Sun | Sep 26, 2021

Dear Doctor: Spotting after menopause

Published:Monday | October 5, 2015 | 12:00 AM

Q. Good day, Doc, I passed the menopause two years ago, and I thought, with relief, that was the end of my periods.

But suddenly, my menses have returned! I have had three spottings in the last few weeks. Doctor, why should my menses come back like this? I have always had regular Pap smears, so I don't think there can be anything wrong with me.

A. Your question is very important, and I hope all female readers will take note of the answer.

Bleeding should not occur after the menopause. That is a red flag and potentially dangerous symptom. What you are experiencing are not menstrual periods, but bleeding from some other cause. It is likely that something wrong in the womb.

I have to be blunt and tell you that all too commonly, 'post-menopausal bleeding' (PMB) is caused from cancer of the womb. It does not matter that you have had regular Pap smears. Those are only useful in detecting abnormalities of the cervix, not of the womb.

I am not saying that you definitely have womb cancer. But it is a possibility. Therefore, you should go to a doctor this week. She will examine you internally, and unless she can find some other reason for this PMB, she will certainly send you to see a gynaecologist.

Please do not delay.


Should I have a baby for my husband's brother

Q. I am 29 and desperate to have a baby, but my husband is sterile. Would it be a good idea for me to secretly get pregnant by his brother who looks like him?

A. Please do not do this! It could lead to terrible family problems.


Viagra vs Sildenafil

Q. Doctor, I recently got a prescription for Viagra. This is a pill which has always helped me to have sex with my girlfriend.

But I have just looked at the box of pills, and I am very surprised to see that it doesn't say Viagra on the label. It has the name of some other stuff, called Sildenafil.

Unfortunately, I had taken one of these Sildenafil tablets before I realised that it was the wrong medication! Admittedly, I got a fantastic erection afterwards, and had very good sex with my partner.

But have I done myself any harm by taking the wrong kind of pills?

A. Please stop worrying. Viagra and Sildenafil are exactly the same thing. You see, Viagra is the trade name. But Sildenafil is the scientific name, or as it is often called, the generic name.

Viagra was the name chosen by the original manufacturers. But now that the patents on the drug have run out, other makers are producing it, and they use the generic name - Sildenafil.

Very often, the generic form of the drug is cheaper. It has precisely the same side-effects, usually mild, as the original tablet did. So it will not hurt you.

And I assure you, it gives just as good erections as the brand-name Viagra does.


Sex with wife after prostitute

Q. When I was in the Corporate Area last night, I had half an hour to myself - so I went with a prostitute. Now I am home. Do you think it would be safe for me to have sex with my wife?

A. No, I do not. Unfortunately, prostitutes have a high rate of sexually transmitted infection (STI). This is inevitable, given the nature of their work.

So any man who goes with a lady of the night is quite likely to catch a STI though it is certainly not inevitable. But if you have caught one of those infections, then having sex with your wife would be a good way of giving it to her!

Therefore, before you resume intercourse with your spouse, you should have a check-up from a doctor or clinic.


I keep smelling my vagina

Q. As a woman, I go to work smelling fresh. But by 11.30 a.m, when I visit the bathroom to urinate, I get back to my desk, and I keep smelling my vagina. This goes on for the rest of the day.

By the way, I don't have sex without a condom. Do I have an infection?

A. Possibly. But only a minority of vaginal infections create a smell.

I think the best thing to do would be to consult a doctor, preferably a gynaecologist and ask her to take some swabs, and send them to the lab.

I hope that will solve the problem. Good luck.


Sex after a heart attack

Q. Doctor, is it OK to have sex after a heart attack? My husband is much older than me, and he has recently had heart trouble. We love having sex, but is it all right for him to continue?

A. I am not quite sure whether your husband has definitely had a heart attack, or whether he has some other form of cardiac trouble.

I am going to assume that he has had an actual heart attack - a myocardial infraction, to use the medical term. It was once thought that after such an occurrence, sex is quite dangerous.

However, doctors' views have changed over the years. Today, many doctors feel that it is OK for men who have had myocardial infractions to resume sex after a few weeks.

About a month ago, a research paper published in the Journal of the American College of Cardiology, reported that sex did not appear to increase the risk of cardiac problems. One of the authors, Professor Dietrich Rothenbacher said: "Based on our data, it seems very unlikely that sexual activity is a relevant trigger of heart attack."

Nevertheless, I feel that your spouse should just check with his own doctor about whether it is safe for him to have sex with you. My guess is that the doctor will say 'carry on'.


Sex after prostate cancer

Q. I have recently been diagnosed with mild prostate cancer. Is it safe for me to continue having sex with my wife? Or could I transmit any cancer cells to her?

A. Research suggests that it is safe for men who have this cancer to continue having sex with their partners. At present, there does not seem to be any risk of transmitting cancerous cells.

But if you or your wife have any concerns about this matter, you could simply use a condom during intercourse.


Should he clean up before sex?

Q. My boyfriend has a messy job, Doctor, with dirt everywhere. So do you think that I should insist that he washes his hands before he comes into my bed?

A. Definitely. It is dangerous to get dirt or germs into the vagina. As you are probably aware, a lot of women catch vaginal infections, and some of these are caused by poor sexual hygiene.

Furthermore, there is evidence that if a man is in an occupation which makes his hands dirty, that increases the risk that his partner will get cancer of the cervix.

So women should always make sure that their husbands or lovers have clean hands when they come to bed.