Reproductive Health

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.

Do you suggest HPV testing or Pap smears for cervical cancer screenings?

DEAR DOCTOR K: I am 31 years old and have always had normal Pap smears. I just read that HPV testing might be better. What do you suggest?

DEAR READER: Screening for cervical cancer has led to a dramatic decrease in the disease. Until fairly recently, all cervical cancer screening was done by Pap smear. But the FDA recently approved the use of a new screening tool -- the HPV DNA test -- that may eventually take its place.

How is vaginal dryness treated?

DEAR DOCTOR K: I've been bothered by vaginal dryness. Sex is painful. My doctor believes it's vaginal atrophy due to menopause. Can you tell me more about this condition? How is it treated?

DEAR READER: During a woman's reproductive years, the lining of the vagina is kept moist and lubricated in part by female hormones made by the ovaries -- particularly estrogen. With the start of menopause, estrogen levels decline. This often leads to vaginal atrophy: The lining of the vagina becomes thin and dry.

Is acupuncture an effective treatment for erectile dysfunction?

DEAR DOCTOR K: Is acupuncture an effective treatment for erectile dysfunction?

DEAR READER: During an erection, arteries supplying blood widen, and veins leading blood away from the penis clamp down. As a result, more blood is inside the penis, causing it to swell and become firm. It sounds simple, but getting to an erection requires extraordinary orchestration of blood vessels, nerves, hormones and, of course, the psyche. Here is an illustration of this process:

How can an enlarged prostate cause troublesome urinary symptoms?

DEAR DOCTOR K: I have BPH. Can you explain how an enlarged prostate causes troublesome urinary symptoms?

DEAR READER: Around the time of a man's 25th birthday, his prostate gland begins to grow. This natural enlargement is called benign prostatic hyperplasia (BPH). It is the most common cause of prostate enlargement. If a man lives long enough, he will almost certainly experience some degree of BPH.

My doctor recommended Monistat for my strong “fishy” vaginal odor but that hasn’t helped. What can I do?

DEAR DOCTOR K: I have a strong "fishy" vaginal odor and a little discharge. My doctor recommended Monistat, but that hasn't helped. What can I do?

DEAR READER: Miconazole (Monistat) is an antifungal medication. It treats vaginal yeast infections, which are caused by a fungus. If Monistat didn't work, you most likely don't have a yeast infection. Instead, you probably have bacterial vaginosis (BV).

Why is it complicated to test testosterone levels?

DEAR DOCTOR K: I've been having symptoms that may be caused by low testosterone. I figured it would be easy to test my testosterone levels, but my doctor says it's complicated. Why?

DEAR READER: Testosterone is one of the main male hormones. Blood levels of this hormone start to sag in early adulthood, and then creep lower. In some men, the levels become low enough to cause symptoms. The classic symptoms of low testosterone ("low T") are low sex drive, erectile dysfunction, poor muscle tone, poor concentration and memory, and low energy.

I was diagnosed with polycystic ovary syndrome — What can you tell me about this condition?

DEAR DOCTOR K: I was just diagnosed with polycystic ovary syndrome. My doctor said it explains why I haven't been able to get pregnant. What else can you tell me about this condition?

DEAR READER: Polycystic ovary syndrome (PCOS) is a group of symptoms that results from an imbalance of certain hormones in the female body. It is relatively common: About 7 to 8 percent of adult women in the United States have PCOS.

Does endometriosis affect fertility?

DEAR DOCTOR K: I have endometriosis. Could this affect my fertility?

DEAR READER: Endometriosis can affect fertility -- but not in every case. Let me explain. Endometrial tissue is the inner lining of the uterus. Normally, that's the only place in the body where it grows. However, with endometriosis, the same type of tissue also grows where it shouldn't -- in places outside the uterus.

What should I do if my baby has an undescended testicle?

DEAR DOCTOR K: My new baby was born with an undescended testicle. What should we do?

DEAR READER: When a baby boy is an embryo in his mother's womb, the testicles form in the lower part of the abdomen (the pelvis). In the weeks before the baby is born, the testicles move down out of the pelvis into a sac (the scrotum) that lies outside the body. In about one-third of premature and approximately 3 percent of full-term male infants, one or both of the testicles have not completely descended into the scrotum by the time the child is born.