Reproductive Health

What is pelvic organ prolapse and what can be done to treat it?

DEAR DOCTOR K: My doctor checked me out because I was leaking urine. She said I have pelvic organ prolapse. Can you tell me what it is, and what can be done about it?

DEAR READER: Pelvic organ prolapse is a condition in which tissue from the uterus, bladder, urethra or rectum drops down into the vagina. As many as 1 in 3 middle-aged women have some degree of pelvic organ prolapse.

What are the treatment options for uterine fibroids?

DEAR DOCTOR K: I have fibroids that cause heavy menstrual bleeding and painful cramping. What are my treatment options?

DEAR READER: As I'll explain shortly, the first question you need to ask yourself is whether you want to have children in the future. That's because some of the most effective treatments for fibroids make becoming pregnant more difficult, or impossible.

What is premenstrual dysmorphic disorder (PMDD)?

DEAR DOCTOR K: I always assumed my premenstrual mood swings were normal. But then I talked to some friends whose emotional symptoms are much less severe than mine. A quick Internet search turned up "PMDD." Can you tell me more about this?

DEAR READER: The physical symptoms of premenstrual dysmorphic disorder (PMDD) and premenstrual syndrome (PMS) are the same. They include fatigue, swollen breasts, backache, headache, food cravings, bloating, constipation and diarrhea. But the emotional symptoms of PMDD, compared to PMS, are much more severe.

What could cause irregular bleeding all month long?

DEAR DOCTOR K: My periods used to be pretty regular. But for the past few months, I've been spotting all month long. Why is this happening?

DEAR READER: There are many possible explanations. Fortunately, few of them can turn into serious problems. Before talking about the causes of abnormal bleeding from the uterus, it's worth reviewing the menstrual cycle. Normally, the cycle is triggered by signals from sex hormones. Hormones made in the brain travel to the ovaries, leading to the production of other hormones by the ovaries: estrogen and progesterone.

What are fibroids and how are they treated?

DEAR DOCTOR K: I saw my doctor because of pain in my pelvis and heavy menstrual bleeding. Tests showed that I have fibroids. What are fibroids and how are they treated?

DEAR READER: A fibroid is a lump or growth in the uterus that is not cancerous. Fibroids can be as small as a pea or as large as a basketball. They are usually round and pinkish in color, and they can grow anywhere inside or on the uterus. The number of fibroids, their size and how fast they grow varies from one woman to another.

What could cause male infertility?

DEAR DOCTOR K: My wife and I have tried to get pregnant for over a year. We're going to be tested soon to see if anything is wrong. I'm worried that the problem lies with me. What are some reasons for a man to be infertile?

DEAR READER: About one in seven couples in the United States is unable to conceive a child after trying for one year. The infertility is caused by either the man alone (about 40 percent of the time), by the woman alone (about 40 percent of the time) or by both partners (about 20 percent of the time). So it is possible that something about you is responsible for your wife's difficulty with becoming pregnant.

What can I expect when my daughter goes through puberty?

DEAR DOCTOR K: What should I expect when my daughter goes through puberty? How can I help her as she goes through these changes?

DEAR READER: Full disclosure: I don't have any personal or parental experience to tap into for this question. Experienced colleagues and friends always emphasize how important it is to discuss puberty with your daughter before these changes begin. She needs to know what to expect and also that these changes are perfectly normal. Otherwise, she might be frightened by the first signs of change, such as her first menstrual bleeding.

What can I do about my heavy periods?

DEAR DOCTOR K: I bleed very heavily during my menstrual periods. Is there anything that can be done about this? Or do I just have to put up with the discomfort and inconvenience every month?

DEAR READER: Excessive menstrual bleeding (the medical term is menorrhagia) is a common problem. In my experience, a few primary-care doctors tell their patients just to "live with it." Not surprisingly, obstetrician/gynecologists are more likely to recognize excessive menstrual bleeding as a problem that needs treatment.

What does anovulation mean — can it effect the ability to get pregnant?

DEAR DOCTOR K: I've always had infrequent periods, but I never thought much of it. My doctor recently used the word "anovulatory" to explain why I've had trouble getting pregnant. What does this mean? Could the two be connected?

DEAR READER: "Anovulation" means you are not ovulating -- releasing eggs. A woman's ovary should release approximately one egg each month. Once released, the egg travels into the fallopian tube. There, it can be fertilized by the entry of a sperm. The fertilized egg then enters the uterus. When a woman does not ovulate, no egg is available to be fertilized by sperm. As a result, a woman cannot become pregnant. Women who are anovulatory have irregular, few or no periods.

Is it ok that I’ve stopped ejaculating even when I orgasm?

DEAR DOCTOR K: For the past few months, I haven't been ejaculating, even when I have an orgasm. Why not? What's wrong?

DEAR READER: It sounds like retrograde ejaculation. To explain that, we need to talk about anatomy. There is one tube, the urethra, which leads from the bladder and through the center of the penis. The urethra carries urine out of the body. Two tubes, one on each side of the urethra, lead from the seminal vesicles and open into the urethra. The seminal vesicles are tiny glands that make semen. (The prostate gland helps make semen, too). Semen is a thick fluid that helps nourish sperm. Semen really has no other purpose: It is produced onlyto help sperm.