Am I the reason why my wife and I don’t have a child?

Dr Flo, I have been married for two years now, but my wife and I still don’t have a child. My wife ovulates and gets her periods every month. I am physically fit and I can ejaculate, but I’m wondering if there is something wrong with me that is keeping us from having a baby. We live in Dar es Salaam. Can you help me? RD

Dear RD,

Concerns about fertility arise after one year of regular unprotected sexual intercourse.

About 15 per cent of couples are unable to conceive after one year of trying.

Of these, a third of the time the problem is in the woman, a third of the time, the problem is in the man, and in the other third, both partners have a problem, or no problem can be found at all.

In women, infertility can be caused by abnormal ovarian function, hormonal disorders, fallopian tube obstruction and abnormalities of the uterus. Some factors that can increase the risk of infertility are alcoholism, smoking, obesity, severe weight loss, extreme physical or emotional stress, and being over 35 years old.

In men, infertility can be caused by a disruption of the function of the testicles, ejaculatory dysfunction, hormonal disorders and genetic disorders. Some factors that can increase the risk of infertility include diabetes, alcoholism, smoking, use of steroids, injury to the testicles, being overweight or exposure to some drugs, toxins or radiation.

You need to see a gynaecologist with your wife for a check-up for both of you. For the woman, these include a pelvic ultrasound to check the pelvic organs, a hysterosalpingogram (HSG) to check the fallopian tubes and a hormone profile. The man may have a semen analysis done to check the quality and number of the sperms, and a hormone profile, if necessary.

Treatment is given, depending on what is found. For example, the woman may be given medication to help with ovulation or to control hormones, or surgery may be done if there is scarring, endometriosis or if the fallopian tubes are blocked. The man may also be put on medication, if necessary. You may also benefit from assisted conception through intra-uterine insemination or in vitro fertilisation (IVF).

Dr Flo, I have had a bulging disc in my lower back for almost a year. I wore a lumbar corset and completed my therapy sessions during this one-year period, but the problem persists. What measures should I take to heal completely? Sirali

Dear Sirali,

The spinal column is made up of many small bones (vertebrae) stacked on top of each other.

Nerves exit the spinal cord at each level, on both sides. Between one vertebrae and the next, there is a cushion made of softer material, called an intervetebral disc. This disc can rupture and the soft inner contents (nucleus pulposus) bulge out, due to injury from a fall, or from lifting something heavy while bending. It can also happen slowly over time from repetitive activity or from ageing.

When this disc bulges, it may press on the spinal cord itself or more frequently, on the exiting nerves. This can cause pain, numbness and tingling, weakness, and even loss of bladder or bowel control. The symptoms depend on which nerve root or which level of the spinal cord is affected.

Treatment involves use of pain medications, physiotherapy, and back support (like the lumbar corset). When the pain is very severe, rest is recommended, but after some time, exercise is beneficial, under the direction of a trainer who understands the condition.

The symptoms may never completely go away since the disc does not heal. If the symptoms are still severe (e.g. severe pain, or weakness of the lower limbs, or loss of bowel/bladder control), surgery can be done by a neurosurgeon. Another option, though temporary, is a nerve sheath injection with a local anaesthetic, also done by the neurosurgeon.

Dr Flo, I have had this problem for more than 10 years – intense itching around my scrotum that leaves me scratching vigorously. Rashes also appear and when I squeeze them, they produce a white discharge. Some of the rashes have turned into permanent bumps. At times I produce mucus-like discharge after urinating. I have sought treatment for this problem almost 15 times. Each time I am given medication which works temporarily, but the problem returns immediately after I finish the dose. I don’t have a sexually transmitted infection. What really is the problem and how can I get rid of the bumps, at the very least? Peter

Dear Peter,

Recurrent swellings or bumps in the groin or armpit occur when the hair follicles (where the hair comes out of the skin) are blocked by bacteria and other substances.

Some people overreact to the blocked follicle, either because their immune system is overly sensitive, or because of hormonal changes. It is also more common in overweight people.

 It is not contagious and it does not occur due to poor hygiene. Sometimes the swellings don’t go away, but sometimes they clear on their own, and may leave a scar. In your case, where the swellings have been there for a long time, you can see a skin specialist (dermatologist) who will let you known if you need further treatment.

The urethral discharge after urinating may be due to an infection, which could be why it goes away temporarily with treatment. You need to do a urine culture test and a culture test for the discharge. You also need to make sure that any sexual partner you have is tested and treated at the same time that you are being treated, otherwise you can get re-infected.

On rare occasions, you may have discharge after passing urine because as the bladder contracts at the end of passing urine, it exerts pressure on the prostrate and the seminal vesicles and they release some semen-like fluid. This is more likely to happen if you have gone for long without ejaculating.

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