DOCTOR'S ADVICE - Help! I had sex with a man

Q: I am a happily married man, but my wife has been ill for a few months so we have been unable to have sex. Well Doc, I must admit that one evening when I was feeling frustrated, I went out in my car and drove around. I saw someone dressed in a very pretty blouse and skirt and high-heeled shoes, and I kind of 'gave chase'. We ended up having sex in my car - for money of course. But she turned out to be a man. So what I want to know is this. Should I get any tests to see if this episode has affected my health?

A: Well, I am afraid that prostitutes do tend to have some infections. So you should definitely see a doctor and have some tests - and in particular, a blood test for HIV. It would also be a good idea to talk to a counsellor about your sexuality.

Q: Doctor, I am married and in my early 30s. Sex with my husband has always been great - much better than sex with my previous boyfriends! But in the last six months, I have been experiencing some severe pain whenever he thrusts very deeply inside of me. I have also started experiencing very severe pain during my menses, which was not the case before.

I went to one doctor, and he diagnosed me with 'dyspareunia'. But the tablets he gave me didn't help too much. I think they were just painkillers. So I consulted another doctor, and she says that she is pretty certain I have 'endometriosis'. She also feels I should see a gynaecologist about that. What do you think, Doc? Could a gynaecologist really help me? And can I get my wonderful sex life back? My husband just cannot understand why we can't have sex like we used to.

A: Sorry to hear about all the pain you have been experiencing, which has obviously affected your sex life. But I am sure all will be well. The first doctor told you that you had 'dyspareunia'. That is a medical word which just means 'painful intercourse'. So it is not really a diagnosis.

The next doctor told you that you have endometriosis. This seems very likely because it is a very common condition in women in their 20s and 30s. What is endometriosis? Well, it is a disorder in which bits of lining of the womb somehow turn up in the wrong places. For instance, they can be in the ovaries, or just behind the vagina - or even in the bowel sometimes.

The trouble with these little bits of lining is that, each month, they try and bleed, just as the normal womb lining does when you have your menses. But there is really nowhere for them to bleed into! So they just swell up and become more and more tender.

It is a characteristic of endometriosis that the swellings are very painful around the time of your monthly period. Another possible symptom is pain during intercourse - particularly 'deep' intercourse. You see, the tip of the man's penis can thrust against the area of endometriosis - and that hurts a lot.

I entirely agree with the second doctor who says you should see a gynaecologist. He will be able to examine you and then do various tests to confirm that you do indeed have endometriosis.  The good news is that there are a number of very good treatments for endometriosis these days. They include:

• Anti-inflammatory drugs.
• The contraceptive pill.
• The intra-uterine system (IUS or Mirena).
• Other hormones called 'GnRH analogues'; (these GnRH analogues include the well-known medication called buserelin).
• Keyhole surgery - during which it is often possible to obliterate patches of endometriosis with heat, lasers or even helium gas.
• In extreme cases, removal of the womb and ovaries.

I am quite certain that the gyno will be able to put you on the right treatment, and so get your sex life back on track.

Q: Good day, Doctor, my regular doctor recently did a complete medical exam. This included a prostate check, which he did by putting a finger inside my anus - quite uncomfortable!  He told me that my prostate is 'slightly enlarged'. This has me very worried, Doc. Does it mean that my sex life will soon be ruined? I lead a pretty active sex life at the moment.

A: The prostate gland is located just below the bladder. Its job is to contribute some of the fluid to a man's ejaculate. What you need to appreciate is that most men will get a slight enlargement of the prostate after the age of 45. In many cases, that does not matter at all. But, in some men, the enlargement of the gland does produce symptoms.

You will probably be relieved to hear that these symptoms are usually urinary rather than sexual. A modest enlargement of the prostate usually has no effect on a man's sex life. But it may cause urinary 'frequency' (i.e. urinating a lot), difficulty in starting, and dribbling. I do not know how old you are, but it doesn't sound as if you have any need to be so concerned about your prostate.

Q: Doctor, I am single and pregnant, of my own choice. Much to my surprise, I remain quite highly sexed. Recently, two different men have asked me if I will have sexual intercourse with them. I am astonished that either of them would be interested in a pregnant woman, but that is how it is! The odd thing is that both of them have said the same thing to me - they claim that having intercourse would make labour easier and less painful. Is there any truth in this? Or is it all foolishness?

A: This idea that having sex will somehow make childbirth easier or less painful is just another of those wonderful stories that some men use when they want to get a woman into bed. It is absolute nonsense!

You haven't definitely told me that you refused to have sex with either of these men. I strongly recommend that you do not have intercourse with either of them, because there is always a possibility that one or both might be carrying germs which could harm either you or the baby. If by any chance you have given in to one of these gentlemen, I advise you to talk to your doctor or your midwife about having some swab tests from the upper part of the vagina, to make sure that no germs are growing there.