Doctor's Advice - My new lover and the Pill

Q. Doctor, I am a 32-year-old woman and I have decided to take a lover. I have not had sex for five years, so I am going to need some contraception by the time the man returns to the island next month. So I hope you can help me! What methods are available for a woman in my situation? I understand that, at the age of 32, the Pill can be a little dangerous for a woman. But I do not know much about this subject since my ex-husband and I rarely had sex.

A. I wouldn't describe the Pill as 'dangerous' for a woman in her early 30s, unless you are a heavy smoker. You see, the combination of cigarettes and the oral contraceptive makes a female much more liable to thrombosis (clotting).

If you decide to go on the Pill, you should first ask your doctor whether you have any other 'risk factors'. These might include high blood pressure, diabetes, and some inherited clotting disorders.

If you decide not to go for the Pill, there are other alternatives for women your age.

These include:

• The Mini-Pill. This contains only one hormone instead of two, so it is 'milder' than the Pill, but has a slightly higher chance of pregnancy.
• The Coil (IUD). Pretty effective, but it makes your menses difficult.
• The Mirena (IUS). A hormone-loaded coil which usually has a very good effect on the periods.
• The Patch (Evra). A skin patch containing similar hormones to those of the Pill. Therefore, it has the same risk of causing clotting.
• The Shot (the Jab). A contraceptive injection given every three months. Can cause some menstrual problems, but highly effective.
• The Implant (Jadelle). This is a small, hormone-loaded device, like two matchsticks, which a doctor inserts under the skin of your arm. May affect your menses.
• The Ring (NuvaRing). NuvaRing is a vaginal device containing two hormones. Has similar risks to those of the Pill.
• The Cap or Diaphragm. Caps and diaphragms are individually fitted devices which you put into your vagina shortly before having sex, and leave in place all night. Virtually no side effects.
• The Female Condom (Femidom). Excellent method, now widely available in Jamaican pharmacies.

You can also insist that your new partner uses a male condom when you are having sex. I hope your relationship works out well.

Q.  Doc, I cheated on my wife recently. I don't want to give her any infection. Would it be OK to have sex with her this weekend?

A. No, it would not. You may have picked up a sexually transmitted infection (STI) from the woman you cheated with. It is important that you do not risk your wife's health. For instance, you could easily give her the all-too-common 'bug' called chlamydia. A man who cheats on his spouse should have a check-up from a doctor before resuming intercourse with her.

Q. Whenever I have sex with my husband, I find that, just as I approach climax, I start thinking about a very well-known movie star.  Am I unusual, Doc? Could this be bad for me?

A. Research has shown that a lot of women do fantasise in the way you describe. Often, they use the image of some handsome and sexy man in order to help them orgasm.

The danger with doing this is that your mind may become 'fixated' on this person. The result could be that eventually you cannot achieve a climax unless you think about this celebrity.  So if you feel that you really must fantasise while having sex with your husband, then it would be wise to vary the images that you think about. That way, your emotions will not become 'stuck' on that star.

Q. Doc, I was very scared this morning when I found that my foreskin was puffy and swollen and a little itchy. Doc, I swear to you, I have not been with anybody except my wife.  So could this be VD?

A. It is very unlikely. My best guess is that you have got a mild fungal infection. In men, this form of infection usually produces puffiness and itching of the foreskin.

What you really must do now is to have a doctor take a look at your foreskin. Also, please give him a specimen of your urine so that your sugar level can be tested.  If it is indeed a fungus infection, then the doctor will be able to cure you with some anti-fungus cream or ointment.  And please do not have sex until you have been successfully treated.

Q. My wife is 41 and has suddenly started having multiple orgasms, I am astonished by this, Doc.  Is it a sign that she has been unfaithful?

A. Certainly not! Many women achieve the ability to have multiple orgasms when they're in their 40s. There are several reasons for this. In particular:

• Mature women often feel more comfortable with their sexuality than they did when they were young.
• Their partners have gained a lot of experience over the years, and have learned how to please them.

So I think you should just congratulate yourself on the fact that you are doing a good job in pleasing your wife.

Q. I am a 38-year-old man and I have fallen hopelessly in love with a beautiful young woman who is 19. She says she loves me and has given me her virginity. My friends laugh at me for 'cradle-snatching'. But is there any hope for a relationship in which the man is twice the woman's age to work?

A. Of course, there is hope. A lot of people in their late 30s have established successful relationships with partners who are 20 years younger. But please remember that the two of you are at very different stages of mental, emotional, and sexual development. So my advice is not to rush into marriage or any form of long-term commitment until you are both absolutely sure that you want to spend the rest of your lives together. Also, I would strongly advise against having any children until the situation is clearer. So please use reliable contraceptive precautions.

Q. I am engaged to a very wonderful man. We are both 31. But he has admitted to me that, 14 years ago, he had sex with another man.  This has really upset me. Do you think it would be safe to go ahead with our marriage?

A./ Well, a lot of men do go through a brief 'bisexual' phase in their teens. But I feel that you need to be absolutely sure that your fiancé is now 'straight' before you proceed with the wedding. My advice is that both of you should see a counsellor before making up your minds.