a man who has developed a strange painless bump on my bottom, just at the side of my rectum.

Could this be connected with the fact that when I was in England last year, I let a woman touch me there during sex?

A. No, it couldn't. It is likely that you have what is termed an 'external pile'.

But you must see a doc and let him have a look at it.

If it is a pile, it will not be a serious thing and can be treated.