Doc, what should I do if I can’t afford pap smear?

Dr Flo,

I have always wanted to have a pap smear done, but I do not have enough money and I cannot afford to be going through this procedure every now and then. What should I do?

Virginia

Dear Virginia,

Pap smears should be done once every three to five years if you are below 45 years old, and annually thereafter unless an abnormality is noted or if you are HIV positive. This means you have enough time to prepare for the test. In public hospitals, the test can be done for as little as Sh100 and is free in some medical camps especially during the cancer awareness months. At some medical camps or hospitals, they may opt for a cheaper procedure called VIA/VILLI, especially if the testing is being done for free. Checking for cervical cancer is an important part of regular health check-up.

Dr Flo,

I sweat a lot, a condition known as hyperhidrosis, and sometimes my hands and legs are as cold as ice even when it is sunny. My concern is can I find a doctor who accepts insurance payment?

Simon

Dear Simon,

Hyperhidrosis means that there is sweating that is in excess of what the body needs for regulation of temperature. Most people have primary hyperhidrosis, which means the sweating is not caused by any disease or infection. It may be triggered by a part of the nervous system (neurological hyperhidrosis), by eating (gustatory hyperhidrosis) or have no obvious cause. In secondary hyperhidrosis, the sweating is due to another disease such as a thyroid problem or diabetes, nervous system diseases or some medication. The child of a parent with hyperhidrosis has a 25 per cent chance of suffering from the same.
Hyperhidrosis can affect the whole body or specific sites such as the face and head (craniofacial hyperhidrosis), the palms (palmar hyperhidrosis), the armpits (axillary hyperhidrosis) or the feet (plantar/pedal hyperhidrosis). 
Because the sweating may be triggered by emotional responses such as anxiety, fear and excitement, it may be beneficial to learn relaxation techniques to help reduce the sweating.
The condition cannot be cured, but it can be managed by applying aluminium chloride solutions or 0.5 per cent glycopyrolate solution; iontophoresis, which utilises an electric current that is run through the skin; use of anticholinergic medication; or by intra-dermal injection with a muscle relaxant. In iontophoresis, the medicines and injection should be prescribed and administered by a qualified dermatologist. In severe cases, surgery may be done. These procedures may not be paid for by insurance. However, if there is an underlying condition such as diabetes, tests and treatment for that condition may be covered by insurance. Each insurance policy is different depending on the terms of agreement regarding the panel of providers, rules on referral, cover limits, coverage of pre-existing conditions and they all have exclusion criteria, which I would advise you to familiarise yourself with.

Dr Flo,

Over the years, I have had a rough time during sex. I ejaculate fast and I also lack interest. What could be the problem?

K J

Dear K J,

Low libido means there is a decrease in desire for sexual activity. It is normal for the interest in sex to change from time to time based on life circumstances. For some people, however, this reduced or lack of interest may be due to underlying issues like low testosterone level, chronic illnesses (like liver disease, heart disease, cancer), sleep problems, ageing, depression, stress, relationship issues, alcoholism and drug abuse, too little or too much exercise and some medication like antidepressants, especially SSRIs.
To manage it, eat a regular, healthy, well balanced diet, exercise, get enough sleep and manage stress. It would be advisable to be evaluated by a doctor, and if there is an underlying illness, it should be managed. Medication that may be causing the problem can be changed. Low testosterone levels can be managed with testosterone replacement therapy. Counselling and psychotherapy can also help.
The normal male sexual response cycle involves desire, arousal, plateau, ejaculation and resolution. The average time from beginning of intercourse to ejaculation is five minutes, and this is average, so for some men, this may be two minutes. If ejaculation happens sooner than you or your partner would like, it is called premature ejaculation. If it happens once in a while, then it is not a cause of concern. If it is frequent and is causing frustration, then it needs to be addressed. 
It can occur due to psychological and physical factors. Psychological issues include early sexual experiences, worry about sexual performance, anxiety, depression, guilt, poor self-image or relationship problems. Physical factors include abnormal levels of hormones or brain messengers (neurotransmitters) or inflammation of the urethra or the prostate.
To manage it, any psychological issues need to be addressed, if necessary, by visiting a mental health professional. You also need to have a supportive partner. Medication can be prescribed and topical creams can be used that have a numbing agent. 
Other ways of managing it include:
1)    Avoiding sexual intercourse for some time and focusing on other forms of touch to reduce the pressure to perform
2)    Strengthen the pelvic muscles using kegel’s exercises – tighten the muscles that you would use to stop urine flow. Contract these muscles 10 times and repeat at least three times a day.
3)    Stop-start technique – during intercourse, when you feel the urge to ejaculate, stop all activity until the urge passes, then start again. By repeating as necessary and some practice, holding off ejaculation can become a habit.
4)    Pause and squeeze technique – during intercourse, when you are about to ejaculate, have your partner squeeze the penis where the head joins the shaft for several seconds, until the urge passes, then continue. 
5)    Using a condom to reduce sensitivity 

Send your medical questions to [email protected] for free expert advice