chatwithketch

Q: Hello, Doctor. GOD bless you for the good work that you are doing to help us.
I am your follower from Zambia and really need your help now.
I have two problems.
1. I got circumcised in 2012, and for the past months I have been feeling pain inside my penis just before the head when the penis erects. I have never had sex before, but I usually feel this pain when I get an erection in the morning and when I am aroused. I am scared this could be worse when engaging in sex with my wife when I get married Doctor.
2. My penis bends to the left when it erects, could this cause me any problem to my sexual life when i get married?  
Doctor, I have never opened up to anybody of my conditions, I need your help. Thank you, and GOD bless you.

A: Hi dear, thanks for opening up to me. I hope this post helps you

Typically, after a circumcision, especially in adults, there’s bruising and swelling of the penile area for about 2 to 3 weeks. Urination may also be painful during this period but although there is general discomfort following the procedure, the pain level is not really severe and analgesics can help.

Some tips to help recovery…

• People think wearing loose fitting boxers or underwear is ideal but the opposite is actually recommended. Use underwear that hald the penis in place
• Make sure that your urine is dilute to prevent the burning pain that could happen with acidic urine during urination. How do you do that? Drink a lot of water and put a dab of petroleum jelly to the penile tip to reduce the burning pain
• Apply only those creams that have been prescribed by your doctor to the circumcision site to encourage healing and avoid infections
• Physical activity may be difficult for a couple of weeks; so leave well alone 😀

Erections are typically painful after this procedure and while in recovery. So you don’t really want to have erections at this time. To reduce the chances of nocturnal emissions:

• Try lying on your side when sleeping
• Try drawing your knees up too in a fetal position
• Urinate and ensure your bladder is empty before bedtime

Now, if indeed your circumcision was seven years ago (in 2012), the symptoms you are experiencing may not be associated with the procedure.

Some causes of penile pain include:

• Priapism: Priapism is a condition, in which there is a sustained and oftentimes, painful erection of the penis, continues for hours beyond sexual stimulation or even when there is no sexual stimulation. It is more common in men in their 30s.

There are three types of priapism (ischaemic, non-ischaemic and recurrent) but to understand this, we’ll take a look at the mechanism of erection. An erection occurs in response to stimulation, physical or psychological. As a result of this stimulation, the blood vessels and smooth muscles of the penis relax, allowing increased blood flow to the penis. This is what causes erection. When the stimulation is over, the vessels and smooth muscles constrict causing the blood to flow out of the penis and become flaccid. In priapism, the order of events causing the blood to flow out of the penis is changed such that the blood does not flow out of the penis

In ischaemic priapism, which is the more common type due to inability of blood to leave the penis, there is pain, rigid penile shaft but flaccid glans (penile tip) and the erection lasts more than 4 hours! Causes include blood disorders like sickle cell anaemia and injuries to the penis and/or pelvis, alcohol, cocaine and other illicit drug use, some medications like blood thinners and antidepressants, cancer of the penis etc.

Non-ischaemic priapism is usually due to an injury to the perineum or genitals that results in poor regulation of penile blood flow. It is not usually painful and manifests as erection that lasts for more than 4 hours but the penile shaft is not fully rigid.

In recurrent priapism, situation is similar to ischaemic priapism with erections that are painful, recurrent but ease after 2 to 3 hours. These erections may subsequently progress to become more frequent and more prolonged. It is common in males with sickle cell anaemia

Any sort of priapism should be checked out with a medical doctor (urologist) to determine type, cause and management. Erection lasting more than 4 hours is an emergency and may led to damage of the penis and subsequent erectile dysfunction. Treatment depends on cause and should be started as soon as possible.

Options include aspiration (in which blood is drained out of the penis with a syringe), use of medications to constrict the penile blood vessels, treatment of underlying medical condition like sickle cell anaemia and surgery in some cases. Note of warning, though it sounds very simple to use a syringe to drain out the blood in the penis, you must never attempt it on your own. You must visit a hospital and let a doctor work out the best treatment option(s) for you. Patients who do not get treated early enough and some that went through surgery eventually end up with poor erectile functions despite the successful treatment.

• Balanitis: Skin irritation of the head of the penis, known as balanitis, could present with itching as you described. Causes include:
  Irritation under the foreskin caused by urine
  • Candidiasis
  • Use of shower gels, soaps and other skin irritants
  • Skin conditions like eczema
  • STI
  • Poor hygiene

Your doctor will work with you to determine the cause and treatment is dependent on that.

• Urinary tract infections: In men, UTIs are not so common and would happen more in people who have an enlarged prostate, people who have a poor immune system and people who have kidney and bladder infections. Symptoms include frequent urination, difficulty with urination, pain during urination, fever etc. Involvement if the kidney leads to loin pain in addition to worsening of feelings if illness.
  The doctor will usually send a urine sample to the laboratory to check for bacteria present in the urine and what antibiotic(s) are effective against them. Be sure to take the antibiotics for the prescribed period of time, even if you feel better before you finish the course to prevent backtracking of infection into the kidneys. Drink a lot of water and take analgesics for pain, if needed.In summary, your specific treatment depends on the organism that is found in your urine at the laboratory. Be sure not to prescribe antibiotics for yourself!

For more on urinary tract infections, please click on the link below:
https://chatwithdrketch.com/2014/05/16/daily-health-tips-urinary-tract-infections/

• Sexually transmitted infections like syphilis, gonorrhea and chlamydia, injuries to the penis, penile cancer, phimosis in which the foreskin of the penis is stretched too tight and cannot be pulled away from the head of the penis, can cause penile pain.

Treatment depends on cause and some have been described above. Antibiotics can be used to treat UTIs and some STIs, including chlamydia, gonorrhea, and syphilis. Stretching the foreskin with fingers may make it looser in phimosis. Steroid creams rubbed on the penis can also help. In some cases, surgery is necessary in phimosis and/or cancer. In the latter, radiation treatment or chemotherapy could be included.

So, your first step is to see your doctor for a proper diagnosis and treatment.

As to your second question, it’s quite common for the penis to bend slightly to the left or right when erect. But if you think it curves more than it should and probably causes pain, then please see your doctor.

All the best!

Q: God bless you Doc for your medical contributions and advice. Please I am a mother of one, expecting the second soonest. I gave birth to my first girl through CS because of prolonged labor. Now can I deliver this second baby through vaginal birth without any complications as my Doc has not prescribed CS for me? What are the chances of delivering normally? Thanks ma’am

A: Thanks for your kind words and I’m eagerly waiting for your second with you 😀

Can you deliver vaginally? Yes, you can. Having had one C-section means you can still try for a VBAC (pronounced Vee-Back and means Vaginal Birth After a Caesarian) but a few years back,  once you’d had two C-sections, it meant you could only have subsequent children with the same procedure. That thinking has changed now and so even having had 2 C-sections may not be an automatic sentence to the knife, anymore 😀 However, there are a few factors that influence the decision for or against a VBAC. An important factor is that people who have had a transverse cut C-section (Lower Segment C-Section in which the cut on the abdomen is made from in the lower abdomen running from left to right) are more likely to be successful candidates for VBAC than those with vertical cuts (classical C-section in which there is a longitudinal cut on the abdomen). So, be guided by your doctor and remember that just because your doctor has said it is okay to try for a vaginal birth after a Caesarian Section does not necessarily mean that it will be successful. The woman may very well still end up having a Caesarian Section if a vaginal delivery is tried and it fails.

Generally, there is no specific number of C-sections that a woman is meant to have (especially in centers with significant technological advancement), though about 3 used to be the mark. There are women who have had more than 3 and are alive to tell the story. Having said that, the more the number of sections, the more the risks and complications the woman is exposed to.

Common risks and complications include:
• Weakening of the wall of the uterus wall with risk of uterine rupture!

• Healing after a C-section comes with development of scar tissue which may subsequently cause adhesions as they cause abdominal organs to stick to each other. This may lead to obstruction of the bowel or even block the fallopian tubes, leading to infertility. These adhesions may develop between the uterus and the bladder making it easier to injure the bladder with subsequent C-sections.

• Placental problems may occur in people who have had C-sections as the placenta may be implanted too deeply into the womb or there may be placenta previa. In these instances, removing the placenta presents a challenge and may result in profuse bleeding which requires blood transfusion.

For more on placenta previa, please click on these:
https://chatwithdrketch.com/2015/03/09/daily-health-tips-can-placenta-previa-recur-in-my-pregnancy/

Daily Health Tips: Placenta Previa

Have a good night, y’all 😀

April 2^nd every year is World Autism Awareness Day.

Ever heard of autism? It is major developmental problem that usually appears in early childhood and usually affects a child’s communication and interaction with other people.

These children usually do not respond to their environment or people. They may not respond when they are called, they would resist hugging/cuddling, do not maintain eye contact and generally prefer playing alone. They may not speak properly or speak later than expected, they don’t appear to understand simple instructions and they usually have a sing-song kind of voice. They also usually perform repetitive motions like rocking, may indulge in self-harming activities like head banging and may have the craving for things like chalk or other items not considered food.

Think about how many of these children have been branded witches in our traditional African societies. Think about how many of them have been beaten blue and black by parents who feel they are not smart enough. Think about the laughter and scorn these children go through. Food for thought.

Who is at risk? Autism can affect anyone but boys are more likely to have it, families with one autistic child are likely to have another and it is also thought that perhaps children born to older parents are more at risk.

Regarding treatment, please note that there is no cure, but autistic children can live full and happy lives if this is discovered on time. The focus is on their areas of concern: communication and social interaction. Family therapy sessions focus on equipping families with the skills to take care of these children and interact with them in a way that encourages them to interact socially; educational therapies aimed at providing structured learning programs have also been successful, and usually these involve a team of specialists. Other programs aimed at addressing their communication and behavioural skills help reduce the problems associated with this area of their lives and teach them new skills.

There are no drugs for the treatment of autism but some meds are given to treat the symptoms that arise. For instance, drugs may be given if the child is too hyperactive etc.

There’s a support group for autism in different countries. In Nigeria, the Nigerian Autistic Society could be a useful resource.

Have agood night, y’all 😀

Q: Hello Doc., please help me here? When is the exact time to start to have sex after giving birth??

A: Good question 😀 The honest answer is, as soon as you and your spouse feel up to it. Usually, 6 weeks is advocated at which time the woman would have had a post-natal check.  However, there is really no scientific basis for this and the time a woman feels like intimacy could differ from woman to woman. Some women feel ready earlier and some much later. Bear in mind that there are new issues contending for attention here…namely the new baby who requires a lot of attention, the overwhelming emotion of being in charge of a new life especially for new mothers, the sheer exhaustion after looking after the baby’s needs and sleep deprivation, the pain of vaginal suturing, if the woman had a tear, the dryness of the vagina at this time etc. We could go on and on! So, with all these, it may be difficult to feel really sexy…trust me, I know 😀

So, what’s the way forward? New mums, get as much help as you can so that you don’t feel exhausted every night. Also, rest whenever the baby is taking a nap. Perhaps, timing for intimacy can also be re-scheduled to other times…maybe mornings while the baby is still sleeping etc. Then again, you don’t have to wait for full sexual intercourse to be intimate. You can start off with cuddling and then move on to more adventurous things. Lubrication may also be a great idea to help with vaginal dryness. To help restore muscular tone to the vagina, pelvic floor exercise (Kegel exercises) should be started as soon as possible. The exercise mimics the movements we make when we want to stop the flow of urine. Try holding this for about 10 seconds and then doing about 10 repetitions per set. Try about 4 to 6 sets per day and increase this as you feel ready.

Remember birth control even if you’re breastfeeding exclusively. You don’t want to get pregnant while nursing a baby, right? 😀

I hope this helps 😀

Good night J

It’s about 2 weeks to Easter. Some of you are already planning to cook up a storm. The rest of you may be travelling and catching up with friends and family…this comes with its special brand of stress 😀 But, there’s just something about holidays that make us forget all the good things we’ve been doing, especially in terms of eating healthy and exercising, and go the ‘dark’ way 😀 Some tips to help you get through this holiday season – a mix of having a great time and keeping healthy!

https://www.health.harvard.edu/staying-healthy/3-health-strategies-to-help-you-get-through-the-holidays

Q: Hello Doctor Ketch. I have a problem. I had a depo injection for the first time after a long time of not using it. I had this injection on the 27^th of November and I was to go back on the 17^th of February. At the end of the month of December, I just had a two-day period. After that it stopped. My problem now is that at the end of March I didn’t get my period. I met my husband early March. Does it mean I may be pregnant? I just feel tired though because I never went back for another injection on the 17^th.

A: Taking these injections affect women differently. In the first few months, there is excessive bleeding during periods, followed by a period of lighter periods. This may yet be followed by a period of irregular or no periods especially in women who have taken these injections for up to a year. Irregular periods should be discussed with your doctor to ascertain the cause. It may be due to the drug or due to an infection, which needs to be treated. Prolonged periods can also be treated.

With any of the injections, it might take up to one year (or 2) before the return of periods and fertility. This is really irrespective of whether it is the 2 months’ or 3 months’ injection. And typically, it is a delay not necessarily a case of not being able to conceive again. In the same vein, because the effects of these injections range from 2 months to 3 months, depending on the one taken, then if there were side effects, one would have to bear them for that same period of time.

So, to your question, could you be pregnant? Maybe or maybe not. Run a test and you will know for sure 😀

All the best!

I hope this helps 😀

Q: How can I deal with the problem of watery semen?

A: Thanks for writing in.

One of the causes of ‘watery’ sperm is pre-ejaculate (a lubricating fluid) which may contain some sperm cells. It is believed that the sperm in the pre-ejaculate is not there at the time the fluid is produced, but is sperm from previous ejaculations that was probably left in the urethra. It is thought that urinating and cleaning the tip of the penis before sexual intercourse helps to clear the urethra of the sperm left from previous ejaculations. Diets poor in protein, frequent ejaculation as occurs in people who masturbate and exposing the testicles to high temperatures like in saunas could lead to a watery consistency of semen.

Just to be sure you do know what normal semen should look like, below is a guide.

Using WHO reference values, a normal semen sample should fulfill the following:

• Volume amount of sperm produced in one ejaculation): Greater than or equal to 1.5 ml
• pH (whether acidic or alkaline. If less than 7, it’s acidic and greater than 7 is alkaline): Greater than equal to 7.2
• Viscosity (being semi-fluid):  viscous
• Transparency: opaque
• Motility (percentage of sperm that move forward normally):  This should be more than 40%
• Morphology (percentage of sperm that have normal shape): This should be greater than or equal to 15% normal, oval sperm heads
• Liquefaction (time taken for the semen to become ‘liquid’): This should be complete within one hour
• Pus cells should be less than 1 million/ml or less than 5/hpf
• Total sperm count: This should be greater than or equal to 15 million.

The causes of low sperm count, which is often considered a cause of watery sperm, could be medical, environmental or due to lifestyle issues. Sometimes, the cause(s) can, also not be identified.

Medical causes include infections like gonorrhea and chlamydia, certain drugs used for cancer and fungal infections, hormone imbalance, undescended testes, varicocele (swelling of veins that drain the testicle) and cancer.

Environmental causes include over-exposure to industrial chemicals, heavy metals and X-rays; over-heating the testicles by frequently using the sauna and hot tubs; prolonged bicycling

Lifestyle causes include alcohol use, tobacco smoking, illegal drug use, obesity and emotional stress.

To get a woman pregnant, a man has to have at least 40 million sperm per ejaculate. People with low sperm count usually have less than this.
If you have been diagnosed with low sperm count, then do something about it. Here are some tips that could help to improve your sperm count. Treatment is generally based on the cause:
Stress has been found to contribute to infertility problems such as hormonal issues. So, prevent excessive stress and perform relaxation exercises. Remember that infertility and life in general can be stressful. Learn to relax.

Stop smoking because smoking significantly reduces both sperm count and the movement of sperm cells.

Prevent overheating of the scrotum: When scrotal temperature rises (caused by tight underwear, long stays in a sauna or Jacuzzi, for example) sperm production can be impaired.

Maintain a healthy weight: Not too under or overweight since weight influences estrogen and testosterone levels.

Stop using drugs: Prolonged use of recreational drugs (for example, alcohol, marijuana, cocaine)

If you have infections like gonorrhea and chlamydia, these need to be treated.

Surgeries can be done for varicocele and cancers. Radio and chemotherapy are also treatment options for cancer.

Medications or hormone replacements can be used for hormonal problems.

The major challenge with low sperm count is infertility. Sometimes, the treatments listed above do not work, especially when the cause is not known. But IVF is an option that exists for this group of people.

So, first thing is to confirm from the doctor what exactly the cause of the low sperm count is (if known) and then review your options from there.

All the best.

Have a good night, everyone 😀

Q: Hello Doctor, thanks for the wonderful work you doing. I’ve been reading your posts since I was pregnant and they really helped me, God bless you. I need your help. I gave birth to a girl a week ago. Her eyes are yellow. At first she spent three days without pooping because I did not breastfeed her a lot but now she poops normal. Is it normal for her to have yellow eyes? Can it be jaundice?

A: Jaundice is a condition in which there is yellowing of the eyes or the skin. So, the condition you describe is jaundice. It can happen in both children and adults. Usually, when old red blood cells are broken down, a yellow pigment, bilirubin is released as part of that process. The bilirubin is removed from the body through urine and stool. It is the bilirubin that gives rise to that yellow colour seen in jaundice.

Other symptoms of jaundice include deep yellow urine and pale stools.

In newborn babies, there are two types of jaundice (neonatal jaundice) that can occur: Physiological jaundice and pathological jaundice.

Physiological jaundice occurs as a natural process of life. While in the uterus, the baby’s bilirubin is removed through the placenta. Once the baby is born, he/she has to handle this bilirubin business by himself/herself J (talk about responsibility immediately after touching down in planet earth!)because his organs are unable to deal with all the bilirubin released from breakdown of red blood cells. As the bilirubin accumulates in blood, jaundice results. Typically, this jaundice appears about 24hours after birth, actually gets worse until the 3^rd or 4^th day. It would usually have disappeared by the end of one or two weeks.

Pathological jaundice is due to a disease condition like infection, mother and baby’s blood groups not being compatible etc. This is typically present before 24 hours of birth.  Indeed, this is the main difference between the two types of jaundice. The one that occurs naturally is seen after 24 hours while the one due to disease is seen before 24 hours…rule of thumb 😀

Jaundice may be mild, disappearing on its own, especially physiologic jaundice. However, sometimes, the yellowness deepens, the baby may develop a high-pitched cry and/or develop arched back. These are dangerous signs and this child should be in a hospital. Indeed, if you observe jaundice in your baby after you have left the hospital, please get it checked out in the hospital just to be sure.  Most babies are able to deal with this excess bilirubin on their own without needing treatment. However, some other babies may be put under special lights called phototherapy or in more serious conditions, an exchange blood transfusion may be done (literally, this involves practically exchanging the baby’s bilirubin-filled blood with ‘new’ blood).

The main focus in jaundice is to bring down the level of the bilirubin. If this is not done, it could cross the blood/brain barrier and stain the brain leading to brain damage, a condition called Kernicterus.  More frequent feeding is usually suggested as this helps the baby get rid of more bilirubin.

All the best!