Doctor's Advice: How effective is the Pill?

Q. Hi, I'm a 24-year-old guy. My girl is 25 and a nurse. We have decided to use the Pill for contraception, because condoms cause her pain. I must admit that I like the idea of her being on the Pill, but I want to make absolutely sure that she won't get pregnant because we don't want any children right now. So my question to you is: can she use a secondary method of contraception, along with the Pill, to make sure that the chance of her getting pregnant is zero? For instance, what about having an IUD as well?

A. Your letter seems to concentrate on what you want. I am wondering what the young lady herself wants?

I'm a little puzzled that your nurse finds the condom painful, because that is unusual in women. Maybe she is allergic to it? So it would be worth buying a pack of the 'lo-allergy' condoms, which are available, and see how those work out.

However, let us assume that she opts for the Pill. If taken properly, this is so effective that very few women would want to bother with using any additional contraception. Admittedly, a few Pill-taking ladies do decide that they will also use pessaries, that is, little spermicidal tablets which are popped into the vagina a few minutes before sex.

I have never heard of any woman who chose to use an IUD (a coil) as well as the Pill. But if that is what your lady friend really wants, then she could probably find a doctor who would be willing to prescribe both the IUD and the Pill.

As she is a nurse and, therefore, must have a lot of medical knowledge, I suspect that she will not want to bother with using two good methods of contraception at the same time.

Can a vasectomy affect my semen level?

Q. A pleasant day to you, Doc. I have no problems getting an erection. However, since my vasectomy 15 years ago, I have been noticing a decline in the amount of semen which I produce during sex. As a result, it is difficult to convince my girlfriend that I am not faking a climax! This is because practically nothing comes out when I orgasm. I have read what you said in previous articles about how men must expect to 'slow down' a little as they get older. But I don't like this lack of seminal fluid. Also, lately I have been experiencing a lot of pain inside the shaft of the penis. I keep a supply of cranberry juice, and if I take it, the pain goes away after a few days. Should I be worried?

A. Well, it is a fact that guys produce rather less seminal fluid as they grow older. But you shouldn't be producing none at all. So that is a little worrying.

I am pretty sure that this has nothing to do with your vasectomy, assuming this was carried out by a competent surgeon who knew what he was doing.

Turning to your other symptom, you should not be having pain inside the shaft of the penis. This suggests that something physical must be wrong.

I cannot tell you what is going on, but I wonder if you have what is called a stricture. That is a narrowing of the urinary pipe inside the penis. It is often caused by gonorrhoea ('the clap'), acquired early in life. The symptoms do not appear for 10 to 15 years. So do you have any recollection of catching a sexually transmitted infection when you were 20 or so?

A stricture could make it difficult for your seminal fluid to squirt out. It would also interfere with the free flow of urine.

Clearly, you need medical help. I suggest that you begin by going to your local doctor, taking a specimen of urine with you in a very clean container. He can test this sample. After that, I think he may well send you to the type of surgeon-specialist called a urologist who deals with problems in the urinary pipe. I wish you good luck.

Can I catch an STI from 'hand contact' ?

Q. I am female, age 17, and at a party last week, for some reason, I let an attractive, older woman of around 25 kiss me, and put her hand up my skirt. The result was that I orgasmed. I think the reason was that I had too much to drink. I am fairly sure that I am not a lesbian. I like boys. But this experience has worried me. Also, could this 'hand contact' have done me any harm, Doc? Like, could it give me some kind of sexually transmitted infection (STI)?

A. It is very unlikely that that kind of 'hand-genital' contact could give you an STI.

Obviously, you have been alarmed by the fact that you orgasmed when you were caressed by this 25-year-old lady. But such episodes are much commoner than many people think. For instance, only last month, a large survey in England found that about 16 per cent of women had had a 'same sex' experience.

We shall have to see how life turns out for you. But as you say that you like boys, the odds must be that you are heterosexual. One final tip: in future, please avoid drinking too much.

Help! Having problems conceiving

Q. I was on family planning, namely Depo-Provera, for some time. I came off nine months ago. Since then, I have been trying to get pregnant, and it's not happening! My fiancé and I are becoming worried, as this is really strange. What do you think is wrong? What should we do? I see a regular period.

A. You used to be on Depo-Provera ('the Shot'). Many people don't realise that there is often a delayed return of fertility after stopping it. This delay averages around nine or 10 months.

So really, I don't think you have anything to fret about, especially as you are having regular menses. If your fertility has been temporarily lowered by the jab, it should soon return to normal.

Best thing to do is to have sex as near as you can to the day when ovulation should occur. Often, this is about 12 days after the start of a period.

Can masturbating affect my fertility?

Q. I have a regular girlfriend, but she is away a lot. When she is not around, I sometimes masturbate, Doc. Will this harm my fertility?

A. No, it won't. So you can quit fretting.

Should I have a laparoscopy?

Q. I am 26 years old, and ever since I started my menstrual cycle (age 13), it has been a complete nightmare. About five years ago, I consulted a gynaecologist, and he suggested I might have endometriosis. He proposed a laparoscopy, but I couldn't afford it at the time. I only became sexually active in June of this year, and it causes me great pain. Do you think I should now get that laparoscopy done?

A. Yes, I do. During a laparoscopy, the gynaecologist will look into your belly through a little 'telescope'. He should be able to see if you have endometriosis. And he may be able to cut it out, or laser it. I wish you well.

Email questions to Doc at saturdaylife@gleanerjm.com and read more in the Outlook Magazine tomorrow.