Doc, I get a painful rash just before my periods

Dr Flo, I am a 38-year-old woman. Five to seven days before my periods I get a rash that makes me feel pain during and after sexual intercourse. After my periods the issue goes away until the next month when it returns. What’s wrong? Rhoda

Dear Rhoda,

Hormonal changes due to the menstrual cycle may cause changes in normal vaginal discharge, more vaginal infections such as candidiasis and bacterial vaginosis, worsening of existing skin conditions (acne, allergic and inflammatory conditions, psoriasis, cold sores) or folliculitis (painful swellings that appear when hair follicles are blocked by bacteria or other substances).

There is also a rare skin condition called autoimmune progesterone dermatitis (APD) where you get skin issues about seven days before the periods, and they last up to three days after periods. These skin issues vary from just itching, to rashes, sores or even swelling.

You should see a gynaecologist at the time when you have the rash so that a proper diagnosis can be made and you can get the appropriate treatment. Unfortunately, as long as you get monthly periods, it is not possible to completely remove the effects of the hormonal changes. In case of severe symptoms, some medications may be given to suppress the production of progesterone or removal of the ovaries (oophorectomy) to clear the symptoms.

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Why do I have a problem ejaculating during sex? I don’t ejaculate at all. Brayan

Dear Brayan,

Lack of ejaculation could be due to two possible conditions: One is retrograde ejaculation. This means that during ejaculation, the semen is pushed backwards into the bladder instead of out of the urethra. This happens if the ability of the bladder neck to close during ejaculation is interfered with either due to an abnormality with the anatomy, or following bladder neck surgery, or due to a nerve disorder e.g. due to diabetes, or nerve damage, or medication that paralyses the nerves. This problem is diagnosed when there is no semen on ejaculation, but semen is found in the urine soon after. Treatment depends on the cause. If it is due to medication, stopping the medication will solve it. If there is partial nerve damage, some medications e.g. pseudoephedrine can help resolve the issue. If the nerve damage is complete or if the issue is due to an anatomical abnormality, it may be impossible to reverse it.

The second cause is retarded orgasm, which means that one is unable to achieve orgasm and ejaculation in good time (30 minutes or more), or in severe cases, there is no orgasm and ejaculation at all (anejaculation). With progressing age, the time to achieve ejaculation increases. Retarded ejaculation or anejaculation may be due to use of some anti-depressants, nerve disorders, or psychological disorders. In some people, there is no known cause. There is no approved medication to treat this condition, though some medications (cabergoline, bupropion) may be useful.

You require a review by a urologist. Physical examination, blood tests and other tests may be done to figure out the exact cause of your inability to ejaculate, and appropriate treatment.

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Dr Flo, my friend’s son is 13. He fell down accidentally while playing football and another player fell on him and squeezed his penis with his knees. It was a very painful experience. Later, the penis swelled and blood started oozing out. The boy was taken to hospital where he was given drugs that stopped the bleeding in two weeks. A few days after that he was hit by a desk on his penis and blood started oozing out again. Where does the blood come from and what should be done for the boy to heal completely? Naomi

Dear Naomi,

The penis has blood vessels that bleed when cut. It also has cavernous bodies along the length (corpora carvenosa) which have spongy tissue containing blood-filled spaces that fill up with blood during an erection. If there is rupture of the tissue surrounding them (tunica albuginea), the penis will bleed, swell and take on an abnormal shape. If the urethra, the tube that carries urine from the urinary bladder to the outside, is torn, there will be blood at the tip of the penis or in urine.

Penile injuries are usually medical emergencies. The boy should be reviewed by a urologist. A urine test, an ultrasound and Doppler studies can gauge the extent of injury. Other tests that may be done include endoscopy, retrograde urethrogram or magnetic resonance imaging (MRI). Depending on the severity of the injury, general wound care may be advised or surgery may be prescribed.