Dear Doc: Threesome invitation

Q I am a fit, healthy, male athlete. To my surprise, I have been asked by a slightly older couple in Mandeville to join them for sex next Thursday night. They say that is the only time that would work for them.

The woman is very attractive, so I am tempted. Her husband says that she would love to have sex with me first of all, and then him. Would this be risky, Doc?

A You bet it would! If this couple is involved in a lot of extramarital sex, then there has to be a chance that one or both of them has chlamydia or some other sexually transmitted germ. And they would probably give it to you.

Another potential problem is that you may get this woman pregnant. In fact, I am wondering whether that is their real purpose for inviting you. Maybe the husband is infertile? I note that they have invited you on one specific date, and it could be that this is the day on which the wife ovulates.

My advice: beware!

Q Doc, I am a 25-year-old female and I would love your advice on three problems that I am having.

1. I wish to use the IUD as my birth control method, but my gynaecologist disagrees because I do not have children.

Does this mean that the IUD can damage my reproductive system and prevent me from having children when I am ready? I have done some research and I am aware of the possible side effects. But my gyno is scaring me to death!

What do you think, Doc? Will it hurt me or cause birth defects?

2. Would you recommend the 'patch'? I researched it and found an article that claimed two girls died as a result of using the patch. What is your medical opinion?

3. Can you also explain to me when a woman is most fertile in her cycle. Assuming I am practising the 'rhythm method', please explain the days that I am to avoid sex. I have a five-day period and a 28-day cycle.

AWell, thank you for your long and interesting questions. These are very common concerns so I will deal with them individually.

1. The IUD (coil) is not easy to insert in women who have not had children, mainly because, in these women, the channel through the cervix is still very narrow. When a woman has a child, the child's head 'opens up' the cervix - and it stays opened for life. That makes it fairly easy for the IUD to be inserted.

There are some doctors who will put a coil into a woman who has never had children, but as your gynaecologist has examined you and knows your anatomy, and he does not feel that you should have a coil, so I think you really should take his advice.

2. The patch method of contraception, also known as 'Evra', is very effective. But it is basically a way of giving the Pill through the skin. Therefore, like the Pill, it can occasionally cause thrombosis - a clot. And that can be fatal.

However, a healthy woman who has no 'risk factors'- such as smoking, obesity, diabetes or a bad family history of clotting, should be able to use the skin patch with very little danger of any problems.

3. Finally, you ask when a woman would be most fertile in her cycle, if she has five-day menses occurring regularly every 28 days.

The answer is that, at all costs, she should avoid sex from day eight to 17 of her cycle, counting (and this is really important) the first day of the period as day one.

So, if she started her period on (say) Saturday, May 3, she should refrain from sexual intercourse from Sunday, May 11 to Tuesday, May 20 (inclusive).

I must add that, personally, I do not regard the 'rhythm method' as very reliable.

QDoc, I am a woman in my mid-20s. My menstrual cycle has been a bit unusual for a year now. It's been anything from 22 to 33 days.

This month, my partner orgasmed in me, so the next morning I took the emergency contraceptive. Five days later, my period arrived very early. It is relatively lighter than usual, but I would consider it a period and not just 'spotting'.

Please tell me what is the cause of this.

AWomen who take the emergency contraceptive should be aware that the next menses may arrive unusually early or unusually late.

However, if you have the slightest doubt about whether this is a real period, you should do a pregnancy test now.

Q Doctor, I slept with a girl in Falmouth around three months ago. We did not use a condom.

Now I have developed a little floppy piece of tissue sticking out from my foreskin. It is about half an inch long and very narrow.

Is this a genital wart? And did I get it from her?

A: This does sound very like a genital wart. These lumps affect both sexes and they are caused from a virus which is transmitted during sex.

One cannot say with any certainty that you caught the virus from the woman you slept with in Falmouth, because the incubation period varies.

What you should do now is to have a doctor check it out and confirm that it is indeed a genital wart. He will give you some treatment for it. Until you have been cured, please do not have any sex with anybody.

QI have just been diagnosed as having a fibroid in my womb. Will this prevent me from having sex, Doc?

ANo. A lot of women have fibroids, and they are more common in Jamaica than in many other countries. They are 'lumps' of fibrous tissue in the womb.

Only occasionally do fibroids cause any difficulty or discomfort during sex.

QI am a 61-year-old guy and I am seriously considering marrying a delightful young 26-year-old woman. My question is this. Would I still be fertile even though I am now in my 60s?

ADefinitely! There have been many cases of men becoming fathers in their 60s or 70s, and possibly older than that.

There is a reference in the medical literature to a man who supposedly got a young woman pregnant when he was 104. However, we have no way of knowing whether someone else was really the father.

Q I am 36 years old and I have been diagnosed with 'duct ectasia' of the breast. Is this serious or cancerous?

ANo. Duct ectasia is a common condition in which a 'milk tube' widens and may produce fluid. It is not cancerous.