Q: Hi Dr Ketch, I have a question. How soon after giving birth can I have sex again? My partner seems very impatient to me. Our baby is only a month old now,

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 😀

Q: How long is the liquefaction of the sperm on seminalysis?

A: Hello there! Thanks for writing in.

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.

Have a good evening, y’all 😀

Q: Hello Dr Ketch, please help. All my life l have been going through 7 days of menstruation period days. Now recently for 4 months back, l started going for 3 days only; on day 3, l will be done. What could be causing this? I’m very worried

A: There are various shades of ‘normal’ in menstrual cycles with the menstrual flow lasting between 2 to 8 days and the cycle lasting anything from 21 to 35 days. A reduction in flow (scanty period) is called hypomenrrhea (pronounced hai-po-men-oria) and a reduction in the number of days of flow to less than 3 days is called oligomenorrhea (oli-go-men-oria).

Now at the onset of puberty, the flow and cycle can vary from one cycle to the other; the same goes for the other extreme of life (old age).

Other issues that can cause a decrease in flow include pregnancy (the supposed period may be an implantation bleed), crash dieting (when you want to lose all the weight you added in 5 years in one week :D), intense physical activity, Polycystic Ovary Disease (PCOD), imbalance of hormones and use of contraceptives. Previous instrumentation like Dilatation and Curettage (D and C), where the procedure was too ‘vigorously’ done can result in a condition called Asherman’s syndrome which manifests as reduction in menstrual flow. In the same way that stress can delay a menstrual period, it can also cause a reduction in flow.

You must work with your gynaecologist in order to manage this. If the cause is PCOD, focus will be on the treatment; if due to intense exercise, reducing intensity will be helpful; if due to crash dieting, focus on eating a proper balanced diet will help etc. Your gynaecologist will carry out a detailed examination and investigation to arrive at the cause and advice on treatment.

Have a good night y’all 😀

Q: Good day Doc. Ketch. I want know more about ‘Gyna …..’! Is it recommended for the cleansing of vagina? Or does it reduces the smell down there? Please help. Thank you in advance

A: Let’s start with a statement of fact….Some degree of vaginal odour is common with all women. The vagina has a natural musky smell. In the same way, some degree of discharge is also normal as the glands in the vagina and cervix produce fluid which wash away dry, dead cells and flush out bacteria. A strong vaginal odour which appears different from normal especially when associated with other symptoms like a burning sensation, itching, discharge etc may be suggestive of a problem…some more easily solved than others.

For instance:
Poor vaginal hygiene. This can be easily remedied by washing the vagina daily with or without soap (if soap is used, unscented or mildly scented soap should be used) and loads of water, not douching, cleaning from the front to the back etc. Vaginal odour may also be more pronounced during a menstrual period and after sexual intercourse. And so, more frequent baths (as much as practicable) during and/or before these periods may be helpful. Frequent change of sanitary towels and tampons are also helpful measures. Forgotten tampons are actually a cause of vaginal odour.

A fishy smell associated with vaginal discharge is suggestive of overgrowth of the vagina by bacteria (bacterial vaginosis). This may be caused by over use of antibiotics or douching.

The brand you mentioned in your question is a type of vaginal douche. Douche is a French word which means to clean or soak. People who douche usually inject/spray a mixture of water and vinegar into their vagina. Other douches contain antiseptics and fragrance too and They believe that douching serves one or more of the following functions:

• Cleaning the vagina
• Cleaning out menstrual blood after a period
• Prevent pregnancy
• Prevent STIs
• Get rid of odour

Unfortunately, douching serves none of those purposes and indeed, may even be harmful as you may have noticed with your experience. I suggest that you go see a doctor to get checked out, if you think something is wrong.

To clean the vagina during or after a menstrual period, one does not really need anything other than water. Mild, unscented soap may also be used on the outside. Douching disturbs the natural balance between the good and bad bacteria which live in the vagina, causing other organisms like yeasts to over grow the vagina. So avoid this and other scented feminine hygiene products.

Douching does not prevent pregnancy as loads of sperm may have already swum up to the womb before douching is done, after sexual intercourse. In fact, for those that may not have reached the womb (uterus), the force of douching may very well help deposit the sperm firmly in the uterus 😀 Talk about a boomerang!

STIs cannot be prevented by douching. In fact, if anything, if there is a vaginal infection, douching can actually push it all the way up to the fallopian tubes, potentially. These may lead to pregnancy complications in baby, labor and indeed, preterm delivery.

In summary, leave douching well alone! 😀

Yellow or greenish or frothy discharge with a bad smell with pain and itching while urinating is suggestive of trichomoniasis infection (a sexually transmitted infection)

Some cancers like cervical or vaginal cancer may also cause vaginal odour.

What’s the remedy? Well, if it’s due to lack of vaginal hygiene, that’s easily solved as noted above. If there are other associated symptoms which may suggest other problems, than a proper diagnosis needs to be made so that adequate treatment can be given. So, see a doctor asap.

In the meantime, vaginal hygiene is a good place to start and then, incorporate the other tips noted above.

I hope this helps.

Q: Hello doctor, please I do have frequent urination. What can cause it and what’s the solution?

A: Frequent urination may actually be due to the simple fact that you’re drinking way too much fluid. However, where this is not the case, it is likely to be due to a health problem.

Some causes of frequent urination include:

• Sexually Transmitted Infections as you have already noted.
• Some medications
• Drinks that contain caffeine, alcohol etc
• Infections that along the urinary tract or changes to the bladder
• Infection or enlargement of the prostate
• Disease conditions like Diabetes Mellitus etc
• Some cancer treatment eg radiation treatment for the lower abdomen

If this is due to excessive fluid intake, limiting this will help. If this symptom is associated with others like difficulty with urination, pain during urination, passing out bloody urine, incomplete emptying of bladder when urinating etc, please see your doctor ASAP.

So, I suggest that you just go and see your doctor. He will take a good history, examine you and order some investigations. The treatment of course will depend on the cause of the problem.

For related posts, please click on the following:

Daily Health Tips: Urinary Tract Infections In Men

Daily Health Tips: Why Do I Have Pain When Urinating?

Daily Health Tips: Train That Leaking Bladder!

Daily Health Tips: Prostate Enlargement

Daily Health Tips: More on The Prostate Gland

All the best!

Q: Good Day Doc. Ketch!!! I’ve got a Problem here. Please help!! Is is Normal for a Vagina to Fart?? Because this thing almost happens everyday

A: Vaginal farts are much more common than you may think. However, many women would rather not talk about it because, it may be somewhat embarrassing! Vaginal farts occur when the vaginal walls expand, pulling in lots of air, and then collapse back to release this air. They are usually odorless, in contrast to anal farts. It can happen with exercise, sex, and with sudden movements like getting out of a chair.

The treatment for vaginal farts is really the same as for feeling loose ‘down there’ after you just had a baby. This treatment is the usual suspect…pelvic floor exercise called Kegel exercise.

This is done by trying to hold your vagina together, tightening it like trying to hold urine. Hold these contractions for 10 seconds, then release for another 10 seconds. This should be done several times a day .You can do these exercises anywhere; while waiting on a queue, working at your desk or while watching TV. It may take 6-12 weeks of exercise to see results. These exercises can strengthen the pelvic wall muscles and help keep the vaginal walls from expanding. These exercises provide other benefits like facilitating childbirth, enhancing orgasm, and decreasing the chances of having a leaky bladder later in life.

Try keeping your legs together as much as possible, and also avoid using tampons when you are not menstruating.

The best advice is to think of vaginal farting as natural and fun instead of embarrassing 😀 However, please see your doctor if the Kegel exercises do not help and you feel the same way.

I hope this helps 😀

Q: I’m a male, aged 29 years. Why do I experience orgasm when I am fast asleep but I do not release sperms? It happens monthly. Looking forward to your reply.

A: Thanks for writing in. Not releasing sperm could be due to a condition known as anejaculation. There is failure of ejaculation in this situation. It can be primary (in which case it is present at birth and is a lifelong condition) or it could be secondary, as appears to be the situation here. In secondary anejaculation, the problem is acquired. The same conditions that cause retrograde ejaculation are also suspect here. Retrograde ejaculation (RE), refers to backward ejaculation. To understand this, a refresher course on how ejaculation happens is needed:

Usually, during ejaculation, the muscle at the neck of the bladder tightens ensuring that semen does not enter the bladder. In people with this problem, this muscle does not tighten enough to prevent backtrack of the semen into the bladder. So, in these people, their ejaculate during intercourse is usually very little (sometimes almost non-existent, even though they certainly know they have had an orgasm) or their urine after sexual intercourse cloudy as a result of the sperm going into the bladder and mixing with urine.

Retrograde ejaculation (RE) does not interfere with a person’s ability to enjoy sexual intercourse, have and maintain an erection or even climax. Usually, these people would show up in the clinic because of infertility.

RE and secondary anejaculation can start after a surgery on the bladder or prostate; it can occur as a side effect of some anti-hypertensive drugs (drugs used to treat hypertension), or as a complication of some surgeries or medical conditions like Diabetes Mellitus, multiple sclerosis or spinal cord injury. A few people are actually born with a weakness of this muscle that closes the neck of the bladder during ejaculation.

During the refractory phase of the sexual response cycle, it is also not possible for a man to achieve orgasm. To better understand this, a quick class  There are 4 phases of the sexual response cycle: excitement, plateau, orgasm (climax) and resolution (when the body returns to its normal functioning). After resolution, men usually need recovery time. During this period (refractory period), the man cannot achieve another orgasm. This period may last for minutes, hours or even days…the older one gets, the longer the refractory period.

If RE or secondary anejaculation is caused by medications, your doctor may consider changing them or stopping them for a while. Otherwise, there are some drugs used to ensure the neck of the bladder is closed during ejaculation. Your doctor will weigh their side effects against their potential benefits in deciding whether to prescribe them to you or not. For those who desire babies, your doctor will also discuss options of ‘harvesting’ sperm to be used on your spouse.

For spinal cord injuries, the ejaculatory pathway may be intact or there may be need for penile vibratory stimulation depending on the level of the injury.

Your doctor should be able to take a proper history, carry out a detailed examination and make a proper diagnosis.

All the best!

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