Ask the doctor: feminine deodorants

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I spend a fortune on feminine deodorants – is something wrong with me?
Regular use of feminine deodorants can upset the pH and bacterial balance in this delicate area. A common condition called bacterial vaginosis (BV) can cause a strong odour, and may also lead to irritation and itching that is often mistaken for thrush. Having BV also increases the risk of miscarriage and preterm labour. Up to one in three women are affected at some point in their lives, but are often unaware that anything is wrong. Using a product designed to replenish the area’s natural acidity, thus promoting the growth of healthy probiotic bacteria and discouraging those that produce unpleasant odours, can help. Try Balance Activ gel (£10.20 from pharmacies, supermarkets and www.balanceactiv.com) and if things don’t improve, visit a genito-urinary medicine clinic (phone your local hospital for details).
Dr Sarah Brewer, Prima (May 12)

I had my ovaries removed plus a hysterectomy, five years ago, due to endometriosis. For the past year, I’ve been on HRT and getting familiar pains – can endometriosis flare up again?
Endometriosis is the only known condition in which apparently normal, non-cancerous cells spread from one part of the body (the womb lining or endometrium) to another (most commonly the pelvic cavity), where they take root and continue to grow. It affects as many as one in ten females, although many have no obvious symptoms. Those that can occur include painful periods, pain during sex and deep pelvic pain. As oestrogen stimulates growth of endometriosis tissues, it’s likely that your HRT patch has reactivated the problem. Ask your GP to refer you back to your gynaecologist. For more information, visit www.endometriosis-uk.org or call 0808 808 2227.
Dr Sarah Brewer, Prima (Apr 12)

I’ve heard that women shouldn’t use talcum powder between their legs. Can you recommend something else to keep this area fresh?
There has been concern that using talcum powder ‘down below’ might increase the risk of ovarian cancer, but this is a low risk, probably linked with the fact that some powders used over 30 years ago may have been contaminated with asbestos. To keep fresh, use panty liners, changing them as frequently as needed. Or try Lactacyd Femina Daily Protective Wash (£4.69 for 200ml, Boots, www.boots.com), which is designed to cleanse the area while maintaining the right acidity to reduce infections such as thrush.
Dr Sarah Brewer, Prima (Mar 12)

I’m 12 weeks pregnant and I've heard that new guidelines say any woman can have a Caesarean section. I’d like a natural birth. Is my doctor likely to put pressure on me to have a C-section?

Don’t worry, the guidance from the National Institute for health and Clinical Excellence (NICE) has caused lots of headlines, but for most women it won’t make any difference. Like you, the majority of mums-to-be plan for – and have – a vaginal delivery, but it’s true that the number of Caesarean sections is increasing every year. There are lots of reasons for this, including: increasing maternal age, increasing weight and having diabetes – all of which make complications in labour more common. Doctors’ fear of being sued if things go wrong during a vaginal delivery may also be fuelling the rise. And some women do ask for a C-section because of a real fear of childbirth, and this is a genuine medical need. However, the new guidance makes it clear they must be offered counselling to help. A few women also request a Caesarean because they think it’s ‘better’ (celebs speedily back in their size 10s don’t help!), but they will be given advice about the risks and benefits – as a C-section is a major operation.
Dr Sarah Jarvis, Good Housekeeping (Feb 12)

My periods have become increasingly painful in the past few years, and now I’ve started to get pain after I make love and even after a bowel movement. My GP thought I had endometriosis, but I’ve had an ultrasound scan of my pelvis and he says it’s normal. He seems to think it’s all in my mind – what can I do?

Go back to him, or to another GP! Endometriosis is a very common condition – it a ects nearly 2 million women in the UK. It’s caused by cells like the ones that line your womb ending up outside it, over the inside of your abdomen and pelvis. It can be treated with keyhole surgery or medication. Unfortunately, while ultrasound is good at picking up endometriosis on the ovaries, it’s not sensitive at picking it up elsewhere, so the scan can appear normal even if you have significant endometriosis. This may be why most women who have it see their GP at least five times before they get referred. Don’t be one of them – make another appointment and explain your concerns.
Dr Sarah Jarvis, Good Housekeeping (Sept 11)

I’d like to go back on the Pill, having recently had a baby. My periods are now very irregular – every five to six weeks. Will this delay me starting the Pill?
Guidelines used to suggest starting the Pill on the first day of a period, but family planning experts now advise that, if it is reasonably certain that a woman is not pregnant, she can start the Pill on any day of her cycle. You will need to take additional precautions for the first seven days if the Pill is started after day five of your cycle (day one is the first day of your period). There are new guidelines on what to do if you miss a Pill. If one active Pill is missed, there is no need to take additional precautions, while if two are missed, additional precautions are required for the next seven days.
Dr Sarah Brewer, Prima (Sept 11)

I recently had a routine smear and the nurse had great difficulty trying to find my cervix – should I be concerned? Also, at 44, would you recommend coming off the Pill?
In around one in five females, the womb is tilted, so the cervix points backwards. It’s nothing to worry about, but can mean a nurse or doctor has to poke around to find it, which can cause discomfort. How long you stay on the contraceptive pill depends on a variety of factors, such as your weight, whether or not you smoke, and if you experience side effects. Some women stay on the Pill until the menopause, while others switch to the mini-pill or to another method, such as the Mirena IUS (which releases a low dose of hormone). Ask your GP or family-planning nurse for more information.Dr Sarah Brewer, Prima (Aug 11)

My periods have become longer and very heavy. I’m only 40, but if I see my doctor will she suggest a hysterectomy? I’d rather not have major surgery.
Over five million womenin the UK experience heavy bleeding, but there are other options apart from surgery. One of the most effective treatments is the drug tranexamic acid. This stops menstrual blood clots from redissolving, considerably reducing blood loss. Until recently, tranexamic acid was only available on prescription, but you can now buy it over the counter from pharmacists (Cyklo-F Heavy Period Relief, £8.99 for 18 tabs). Another
approach to consider is the Mirena intrauterine system – a coil that releases low doses of levonorgestrel hormone. This can reduce blood loss by 90 per cent, although it may cause irregular bleeding initially. A more permanent alternative is to have the womb lining removed using a laser. After treatment, most women have little or no menstrual flow.
Dr Sarah Brewer, Prima (Aug 11)

My husband has lost his ‘joie de vivre’ over the past year, and it’s now affecting us in the bedroom. We no longer have sex and he gets cross whenever I try to discuss it. We’ve always been very close, but I feel he’s shutting me out.
Erectile dysfunction is incredibly common – about 40% of men over 40 suffer from it. There are lots of causes, and it can be a marker of underlying health issues like diabetes or furring up of the arteries. Medication, including blood pressure treatments and antidepressants, can also be a cause. If your relationship is strong, it’s less likely to be due to problems in your marriage. If your husband is also lacking in energy and vitality, depression or low testosterone levels could be to blame. Both conditions can cause lack of interest in sex, as well as lack of performance. This is a sensitive issue, so keep supportive lines of communication open. As a first step, your husband really needs to get physical problems such as diabetes or low testosterone ruled out – and both conditions are treatable.
Dr Sarah Jarvis, Good Housekeeping (July 11)

I get thrush, which keeps coming back. The usual anti-fungal creams and pessaries make me sore. The fluconazole capsule usually works but I’d like to use something to reduce itching, too. Is yoghurt worth a try?
Yoghurt can soothe the inflammation of thrush. An organic, natural bio yoghurt without additives is usually advised, though these are messy to use. Have you tried Bio-Fem FloraPlus? This is designed to treat vaginal thrush using five single-use tubes of aloe vera gel extract, plus a pre-biotic (£12.95 for five tubes from www.passionforlife.com or pharmacies). For treatment, use one tube before going to bed for five consecutive nights. For prevention, use one tube every three days. Bio-Fem ActiGel is also available to re-balance acidity and reduce irritation when you don’t have active thrush (£9.95 for 50ml, www.passionforlife.com).
Dr Sarah Brewer, Prima (June 11)

I haven’t had a period for two years, but still get symptoms of bloating and almost constant pain. My GP brushed it off as ‘a thing I have to get through’ which didn’t really help.
If your periods have ended due to the menopause, you shouldn’t experience continual pain. Go back to see another doctor, as you need a referral to a gynaecologist to assess your ovaries. If they can find nothing wrong, ask them to refer you to a gastroenterologist in case the pain is related to your bowel. If you’ve ever had abdominal or pelvic surgery (such as a Caesarean section), another possibility is adhesions – bands of scar tissue that can cause you pain many years later. You shouldn’t have to put up with constant pain, so don’t let your doctor fob you off.
Dr Sarah Jarvis, Good Housekeeping (May 11)

I had a recent pregnancy scare after my husband and I got carried away on a romantic break and didn’t use a condom. I couldn’t get to my GP the next day for the morning-after pill, but I’ve heard you don’t have to take it straightaway. Is that true?
Many women talk about the ‘morning-after pill’, but this isn’t an accurate name. A new kind of emergency contraceptive pill, ellaOne, is more effective than the traditional version and can be taken up to five days after unprotected sex, although the sooner you take any hormonal method, the more effective it’s likely to be. You can get emergency contraception from pharmacies without a prescription, but remember, the emergency pill is never 100% effective, so a long-acting reversible contraceptive may be worth considering. The traditional coil, Mirena coil or a hormone implant, for example, all work for at least three years.
Dr Sarah Jarvis, Good Housekeeping (Jan 11)  

Will my 13-year-old daughter still need a cervical smear in the future, even though she’s had the cervical cancer vaccine?

Around 3000 women are diagnosed with cervical cancer every year. In seven out of ten cases, the cause is infection with certain strains of the human papilloma virus (HPV), which can be prevented by immunisation. Because the HPV vaccine does not protect against all the causes of cervical cancer, it is still important she has a smear as often as she is invited to attend. When your daughter is between 25 and 60, she will be contacted at least every five years and asked to attend for a test. Smears pick up early changes that can be treated before cervical cancer develops, so they are just as important a preventive measure against cervical cancer as the vaccination. For more information, visit www.jostrust.org.uk and www.eveappeal.org.uk.
Dr Sarah Jarvis, Good Housekeeping (Oct 10) 

I've found magnesium supplements helpful for premenstrual syndrome, but they also have an unwanted laxative effect. Is there any way round this?

Taking 200-360mg magnesium per day for two months has been shown to improve monthly symptoms. Although most people tolerate magnesium well, higher doses are used for their purgative effect. If you are sensitive to this effect, you could try bathing for 20 minutes in a bath to which you've added two generous handfuls of Malki Dead Sea bath salts (£6.99 from Boots) as these are readily absorbed across the skin into the body without causing a laxative effect. Another option is Magnesium Oil mineral spray mist (£11.95 from Holland & Barrett). Ten sprays morning and night, massaged into skin, delivers 360mg magnesium.
Dr Sarah Brewer, Prima (Aug 10) 

Too late for emergency contraception?

I thought emergency contraception could only be used up to three days after unprotected sex, but my friend was prescribed one after five days. Why?

There are now two types of emergency contraceptive pill. Levonelle (which contains levonorgestrel) must be used within 72 hours of unprotected intercourse. A new version, EllaOne, contains ulipristal, which interferes with the action of the pregnancy hormone, progesterone. This can be taken up to 120 hours (five days) after. A copper-containing coil can also be inserted up to five days after unprotected sex (sometimes later if the doctor is able to calculate the likely ovulation and implantation dates). Seek medical advice as soon as possible.
Dr Sarah Brewer, Prima (Mar 10) 

I got divorced last year at the age of 52 and am beginning to think about starting a new relationship. It's been a long time since I've dated, and I want to make sure I stay safe. Getting pregnant isn't an issue - I've been sterilised - but I do worry about sexually transmitted infections (STIs). I'm too embarrassed to speak to my GP - what should I do?

You're wise to think about this - recent years have seen a huge rise in STIs among women of your age as more embark on second relationships after divorce.

If you don't have any symptoms, you can be fairly sure you don't have most STIs, but chlamydia is the exception. If your husband was unfaithful, he may have passed it on without you having any symptoms. It's not just an issue for younger women - as well as infertility, chlamydia can cause painful long-term pelvic infections, even without short-term symptoms.

Contact your local sexual health clinic in complete confidence - they won't inform your GP without your permission. Alternatively, you can buy an accurate do-it-yourself chlamydia test called Clamelle from Boots. Good luck in your search for a new man - but don't be embarrassed to ask him to use condoms until you're in a steady relationship and you've both been checked out. 
Dr Sarah Jarvis, Good Housekeeping (Mar 10)