chatwithketch

Q: Hi Doc, I am sorry to just barge into your inbox. I have a problem. I am breastfeeding an 11-month old baby, while pregnant for 10 weeks. Is it safe?

A: It’s generally considered safe to continue breastfeeding in pregnancy. In fact some mothers would even breastfeed the new baby and the older one, concurrently. This is called tandem nursing. However, given the requirements of breastfeeding and of pregnancy, this mum must ensure that she is eating healthy and drinking sufficient fluids.

If your already born baby can talk, he may comment on the fact that the taste of your breast milk has changed especially towards the end of pregnancy and a few days after the birth of the new baby as colostrum is produced.

For more posts on colostrum, please click on this link: https://chatwithdrketch.com/2014/05/27/daily-health-tips-what-should-i-do-after-having-my-baby-if-my-breast-milk-doesnt-come-in-immediately/

For the mum, she may notice more breast tenderness…sorry 😀 And also, milk production reduces as pregnancy progresses.

The process of letting down milk involves the release of a hormone called oxytocin. This hormone can also cause uterine contractions, which you absolutely do not want when you’re pregnant until it’s time for delivery. The good news is that the oxytocin released is not enough to cause significant contractions that can lead to a pre-term labour. However, people who already have a history of pre-term or premature contractions need to check with their doctors as nipple stimulation (either during sexual intercourse or breastfeeding may lead to pre-term contractions)

Your 7-month old baby can take water (of course). You can give him freshly squeezed fruit juices (this basically means you’re buying the fruits and squeezing out the juice yourself or blending up a smoothie). Remember that your baby must not have any cow milk until the baby turns 12 months…well, unless it’s in yoghurt (unsweetened, flavor-free yoghurt). You can add some bananas to the yogurt and blend it up.

For more on weaning and preparation of yoghurt, please click on these links: https://chatwithdrketch.com/2014/12/29/daily-health-tips-weaning-foods/

Have a good night y’all 

Q: Please, I want to know what can stop my watery sperm. I am a boy of 16+ years

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 😀

‘Avoiding animal products and eating a plant-based diet is a great way to keep type 2 diabetes under control’ Read!

https://www.health.harvard.edu/staying-healthy/meat-free-diet-linked-to-benefits-for-people-with-type-2-diabetes

Having trouble sleeping? Want to deal with this without resorting to sleeping pills? Read!

https://www.health.harvard.edu/healthbeat/better-sleep-naturally

Q: Hallo! I have a 1-month-old implant. I started my periods one week ago and it’s still on. How long can it take? Previously it was going for a maximum of 4 days

A: How long can it take? Well, it varies, but this change in duration of period would typically revert to ‘normal’ between three to six months after you inserted the implant.

For those who do not know, the contraceptive implant, as the name suggests, is implanted under the skin….under the skin of the upper arm and protects against pregnancy for about 3 years.

This birth control method contains the hormone progestin which prevents the egg from being released from the ovary (if there’s no egg, then there’s nothing to fertilize, right? :D) and also makes the mucous in the uterus so thick that the sperm cannot sperm cannot swim through to get to the egg, even if it were released!

This method of birth control is good for breastfeeding mothers (because it does not contain estrogen which affects mother’s breast milk production) and is long lasting such that the woman does not need to take pills every day. However, this implant can cause unwanted side effects. While some women would have heavier, prolonged periods (as appears to be the case here), some others experience fewer and lighter periods. Indeed, some may stop seeing their periods after one year of use. Other side effects include headaches, nausea, mood change, nausea, acne, infection at the site of insertion etc. These symptoms would usually stop within the first few months (3 to 6 months). If, however, these continue or your experience severe headaches or excessive bleeding, please see your doctor.

Please note that, this method is not suitable for women with breast cancer.

If you experience a new lump in your breast, yellowing of the eyes, you have concerns about the location of the implants or just have questions to ask, please see your doctor.

I hope this helps.

All the best!

What is it about French Fries that increase the risk of cardiovascular diseases? Well, among other things, portion size and frequency of consumption play a key role! Read!

A: Hi Doc, can I ask a question about what causes a men not ‘to sperm’ while having sexual intercourse and how can that be treated?

A: Of course you can ask a question and as it turns out, you already did! 😀

In a male, ‘not sperming’ as you call it, could be due to a condition called anejaculation. Anejaculation is a situation in which there is failure of ejaculation. 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 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.

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

In females, ‘fluid not coming out’ could be due to vaginal dryness. Vaginal dryness can occur due to variety of reasons and at any age. Usually the vagina has a thin film of fluid that coats it. This fluid helps lubrication during sexual intercourse, maintains the normal environment of the vagina preventing the overgrowth of organisms like fungi, flushing out dead cells and menstrual blood. The level of this fluid/moisture varies with the level of estrogen released in the body. During sexual intercourse, there is increased blood flow to the vaginal area leading to an increase in the volume of moisture. During menopause, however, the level of estrogen is very low leading to vaginal dryness, loss of elasticity and thinning.

The main consequence of vaginal dryness is the fact that it affects sex life such that these women experience significant pain and sometimes, bleeding. Other problems that vaginal dryness could cause include soreness, itching and burning around the vaginal area, recurrent urinary tract infections and frequency of urinating etc.

There are other conditions, other than menopause that can lead to low estrogen and consequent vaginal dryness. They include childbirth, breast feeding, cigarette smoking, some medications (like anti-estrogen drugs used to treat cancer) and douching. Douching refers to the practice of cleaning the vagina with a ‘cleansing’ fluid. For more on this topic, please click on this link: https://chatwithdrketch.com/2014/09/30/daily-health-tips-what-is-douching/

Other very common causes of vaginal dryness include a lack of foreplay during sexual intercourse, feelings of guilt, relationship issues, allergy etc.

Treatment depends on cause. If it’s due to low estrogen, the focus would be on replacing this either through Hormone Replacement therapy or through the insertion of estrogen pessaries (tablets, cream or ring) into the vagina) should help. If due to rushed foreplay, there should be a conscious effort to slow down allow enough time for foreplay and sometimes, discussion with the partner may be helpful. Avoid heavily perfumed products like sanitary towels, tissues etc which may lead to irritation of the vagina and subsequent dryness etc.

I hope this helps.

“The brain is the body’s most important sex organ.” This well-known phrase bears more than a little truth.  Read!

https://www.health.harvard.edu/healthbeat/5-things-that-can-scuttle-good-sex