Taboo health Q&A - NAME CHANGES ALLOWED

Flowerofthewest

I have to have yearly up to this year, then two yearly cystoscopy. This after kidney cancer. I have no problem with the procedure just the embarrassment of multiple small sebaceous on the edge of my labia major. They started about 25 years ago with two or three. Once I past 50 they increased. My sister also has several but not as many as me. I'm sure the medical staff are used to these things but I am so embarrassed and ashamed.

These little cysts are really quite common. They form when the entrance to the sebaceous glands become blocked, and as there are numerous of these lubricating glands in the genital area, they often develop there. They can vary in size from just a little yellow pin head, to something larger, like a small grape. There really is no need to be embarrassed or ashamed – I suspect the medical staff won’t even notice them when they are doing the cystoscopy as they are so common. However, if they are bothering you, you can ask your GP whether she could help with their removal. This usually involves piercing the overlying skin with a sterile needle, then squeezing out the contents. It can be a bit uncomfortable, and the skin around can be a bit sore afterwards, so I generally only deal with a few at a time. It’s also, strictly speaking, a cosmetic procedure, and so not available on the NHS, but a sympathetic GP will hopefully understand your predicament and not refuse your request.

harrysgran

I had a smear a week ago it was a little painful but I'm worried as I've had cramp like period pains since then, I'm 60 and have been a widow for 6 years so not had any sexual activity I just wanted to know if this might be the reason for the cramps as I've never had this before after a smear test.

After the menopause the loss of oestrogen means the genital tissues become dry and thin, and this can make having a smear test quite uncomfortable. And sometimes it can jar the uterus, and cause some discomfort for a few hours afterwards. But it really shouldn’t cause cramp-like pain that continues for a week afterwards. I suggest you go back and see your GP, who can do a gentle pelvic examination, and check what the cause might be.

Morag1

Hello Dr Rosemary. Over the last 8-10 years I have lost all underarm hair and most of my pubic hair. This happened to my mother also but she believed it was as a result of radiotherapy treatment she had for cervical cancer. I have not had radio- or chemotherapy, nor do I wear tight undies that may have rubbed it off - the hair has just gone.

I had a hysterectomy at 31 but kept the ovaries, however I did take HRT tablets for quite a few years. The hair loss started at about the same time my doctor stopped prescribing HRT.

Is this a normal occurrence, knowledge of which has just passed me by, or is it indicative of a deficiency of some sort that has not shown up in blood tests? I would be grateful to read your comments.

The hair in both the pubic area and the armpits is what is known as ‘secondary sexual hair’ which grows in response to the sex hormones oestrogen and progesterone – which is why it starts to grow at puberty. This means that when these hormones disappear – usually at the menopause, or, in your case, when you stopped taking HRT – then the hair thins. For some reason no-one seems to talk about this, or warn post-menopausal women that their pubic hair will become much more sparse. Unless you are losing hair from your head, then you really don’t need any tests – it is just part of being slightly older. The upside of this is that you don’t need to shave your armpits so often, or bother with a pre-holiday bikini wax… clouds, silver linings and all that!

gettingonabit

Is Overactive Bladder a symptom of the menopause? I've had this condition since I was 42 and although taking tablets, the condition hasn't really improved.

Will I have this for life?

Having an over active bladder means you suddenly need to wee, often when there is only a small amount of urine in the bladder, and find it very difficult to ‘hang-on’, which can lead to very embarrassing accidents. It's caused by the muscles in the wall of the bladder suddenly going into spasm, but why this happens isn’t known. It is a surprisingly common problem, affecting about 1 in 6 adults, and though it is more common in women, it can occur in men as
well. It can occur at any age – including in children, but it generally occurs more often in older people. Though it is not generally a symptoms of the menopause, some women do find it gets worse in their fifties, and the tissues in the genital area become thinner with the loss of oestrogen. It is usually treated with drugs that relax the bladder muscle, and several of these are available, including skin patches. They can cause side effects, such as a dry mouth and constipation, and their effectiveness varies between individuals, so if the tablets you are taking don’t seem to be helping, it is worth asking your GP if you could try something else.

Many people with an over active bladder get into the habit of going to the loo very frequently, in order to avoid having an accident, and unfortunately this can make the problem worse, as the bladder shrinks, and goes into spasm when holding even less urine. Bladder retraining exercises can help with this, where you learn to delay going to loo, and so gradually your bladder copes with more urine. You can start doing this yourself, but help from a specialised physiotherapist can be really useful (ask your GP for a referral ). You probably know this already but caffeine and alcohol ( especially gin, I am told!) can really irritate the bladder and make the problem worse – so avoid them as much as you can.

Spangles1963

Is it possible to have a blood test done to determine whether or not you have gone through the menopause if you have a Mirena IUS?

The blood tests that is usually done to check whether you have gone through the menopause is an FSH level. FSH is the hormone produced by the pituitary gland that drives the ovaries, and at the menopause, levels of FSH rise. Though the mirena releases a progesterone like hormone into the womb lining, this does not affect the level of FSH, and checking FSH levels can be useful in women whose mirena means they don’t have periods, and so have no indication if they are menopausal or not.

Faith1

I have a vaginal prolapse. Apparently the other organs are supported ok. My pelvic floor muscles are very poor so I am doing the exercises regularly but so far with little improvement. What are my options?

Doing pelvic floor exercises should help, but like all exercises they need to be done properly, and they also take time to take effect. I give my patients this print- out
patient.info/health/pelvic-floor-exercises which not only explains the anatomy of the pelvic floor but also how to do the exercises. If you keep at it you should notice an improvement in about 3 months, but you need to keep at it for 6 months ideally to really tell if they are going to help your problem or not. And if they do help, it’s important to carry on doing ‘maintenance’ exercises, so the muscles don’t become slack again. Unfortunately, though, pelvic floor exercises only tighten up muscles – they cannot tighten up the lining of the vagina is that has become slack. The only way to deal with a prolapse of the vagina is with surgery. Different types of operation are available depending on which part of the vagina – front or back – is the problem. Most of these operations are very straightforward,, and can be done on a daycase basis, so speak to your GP about a referral to a gynaecologist.

vampirequeen

My problem isn't about losing hair but gaining it. What's the best way of dealing with facial hair? At the moment I'm plucking it but it's increasing in area coverage. How can I avoid becoming a bearded lady?

I’m going to make an assumption here (and sorry if it’s wrong!) that you are post-menopausal. In all women the adrenal glands make a small amount of testosterone. Before the menopause, the ovaries make a bit of testosterone too, but also oestrogen, and the oestrogen is the more dominant hormone and balances out the masculinizing effects of the testosterone. After the menopause, you lose all the hormones from the ovaries, but the adrenal glands keep on working. This means that the testosterone they produce becomes the dominant hormone, and that is why older women tend to grow facial hair, especially across the top lip. Later in life it can also lead to thinning hair too. Unfortunately there is no way of avoiding this happening and though taking HRT can help, it’s not a good long term solution. The only answer is find a way that suits you of getting rid of the hair. It really doesn’t matter how you do this, and no matter what you may have read, plucking does not increase the hair growth. Waxing is one solution, but you do need to be careful with this on delicate older facial skin – I’ve seen some nasty rashes where some skin has been removed as well. A lot of women sweat by threading, or their own tweezers! Or if you have the spare cash, laser treatment can permanently destroy the hair follicles. If you decide to do decide to go down this route though, do a lot of homework beforehand and find someone who is properly qualified and an expert in this field. A cream, Vaniqua, is available for women with hirsutism, to reduce the growth of excess facial hair, but this is mainly aimed at younger women, such as those with polycystic ovarian syndrome. It can cause skin irritation, and again, you ned to be careful with it on a more mature, drier skin ( and its only available on prescription).

Tegan dont give up on the smear tests, one year it took 12 attempts over 2 days to manage to get mine done and the next year the Medic didnt lock the door and in barged another medic without knocking which gave a young man waiting for the pharmacy a view he really didnt need to see

Are we going to have replies to any more of these? I would be interested to see some of them.

Dear Dr Rosemary, I am delighted it's not too late to add a question. I am 52 and perimenopausal but not menopausual yet which means I still need to use some form of contraception. I won't bore you with the details, but for various reasons we (me/GP etc) have had to rule out pretty much everything apart from the mini pill.

I was told that once it settled my periods would probably stop (and they would do a blood test at some point to check whether i had reached menopause) and that the progesterone might be helpful in terms of reducing hormonal issues such as severe PMT. I felt that there was nothing to lose so started almost 3 months ago (11 weeks).

I was given 3 months of cerazette to try before reviewing and then they would prescribe more. The trouble is that I am getting or at least I think I am getting a lot of side effects (having read up on this I don't think any of them are that unusual but I am not a medic obviously). I am exhausted all the time. Much more so than usual. I don't think I have ever yawned so much in my life and this goes on all day. I have also put on half a stone in that short time. I mentioned this at the family planning clinic this week and they asked if my appetite had increased because cerazette is a steroid. I had no idea about this. And yes I am ravenous all the time to the point of feeling ill if I don't eat. I usually regulate my food intake very well but am finding it impossible at the moment. Lastly I have been bleeding almost continuously for the last 4 weeks, sometimes heavy, sometimes just spotting.

Sorry for the long rambling details but I thought it was essential to offer all the information. So my question is if I stick it out for the full three months i.e. another couple of weeks is it likely to settle down? Would another brand of pill be better (as the nurse suggested) or might I have the same issues? Would changing to a new pill mean another miserable three months of settling? Or given my age should I just keep my fingers crossed that I won't get pregnant and stop taking anything? I feel miserable at the moment.

Nelliemoser

Hello Dr Rosemary. My libido went went when I reached the menopause after 50ish. It has not really bothered me.

Are there any statistics about what proportion of post menopausal women will actually say they really miss sex, and how many say they are no longer bothered.

A. Trying to find accurate statistics about libido after the menopause is very difficult, but most doctors would agree that decreased libido after the menopause is incredibly common. Some women find that their libido increase when they no longer have to worry about an unwanted pregnancy, or coping with horrendous heavy periods, but they are very much in the minority. And sexual desire in older women in certain circumstances, for example, on meeting a new partner after years of being on your own, or having no sex, can be very strong no matter what your age. But the fact is that the hormones produced by the ovaries, especially oestrogen and testosterone, play a large role in sex drive, and levels of these fall to very low levels – and stay that way – after the menopause. How much this bothers women depends very much on the individual, and also their circumstances. For those who are not in a relationship or in relationships where sex has always been low on the priority list ( and yes, this does happen ), then lack of libido is really not an issue. But for many others, not being bothered about sex, and wanting to go to sleep rather than spend time lovemaking can be a very real problem. And of course it can cause relationship difficulties. The key thing is to be open and honest with your partner, and explain it is not their fault, but rather the change in your hormone status. Libido can be improved with HRT, as this boosts up oestrogen levels again, but it’s not always very effective. A better solution is increasing testosterone levels, but unfortunately at the moment there is no licensed testosterone replacement product for women in the UK. However, some specialists are willing to prescribe the testosterone gel that is available for men, but women only need to use a fraction of the male dose.

NanKate

Good Morning Dr Rosemary,

How effective are pelvic floor exercises to stop an occasional leak ?

t really depends on the cause of the ‘occasional leak’. If the leaking occurs when you exercise, or cough or sneeze, then you have what’s known as ‘stress incontinence’. If however, the leaks occurs when you are pretty desperate to go, and don’t quite make it to the loo, then it’s more likely that you have ‘urge incontinence. Urge incontinence is caused by overactive bladder muscles, and this is usually best treated with medication along with ‘bladder re-training’ exercises ( dreadful name, I know – makes grown women feel as if they are back to the days of potties). But stress incontinence is usually caused to some extent by weak pelvic floor muscles, and can often be improved by pelvic floor exercises. However, to be effective, the exercises must be done properly, and also regularly, every day. And they don’t work instantly – I reckon like any exercise, ay least a couple of months month of hard work is needed for any noticeable improvement in tone, and it can be up to 6 months for things to really get better. So patience and determination are really important. But if leakage continues despite doing enough exercises, then see your GP, as sometimes the bladder has prolapsed so much that the only way to improve matters is some sort of surgery. More about that in another question!

Because it’s essential you do pelvic exercises properly, I suggest you have a look at
patient.info/health/pelvic-floor-exercises.

Print it off, then go somewhere private, when you have some spare time, and carefully go through what you have to do to work those muscles. If you’re not sure you are doing them properly, ask your GP for a referral to a physiotherapist – ideally one who specializes in urogynaecology.

Not a question, but I would just like to let you know that I am enjoying your books. I read "Doctor Doctor" and am halfway through "Doctor's notes".

My third child was born 15 years ago by C section. I had already had a couple of gynaecological operations and so have a couple of long scars across my tummy, one above the other. My issue is that even 15 years later parts of the skin between the scars remains numb. Also no matter how trim I am elsewhere there is a pouch or overhang between the two scars that nothing will shift. Is there anything I can do about this? The numbness doesn't bother me at all but made me think the muscles in that area had had it. I've got so down about it I have ended up putting on weight everywhere else because what's the point of being slim if you still have a huge pouch?

I have question about piles. I eat plenty of fibre and have never been constipated though I find my stools can vary in consistency depending on what I have eaten (which I assume is fairly normal)

But I have sporadically had piles on and off for years. Sometimes they bleed a lot and I can really feel them. Sometimes they hurt. And most of the time they are not there (or at least not apparent) at all

Had it been a persistent issue I would have plucked up the courage to see the doctor (I realise it is only embarrassing to me and not to them) but every time it has reached that stage they have got better again for months on end.

Dear Doctor, I have two questions under the heading of taboo subjects.

Firstly, Unlike migs above, I seem to be readily and regularly "moist". As I still have an active sex life in my late sixties, this is not a problem (in fact, judging from what other say, it is a bonus) but with so many people complaining about the opposite, I wonder whether this is usual or normal. I did shyly mention it to my GP once, and all she said was "Does it smell?" to which I could happily reply "No".

Secondly, I too have an infrequent problem with a "leaky bum", but I know it is due to an injury (tear) from giving birth 40 odd years ago. I manage it quite well as I am aware of it and for example, I am careful what I eat (no spicy food, not too much fibre) but I am a bit worried about whether it will get worse as I get older. I did have myself checked out a while ago at a specialist clinic and had various tests, also to make sure that it wasn't down to "anything sinister" as the GP said when he referred me. At the end of that examination the specialist didn't really tell me what my options were, he just confirmed what I already knew re the old injury and said I should keep on doing what I am doing in terms of how I eat, and consider pelvic floor strengtening exercises (I do Pilates). So I am wondering what my options might be to have a repair at this late stage?

Dear Dr Rosemary, I am 57 and since the menopause have been very dry 'down there' which is ruining my sex life. I know that we can use lubrication but find faffing about with tubes etc too clinical and it ruins the mood. Is there anything else I can do?

Grannykath My doctor recommended Head and Shoulders Itchy Scalp Care shampoo. It helped a lot. You can also get the same conditioner.

Does anyone have a problem with skin irritation? Mine is my scalp and to some extent to face and body. I was offered shampoo by my doctor which didn`t cure it. I resort to anti-histamine every few days which does help. I would be glad to hear if anyone has experience of this. Thank you.

I do that nankate. The last time it happened I was sharing a hotel room with an old school friend. I was mortified

Monica I supposed I used the wrong word. Did mean embarrassed. Reassured after reading your comment. Thank you