DOCTOR'S ADVICE - Contraceptive blues

Q: Good day. Last summer, I decided to go on 'the Jab'. But since then, I've been facing many problems with this type of contraceptive method. For one thing, I have been bleeding constantly. It has lessened, but it's still there. The clinic that I went to gave me a check-up and told me to return if the bleeding continued. I did just that, and they gave me Oralcon to stop the blood loss. This works. But the problem is that when I cease taking it, the heavy bleeding resumes. So at the moment, it's as if I am on two kinds of contraception - the Jab and the Oralcon. Please help.

A: Well, the Jab (aka 'the Shot') is a very efficient method of contraception. But its big drawback is that it tends to affect your menstrual cycle. Around 40 per cent of women get either heavy, irregular, or absent menses. Admittedly, that leave about 60 per cent of women who do not have these menstrual problems on the Jab.

Now in your case, you have had a very bad time. I don't think that the injection is turning out to be a suitable contraceptive for you. My advice to you would be to not take the Shot again.

At present, you have been given Oralcon to stop the excess bleeding. This, as I think you know, is an ordinary oral contraceptive. It contains two hormones which are used in various other brands of Pill.  It seems to have worked in preventing the heavy blood loss. But you will need to stay on Oralcon, or some similar hormone preparation, until the effects of the Jab have worn off.

Q: Doc, I am a man who regularly visits bodybuilding websites. Recently, I have been feeling rather tired, and I don't think my erections are as strong as they use to be. I read a quiz on an American website and found that I may be suffering from something called 'low T'. Is this serious? Should I order some medication?

A: A lot of American men do seem to have convinced themselves that they are suffering from 'low T'. This actually means 'low testosterone', which is the male hormone. Inevitably, there are commercial outfits who are trying to sell testosterone medication to men who feel this way. But I do not think you should go down that road. It is crazy for a man to buy testosterone unless he has had a blood test which shows that his blood level is genuinely low. So I suggest you talk to your doctor about your feelings and your 'soft' erections. If necessary, he will order a blood test.

Q: I recently had intercourse with a man, and it was pretty rough. Since then, I have had some vaginal bleeding. Can you advise me, please?

A: I am not sure why you are having sex with a man who is rough with you. I suggest that you do not have intercourse again until a doctor has inspected the interior of your vagina, to check that everything has healed. When you eventually resume having sex, it would be a good idea to protect your delicate vaginal tissues by using a lubricant.

Q: I am a 40-year-old married woman, and I feel as if I am in bondage. Over all the years I have known my husband, I have never been disrespectful to him. My problem is that he is too sympathetic to women. Sometimes he helps them out financially, and so they cling to him. When this occurs, he curses and tells me expletives for no reason.

I have received a lot of disrespect from my husband over the years, and we have been to counselling twice. Recently, I was away for two nights and when I returned he did not want to talk to me, and insisted on sleeping in his chair. When I got up at 2 a.m., I found he was texting my sister. I got very upset. He said he was 'not having an affair'. But I dread that he will give me an infection. I am trying to mend this marriage, but am I doing the right thing?

A: Well, you are obviously doing your very best. This has not been a great marriage, but at least the two of you have tried to keep it together, for instance, by going to counselling.

I am concerned by your account of husband's behaviour, and I wonder if he is well. Men who are depressed often treat their wives in this manner. So I think you should suggest to him that he goes to a doctor, and discuss taking what is called 'a depression inventory'.

If that test does show that he has a depressive illness, then he might be helped by going on some medication. Incidentally, do either of you drink? Alcohol can be very dangerous in a troubled marriage. It might be a good idea to ban it from your home. Finally, I feel that both of you should return to marital counselling. That would be the best hope for saving a relationship which is clearly in dire straits. Good luck to you both.

Q: How long does the vagina take to repair itself after intercourse? And is there any home-made remedy that can be used to heal a bruised or sore vagina?

A: Intercourse does cause a thin layer of cells to be scraped off the walls of the vagina. But that does no harm, and everything should return to normal within 24 hours or so. No, there is no 'home-made remedy' that will heal a bruised or sore vagina. If you have sustained some kind of damage during a sexual encounter, you should ask a doctor to have a look inside and check that all is well.

Q: I recently wore an ill-fitting shoe, and then I noticed that I got a 'bloodshot' in my toenail. Doc, can these bloodshots cause cancer? I'm scared.

A: No, this could not possibly lead to cancer. Collections of blood under the toenails are often painful, but they can't do you any serious harm. Please see a podiatrist. And avoid ill-fitting shoes in the future.

Q: What does a gynaecologic check-up consist of?

A: Generally, the doctor will begin by spending some time talking to you, and finding out exactly what your symptoms are, and if you have any worries. Next, she will ask you to remove all the clothing below the waist, and to lie on the examination couch, face upwards. She will then examine your belly with her hand. After that, she will generally put two fingers of her gloved hand into the vagina, in order to feel the organs near it. Finally, she will put in a speculum, which is a device that lets her see your cervix. At that point, she will, if necessary, take some swabs before sending them to the lab for testing.