Reproductive Health

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.

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).