Dr Flo, my seven-year-old son is not able to speak fluently. He can only speak a few words of Kiswahili, his first language. Every time he learns new words, he forgets them in no time.
He has problems communicating with his teacher and he is lagging behind his classmates. I was told it is a normal delay, but I am not satisfied with that explanation. Please give me a way forward. Vincent
By the age of four, a child should have more than a thousand words in his vocabulary. He should also be able to tell a story, and make sentences with four to five words, identify colours and shapes, name some body parts and ask questions.
At seven, he should be able to read and write and tell time.
Delays in speech development could be due to oral-motor problems (structural problems in the mouth) like cleft lip and palate, or tongue-tie, which would impair word formation.
It could also be due to hearing problems or due to neurological problems like cerebral palsy or brain injury. It can also be due to developmental disorders like autism spectrum disorder and mental retardation.
It could also be due to auditory processing disorder (where there is a problem with understanding speech sounds) or speech apraxia (difficulty in carrying out speech movements).
Another cause of speech delay is severe environmental deprivation – no one talks to the child for prolonged periods of time, or the child is neglected or abused. Forgetting easily may be due to a problem with understanding, paying attention or being easily distracted.
Since your son has only a few words, lags behind his peers and also forgets easily, he needs to be evaluated by a paediatrician, ENT specialist and by a paediatric psychiatrist to find out the exact cause of the problem. You will be advised on the best course of action, depending on the diagnosis. He may also benefit from working with a speech therapist.
At home, spend a lot of time communicating with your child. Talk to him, play games with him, read to him, sing with him, use gestures together with words; describe activities, items, and feelings.
Look at him when talking to him and when he is communicating back, giving him a lot of time to respond. Ask him questions and encourage him to tell stories. Also let him interact with other children his age.
Dr Flo, you recently tackled a problem that is similar to mine. I ejaculate without getting an organism. Haina sukari (It is not pleasurable). I have had this problem since last year. What is the problem? Please recommend a remedy. Many men could be suffering silently due to the repercussions of disclosure, especially because ours is a society that pretends that only women have orgasm issues. Amari
Dr Flo, I am 39. During ejaculation, I don’t feel what I used to feel before (that feeling of striking a ball towards the goal). What might be the problem? Peter
Dear Amari and Peter,
The normal male sexual response cycle involves desire, arousal, plateau, ejaculation, and resolution.
Ejaculation happens due to coordination between the nerves and the muscles to include deposition of semen in the urethra and the ejection of that fluid. The fluid comes from contraction of the vas deferens, seminal vesicles and ejaculatory ducts. The ejection of the fluid happens when the muscles around the urethra push it out.
Ejaculation happens at the climax of the sexual response cycle, and is usually accompanied by orgasm, which is an emotional “high” together with muscle contractions and tension, increased heart rate, blood pressure and breathing rate.
This is followed by a feeling of resolution, emotional wellbeing and generalised muscle relaxation.
Ejaculation is a reflex action of the body and the nerves, just like a sneeze. Orgasm on the other hand, is more about the brain. Some people are able to distinguish between the two – ejaculation and orgasm, and may be able to feel one and not the other. Having persistent delay or absence in orgasm after adequate stimulation is called male orgasmic disorder.
The most common cause of male orgasmic disorder is psychological problems like depression, anxiety, low self-esteem, stress, feelings of guilt, anger or fear, stress, relationship issues and history of sexual trauma.
Other causes of male orgasmic disorder include low testosterone levels, thyroid problems, other hormone disorders like Cushing’s syndrome and hyperprolactinemia; nerve problems e.g. due to diabetes, multiple sclerosis, stroke or spinal cord injury.
Alcoholism and some medications can also cause the problem e.g. some antidepressants, anti-psychotics and some blood pressure medications.
It would be advisable to be evaluated by an urologist. Some tests may be done to see if there are any underlying issues. If any medications or substances (like alcohol) are causing the issue, they can be withdrawn and alternative medications given.
Other illnesses like hormonal disorders can also be managed. Treatment should also include psychotherapy, and, ideally, should include participation and support from your partner.
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