HELP! HIS SPERM KEEPS LEAKING OUT AFTER INTERCOURSE!!!

Leakage of Sperm after Intercourse

Doctors are being asked everyday about this phenomenon that is causing concern to a lot of women, especially those that are seeking to get pregnant. For those who are not, the mere messiness and discomfort  is disturbing enough. Should women really be concerned about this? This is a question I will attempt to answer with the assistance of a consultant obstetrician and gynaecologist from a prestigious hospital in Nigeria.
First of all, I will like to point out that the title should more appropriately be “leakage of semen after intercourse.” This is because sperm is only a component of semen, which is the general term for the male ejaculate after a sexual intercourse, and is composed of  different  components released by the different organs and glands in the male reproductive repertoire. So, in the semen you have sperm or spermatozoa, seminal fluid and other components like fructose, proteins, minerals, etc.

Where is semen deposited?

After intercourse, semen is deposited in the posterior fornix of the cervix. From here, the sperm cells have to find their way into the cervix, through the uterus to the Fallopian tubes where fertilization takes place, an arduous journey that reduces the chances of deformed and unhealthy sperms from

fertilizing the egg and screens off a large percentage of the millions of sperm in the ejaculate. Remember that only one spermatozoa is needed for fertilization to occur.

You can read about best treatments for premature ejaculation here

Is It a problem when there is leakage after intercourse?

Dr. Adebayo Adewole, a consultant obstetrician and gynaecologist with the Federal Medical Centre Lokoja, puts the question to rest. He says,
“It is not a problem. Semen undergoes liquefaction after ejaculation, which is normal. The spermatozoa that will fertilize the ovum would have to swim to meet the ovum or "egg". So it doesn't really mean anything if something comes out after copulation.”
He explains further,
“Anatomically, the vagina is apposed together, don't mind the diagram in textbooks where the vagina is drawn as open with space, they're meant to explain some things.

With copulation the male organ occupies the potential space in the vagina. After ejaculation, depending on the volume of the sperm, when the male organ is withdrawn, the semen can leak as the vagina goes back to the normal apposed position, although this may take time in some women making them not to experience it. The volume of the Semen is also important.”

Does it affect fertilty?

When asked if it affects fertility, Dr Adebayo answers,
“No, although many people have attributed infertility to "leakage of sperm". The Yorubas call it "Eda". The majority of those complaining about it have one problem or the other responsible for the infertility. Whether male or female factor or combined. I've had to ask some of my patients after treatment and getting pregnant, whether the sperm is no longer leaking. They used to laugh and say doctor you were right, it’s still leaking. Even if couples who are normal and are having children engage in sex, the sperm at a point in time, in the majority of cases, will leak.”

My Take

The internet is rife with series of advice about the causes of leakage of semen and how to stop it, but in my interactions with senior colleagues and specialists in the field, there is no scientific backing for their postulations. Some have blamed infections (read more on "toilet infections" here), pH of the female tract, size and shape of the male organ, orientation of the uterus, etc. The plausible cause among all is the volume of ejaculate, which follows with Dr. Adebayo’s explanation of liquefaction. The more the volume, the more fluid that will come out after liquefaction.

This does not mean that if nothing is coming out, your husband is not producing enough ejaculate, no, no.  As earlier explained, semen is composed of the sperm cells bathed in seminal fluid along with other components. So it is the number of healthy sperm cells that matter, not the volume of ejaculate.
People have also been advised to place pillows under the hips, increase foreplay, employ the missionary position, remain inside for about 20 mins after ejaculation, time the thrust etc., especially when looking for a child. The fluid that comes out has nothing to do with the inability to conceive.
Dr. Adebayo advices,
“Couples who have that complaint should go for infertility evaluation. They should see a gynaecologist if their problems cannot be taken care of at the GP level.”

Conclusion

So there you have it. Apart from the mess it makes where the action took place or in your undies, you really have nothing to worry about, and  if you are really concerned, see a gynaecologist. People have advocated a lot of drugs and supplements to stop the leakage. Some of them are great for priming the uterus and improving your chances of getting pregnant, but if you know of any that completely stops the leakage you are having with the same partner, kindly drop a comment. If not, keep a roll of tissue handy so as not to have a lot of cleanups to do.

(A big shout out to my ever responsive consultant for making this task easy).

LOOKING GOOD FOR HIM: SAGGING OF BREASTS, USEFUL TIPS

Introduction: Breast Sagging, is it a Big Deal?

Every woman wants to remain sexy for her man for life, or least for the most part of life, and the first cause of concern is her breasts. Right from the age of puberty, she begins to pay close attention to them; are they the right size, are they perky enough, are they attractive? Then, as she ages, changes begin to occur to them and her worries increase. It is not surprising that plastic surgeons are the richest doctors in the world today, and the majority of their income comes from eliminating these concerns for women. The question is, do men really care? The ideal answer is yes. The bust is usually the first part to arouse a man, not even the face, and media propaganda has embedded in the psyche of most men what an ideal woman should look like with photoshopped pictures of celebrities and models. In reality, however, the fever usually dies after the man has tested the waters. There is more to keeping your man happy than just the perkiness of your breasts. The man that will cheat on you will do so even if your breasts were pointing to heaven, but what will make him come back on his knees is how you make him feel both during the match and off the ball. That said, it is very important to look as sexy as possible for your man.

Composition and Natural Cycle

Your breasts usually start developing at around the age of 12, though it may be a little earlier or later in others. They have no muscles and are composed mainly of glandular tissues, fat, (Cooper’s) ligaments and milk ducts. A lot of factors affect your breasts ranging from age, to pregnancy, to your menstrual cycle and your lifestyle as we will be seeing as our discussion progresses.

Are Your Breasts Really Sagging?

As I have alluded to in my intro, the conclusion that your breasts are sagging is usually defective because it is based on assumptions of what you see in the media. You cannot compare the natural breasts of a 40 year old to that of a 16 year old. Plastic surgeons have tried to make the assessment as objective as possible by comparing the position of your nipples to the infra-mammary fold. So, let your doctor decide whether your breasts are sagging or not. The majority of women who think their breasts are sagging actually have normal breasts.

What Causes Sagging?

Sagging of the breasts, that we call ptosis in medical parlance, is a natural and mostly, an inevitable phenomenon. What doctors try to do is to preserve the status quo for as long as possible. Factors responsible are:

Age 

Naturally. The more you age, the more the cells in your body age with you and lose their regenerative ability. More so, the body naturally begins to shut down faculties that are not no longer essential for self-preservation again.

Smoking

Many studies have rated smoking very high among the causes of ptosis. The reason for this is that smoking destroys elastin, which is essential for the Cooper’s ligaments to maintain their natural recoil and keep your breasts firm.

Pregnancy

Because of the hormonal changes that occur during pregnancy, and the effect of these hormones on the breasts, they progressively fall with each successive pregnancy. One thing I have to commend celebrities for is the fact that they have proven to our women that you can have the number of children you want to have and still maintain your assets in as close to natural beauty as possible.

Menopause 

Closely related to aging discussed above. Some organs naturally start to atrophy when menopause commences.

Breastfeeding

Many of you would have expected to see this on the top of the list, but, ironically, it has actually been found not to contribute to sagging if done properly. When you breastfeed your baby for at least 2 years, with gradual weaning, your body gradually replaces the atrophying glandular tissues with adipose tissue, so at the end of the weaning period, you are an omoge again.

Rapid weight loss

When you rapidly lose about 23kg over a short period of time, not your breasts alone, but your whole body will look wrinkled and worn. You will have to tone up with protein-rich diet and exercise.

Poor diet

They say rich men’s children always look attractive. It’s not just cream. It’s mainly the diet, and you do not have to be rich to achieve a glowing firm skin packaging your asset. Just make sure that you eat a balanced diet. A eats apples, B eats oranges, both eat fruits (abi?).

Use of bras

Yes, you read that right. Except you are a sports person whose breasts move excessively during sports, or you have exceptionally large breast, you should try as much as possible to free your breasts. If not when you are going out, at least when you are at home.

Tips That Help/Prevention

I do not want to call this part the cure, because this is not a disease per se. The worry is mainly for aesthetic reasons.

You can take the very rapid solution, the rapid solution, or the slow solution.

The very rapid solution is to see a plastic surgeon for a Mastopexy or an augmentation surgery. Just remember that these solutions have to be repeated at regular intervals because the breasts will fall again over time.

The rapid solution is to use specially formulated creams, lotions and supplements to strengthen the ligaments and improve the elasticity of the overlying skin and probably reverse oxidative changes that may have taken place. There are a number of these products in the markets with varying user satisfaction based on what you can afford.

The slow solution is not really slow, but makes my categorization easy. I also like to call them the natural methods. They include:

1       Exercise and good posture: Remember we said that the breast tissue has no muscles, so strenuous exercise may not assist in restoring their texture or preventing their fall. Exercise and good posture will assist the supporting muscles to stretch out the skin overlying your breasts and give them a firmer appearance. Also, the ligaments respond, albeit slowly, to regular mild exercise. So stretch out those shoulder and chest muscles and comport yourself both in the office or while walking around in a good posture.

2.       Complete breastfeeding: As pointed out above, it is advised to breastfeed your baby for at least 2 years, maybe a little more, maybe a little less. Some have advocated for 3-4 years (not in Naija right?). This allows your breast tissue to naturally revert to its pre-pregnancy state. Rapid stopping of breastfeeding will invariably contribute immensely to ptosis.

3.       Go braless for most, if not all day. The gentle up and down movement of your breasts have been found to be an adequate exercise for them. When you make them fixed and motionless, they lose their elasticity due to disuse. If you have big breast, you may wear bras as they may not entirely prevent movement of the breasts, but the experts are still arguing even this out. As a sportswoman, you definitely need to wear sports bras.

4.       Nutrition: Drink a lot of water and eat more of whole foods. Fresh fruits and vegetables are advisable. Your cells are composed mostly of water and the regenerative capacity of the cells depends mainly on the availability of nutrients they need for synthesis.

5.       Aloe vera: You can harvest aloe vera gel or buy from trusted companies. Massage this gently onto your breasts for about 10 minutes, leave it on for another ten minutes and wash off with cold water. For best results, do this 4-5 times a week. 

You can also make a paste consisting of a spoonful each of aloe vera gel, mayonnaise and honey and apply to your breasts. Wash off after 15 minutes. This should be effective when done once a week.

6.       Olive oil: Pour this on your palms and rub them together until you feel some warmth, then gently massage your breasts upwards with them 3- 4 times a week. You can also use jojoba oil or coconut oil.

7.       Cucumber: Blend a mixture of a small cucumber, 1 egg, and 1 teaspoonful of Sheabutter (ori, man kadai). Apply this to your breasts for 30 minutes and wash off with cold water. Do this twice a week for best results.

Conclusion

There’s always much ado about a woman’s breasts. This is because they are easily the most noticeable part of her. If a man wants to describe a woman, her face, bust and derriere are usually the parameters he uses. So it really is a big deal for guys. But it gets to a stage when he accepts that the southward migration is part of the package. He just has to realize that if he wants one that will never fall, then he should prepare to keep searching for life. He can, however, assist in maintaining the one he has. And please, ladies, there is no study that shows that too much fondling contributes to sagging of breasts, in fact, that may actually reduce your risks for breast cancer as some have suggested. The care you give to any part of your body determines how it flourishes. So pay more attention to your breasts and whenever you notice anything suspicious, never postpone seeing your doctor. 

Okra: Helping Diabetics Regain Their Stamina

Okra

My people call it abonu, Hausas call it kubewa, Yorubas call it ila and the Igbos call it...(well, all my Igbo friends say it's okra, maybe someone here will provide the right term). Known botanically as Abelmoschus esculentus, okra is indigenous to West Africa, but has become almost ubiquitous, enjoying more popularity in Africa, Asia and southern Europe. It is a seed pod edible as a whole when fresh. Some people also use the leaves in making varying dishes and medicinal herbs. When my mum mixes the leaves with beans, ruwan toka and smoked fish, I know I will overfeed that day.

Composition

100g of okra, which is equivalent to about 10 long seed pods, or fingers, as some people prefer to call them contain:

Nutrient	Quantity	% Daily requirement
Energy	22.0kcal
Carbohydrates	4.9g
Protein	1.9g
Fat	0.2g
Dietary fiber	2.5g	10%
Folic acid	46.0mcg	11%
Vitamin C	16.3mcg	27%
Vitamin A	283IU	6%
Vitamin K	40.0mcg	50%
Calcium	77.0mg	8%
Manganese	0.3mg	15%
Magnesium	36.0mg	9%
Water	96.2g	3.2%

Properties

This slimy, but fantastic vegetable has a lot of amazing properties and is presently the basis for research in many pharmaceutical and biomedical laboratories.

The vegetable is rich in antioxidants that reduce oxidative stress and prolong cellular life and function.

The bark and seeds contain okra polysaccharides that lower blood sugar. The seeds contain lectin, which kills cancer cells, is anti-inflammatory and anti-nociceptive. Just under the peel, you will find okra pectin which has been found to be effective against melanoma.

Okra and Diabetics

Diabetes becomes a terrible disease when it is not properly managed and complications have started setting in. One of these complications is loss of libido and erectile dysfunction (ED). Unfortunately, people get tired of the drugs, the dietary restrictions and the weekly or monthly pricking to do random and fasting blood sugar tests. A lot of patients are looking for alternatives and a lot of "natural products"companies are capitalizing on this with various claims. I cannot, for now, support or refute their claims (maybe I will study the extent of their researches in subsequent posts) but what I can tell you is what has been proven scientifically, and one of them is okra.

Most doctors will be careful about being overzealous in recommending just a vegetable to combat diabetes, but they will advise you to use your medications while trying orher healthy alternatives. If your blood glucose is coming down steadily while you are on these alternatives, your drugs will be tapered off until a balance is maintained.

100-200mg/kg of okra seed powder and pod powder have been found to significantly reduce the rate at which sugar is absorbed from the intestinal tract. The mechanisms postulated include:

Enhancement of insulin sensitivity,

Inhibition of carbohydrate metabolizing enzymes,

Regeneration of damaged pancreatic islet B-cells, and,

Enhancement of insulin secretion and release.

In other words, sufficient consumption of okra may help in reversing diabetes. Added benefits for a diabetic include:

Regaining lost weight,

Prevention and correction of complications of diabetes, like ED and loss of libido,

Protection of liver tissue, and,

Reduction of hyperlipidaemia associated with diabetes.

Preparation

Buy or harvest fresh okra. These are the ones that are about 6-10cm long and snap easily at the tail or in the middle when you try to bend them. They can be kept in the refrigerator for 3 days.

1. Select 5 pods. Cut off the heads and tips, and cut the pod into 2-3 transverse pieces. Soak the pieces in a glass of water overnight and drink the water the following morning. People who do this regularly for 1 month have reported reduction in their blood sugar and improvement in overall well-being.

2. You can wash the okra properly and eat it raw as a snack (my personal favorite). Some people shake some salt or ground pepper on it to make it more palatable.

3. You can cook it the traditional Nigerian way, either plain or with other ingredients (asepo as Yorubas call it, or dafaduka by Hausas).

4. My mum fries okra with locust beans, tomatoes and sweet pepper to eat yam or pounded yam with, and I always found it wonderful.

There has been little research done as to whether heat destroys the properties of okra, but generally, the fresher a fruit or vegetable, the more beneficial it is to the body. So, I would recommend the raw forms of eating the pod.

Other Benefits of Okra

Okra has been found to be useful in:

1. Treating exhaustion,

2. Treating depression,

3. Curing irritable bowel,

4. Reducing the frequency of asthmatic attacks,

5. Reducing cholesterol levels and improving omega 3 fatty acids,

6. Preventing involuntary discharge of semen,

7. Smoothening the skin and preventing pimples,

8. Preventing Helicobacter pylori from sticking to the stomach wall, thereby preventing ulcer.

It has also been shown to produce substances that bind to bile acids and prevent cancer. Some studies have suggested that it kills breast cancer, prostate cancer and melanoma cells.

Conclusion

As we advance in technology, we have come to realize that returning to organic ways of life will reduce the rates at which we fall ill, and may even treat some of our conditions. Okra is one of those beneficial organic foods that is piquing the interest of scientists all over the world. A little piece of advice here; always let your doctor know other steps you are taking to combat whatever ailment you are dealing with, this will assist both of you in monitoring the progress of your treatment and prevent conflicting results.
If you have great recipes for okra or any experience with those trying to use it for their diabetes, let us know.

Image credits: www.freeimages.com and www.pixabay.com

TOILET INFECTION: WHY SO TROUBLESOME?

"TOILET INFECTION"

The term TOILET INFECTION is known and used by all Nigerians, educated and uneducated alike to refer to infections of a woman's v-part by whatever organism. My Patients will come in and say,
"Dr., I have an infection," and I would say, "I don't understand," just to ensure they actually spill the beans. Some will timidly clarify further while others will boldly tell you "toilet infection now".
"Toilet infection" is a socially acceptable term to obscure the implication that the sufferer has a sexually transmitted infection and is by extension promiscuous (we are all "saints"in Nigeria). Let me, however, quickly point out that, of the commonest causes of "toilet" infections, only trichomoniasis is sexually transmitted. It is also important to note that you do not get these infections from toilets, not even from public toilets. The chances are very slim, so no doctor will even believe you got it from the toilet.

Toilet infections are actually vaginal infections, which is a broad diagnosis encompassing infection caused by different organisms. The commonest vaginal infections are vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis. The organisms implicated in these diseases are actually normal flora of the v-part, but because of our habits, or changes in our system, they proliferate beyond what the body can naturally curtail and result in diseases.

How do I know I have a vaginal infection?

This is one of the commonest self diagnoses made in Nigeria. Most females from the age of puberty will come in and tell you they have toilet infection. On further questioning, they will tell you they have:

Vaginal discharge

Vaginal odour

Vaginal itches

Painful intercourse

Painful urination.

These are all correct symptoms of vaginal infection. Remember though, that not all vaginal discharge is due to infection. When you have an abnormally copious discharge which smells offensively, is greenish, brownish or like spoilt milk, it is time to see your doctor.

Why is it difficult to treat?

Vaginal infections constitute the commonest complaint in the gynaecology clinic. They are very easy to treat, but our practices either lead to treatment failure or recurrence. Factors that make them seem difficult to treat are:

1. Douching

This is the act of washing the inside of the v-part with plain or soapy water. Some women use over-the-counter douching preparations. The majority of women douche because they want to reduce the smell of the area, prevent infections, prevent pregnancy, wash out menstrual blood etc. Now, as I said earlier, the organisms that cause vaginal infections are normal residents of that area. The body has its natural system of keeping the area clean and safe. Everything there is important; the mucus lining, the pH and the organisms there. So, when you wash out the area, you allow for free proliferation of the troublesome organisms.
Ironically, researches have shown that douching at least once a month SIGNIFICANTLY increases the risks of bacterial infections, preterm labour and delivery, pelvic inflammatory disease, ectopic pregnancy, infertility and cancer of the cervix. Consequently, The American College of Obstetricians and Gynaecologists have strongly discouraged the practice.
Simply washing the outside of your area with mild soap and warm water is enough.

2. Washing the private part

When washing the private part with water, especially after "number 2" (passing stool), the movement of the hand should be from front to back, then out. Front to back, then out. Not back to front, or front to back to front again. This is to prevent introduction of bacteria from the a-part behind to the v-part in front.

3. Sexual habits

Anything that will cause introduction of a large bacterial load to the v-part should be avoided. Common sexual practices that may predispose to bacterial infections include:
"Fingering" with a dirty hand,
Unprotected sexual intercourse,
Multiple sexual partnering,
Poor technique in handling condom: only wear it when you are about to go in,
Poor hygiene of sex toys (yes they are becoming very common in Nigeria now), and
                                                                Inappropriate lubricants.

4. Wrong therapy

Because of the patient:doctor ratio, and the amount of patients a doctor has to see per day in a typical government hospital in Nigeria, the infection may not be adequately treated.
Other factors in this category are:

Treating only one partner: The couple has to be treated at the same time. If it is a polygamous setting, all the wives have to be treated with the husband. If there are concubines, they should be treated too. Some experts advise abstinence during the period of therapy or using a condom.

Not completing therapy: I am very guilty of this even as a doctor. Once I start feeling better or feel that I am well already, I just discard the remaining drugs. This is not good as it can lead to resistance in the organisms when the infection recurs. Candidiasis, for instance, may need application of cream for at least two weeks, even when you do not feel the itches again.

Over-use of antibiotics: This is the other extreme. Just yesterday, I saw a lady that had been using Augmentin for 3 months! Yes, 3 months to treat "toilet infection". When you use antibiotics excessively, you kill the normal bacterial flora and create a fertile environment for candida to grow.

Treating yourself: DON'T. Seriously, stop it. It is wrong, uneconomical and complicates your therapy. Do not call doctor friends on phone. See a doctor.

5. Medical conditions

Conditions like diabetes mellitus, pregnancy, reduced immunity from systemic diseases like cancer or HIV or drugs, and oestrogen-containing contraception may increase the risk for vaginal infections.

6. Personal hygiene

Biko, wear well aerated and dry underwear and change them regularly. Do not use padded undies to give you the shape you do not have. There is a man for every shape. Do not overprotect the place. Only you: menstrual pad, then panties, then leggings, then bum short, then skirt, haba! Na Central bank? Seriously, even when you feel like being well assured going out, when you come back, wear lighter clothings to prevent too much moisture in the area.

Conclusion

In conclusion, take note of the factors pointed out and help your doctor to help you. Feel free to ask your questions. Aliases are accepted on my blog if you want to protect your identity. Let me know for how long you have been battling with this problem. Your experience will help us become better doctors.