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Adenomyosis is a condition where the inner lining of the womb (endometrium) is abnormally embedded in the muscle layer of the womb ( myometrium). During menstruation, this misplaced tissue also bleeds causing surrounding muscle layers to become reactive and thickened. As a result, the whole womb gets enlarged giving rise to symptoms of heavy and painful menses. Adenomyoma is a localised form of adenomyosis where only some parts of the womb are swollen. This condition can mimic uterine fibroid on ultrasound examination which is just a simple growth in the myometrium. The differentiation between adenomyosis and uterine fibroid is further complicated by the fact that both can coexist in the same patient .and present similar symptoms.

When semen is ejaculated, it is thick and gel like. This is to help it adhere to the neck of the womb (cervix). The semen eventually liquefies within 15-20 minutes, setting free the sperm and enabling them to swim up the genital tract . A viscous semen with delayed liquefaction may affect your fertility as it may indicate infection of the testis, seminal vesicles( a pair of tube-like glands, behind the urinary bladder) and the prostate gland, (a walnut-sized gland located between the bladder and the penis). Both the seminal vesicles and prostate gland contribute and secretes most of the seminal fluid that nourishes and protects sperm . Most of the time, the infection of these organs is due to sexually transmitted diseases such as Mycoplasma, Chlamydia and Gonococcus. Early treatment of the infection is important to correct the abnormality of the semen. Anti-inflammatory medications and diuretics (pills that help rid your body of salt (sodium) and water) are also helpful.

Do men have “Menopause”? What are the symptoms? What is the treatment? Men may experience menopause, just like women. The condition is variably termed andropause, testosterone deficiency, androgen deficiency, or late-onset hypogonadism. It is related to the gradual decline of the male hormone, testosterone, with age. Testosterone is a sex hormone produced by the testes. It plays many important roles in men, including regulation of sex drive (libido), bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm. Its levels peak at about 20 and start to decline gradually. It is estimated that the levels decline by about one percent every year after the age of 40. Unlike female menopause, the development of symptoms in andropause is more gradual as testosterone levels decline slowly over a long period of time. The symptoms are only present in about 30% of men in their 50s. They include the following: · Low energy, lethargy, constant fatigue · Depression or sadness · Decreased motivation, lowered self-esteem · Difficulty in concentrating · Insomnia · Increased body fat in the tummy area · Irritability and mood swings · Osteoporosis (brittle bones) · Loss of sex drive · Erectile dysfunction · Reduced muscle mass and feelings of physical weakness · Gynecomastia, or enlargement of breasts · Loss of body hair · Hot flushes · Decreased bone density · Infertility It is important to note that many of the symptoms associated with andropause are also a normal part of aging. Andropause is usually diagnosed by correlating the symptoms with a low testosterone level in the blood. Many men do not seek treatment as they think they can manage the symptoms themselves without treatment. Oftentimes, many patients also feel too intimidated or shy to discuss sexual topics with their doctors. Treatment usually involves making healthier lifestyle choices which include: · Eating healthily · Exercising regularly · Getting enough sleep · Reducing stress Medication or a psycho-therapy, such as cognitive behavioural therapy (CBT) may help if symptoms of stress and anxiety get more severe. Sexual counselling and medications may help in erectile dysfunction. Hormone replacement using testosterone is another treatment option. This treatment may provide relief from the symptoms and help improve the quality of life in many cases. Testosterone is given in the form of tablets, patches, gels, implants or injections. But there are concerns regarding the side effects of testosterone such as the risks of developing prostate cancer. Testosterone should not be taken by any man with prostate or breast cancer. If the patient has heart disease, is taking some medications such as blood thinners, has an enlarged prostate, or has kidney or liver disease, he should discuss with the doctor the pros and cons of testosterone therapy before deciding on the treatment

I am 28. I have been suffering from bloated stomach and tender breasts about one week before menses for the past few years. These symptoms disappear soon after menstruation begins. My friends tell me I am also grouchy at times and they can almost predict when my period is coming. Am I suffering from PMS? Anything I can do to help relieve my symptoms? I don't like to take medicines. You are suffering from PMS or premenstrual syndrome with physical, psychological and behavioural symptoms which appear one to two weeks before your monthly periods and gradually improve or disappear when menstruation starts. About 10 % to 20% of women of childbearing age have PMS. The symptoms are often mood-related and include feelings of unhappiness and extreme grouchiness. Abdominal bloatedness, breast tenderness, weight gain, fatigue, headache and loss of sexual desire are common. The cause of PMS is not well understood. Studies have suggested that fluctuating levels of hormones and brain chemicals are important in the causation. Dietary and drinking habits, stress and lack of exercise are also contributing factors. A wide range of medications including painkillers, oral contraceptive pills and antidepressants have been used to treat PMS with varying degrees of success. Lifestyle changes may relieve some of the symptoms of PMS without medication. These include: A healthy diet: 1. Eat plenty of fruits, vegetables and whole grains Taking plenty of high fibre food like fruits and vegetables, and whole grains, such as brown rice, oatmeal and rye bread will reduce PMS symptoms 2. Increase intake of calcium and vitamin D: Studies have shown that women with high intakes of calcium and vitamin D are less likely to develop PMS. It is suggested that calcium works in the brain to relieve depression or anxiety and vitamin D may influence emotional changes. 3. Cut down on sugar and salt. Fluctuating female hormones may cause the woman to have craving for sugar and reduce levels of the chemical serotonin in the brain. These changes may affect a woman's mood and trigger PMS symptoms. Increase intake of salt may worsen the symptoms of bloatedness and water retention from PMS 4. Reduce intake of alcohol: Alcohol consumption has been linked with PMS. Reducing the alcohol intake will relieve some PMS symptoms. Good eating habits: Eating regular smaller meals will help reduce bloatedness. Skipping a meal may make the woman more irritable as blood sugar levels plummet. Drinking plenty of water will hydrate the body and relieve the symptoms of headaches and tiredness. Regular exercise Maintaining a healthy body weight may help prevent PMS as evidence suggests that overweight or obese women are more likely to have the symptoms Reduce stress Stress may intensify PMS symptoms. Exercise such as yoga, Pilates and deep breathing are ways to relax your mind and reduce stress. Quit smoking A recent study has shown that smoking, especially in the teens or early 20s, may increase the risk of PMS. Adequate rest and sleep Feeling tired is a sign of PMS. Proper rest helps PMS Psycho-therapy Psychological symptoms, such as feeling depressed or emotional, may be alleviated with the help of psychologist. Cognitive behavioural therapy (CBT) helps solve problems such as anxiety and depression.

I have been taking oral contraceptive pills for more than 10 years. Occasionally, I had very heavy vaginal discharge together with itchiness soon after my periods. This was white in colour, very thick, with the texture like mashed “tofu “in bits and pieces. The discharge would last a few days. I am not sure if oral pills have anything to do with it. What should I do? A. From your description, the vaginal discharge is likely to be due to fungal infection. The discharge is related to oral contraceptive pills. Fungal infection or candidiasis is one of the common causes of vaginal discharge. It is due to the fungi, Candida. These fungi are found almost everywhere in the environment. They are present in about 20% of apparently healthy women. They live harmlessly together with the “good” bacteria that stay in and around the vagina. They are kept under control by these bacteria and the body's immune defence system. When the number of the native bacteria is reduced by antibiotics or if the person's immune system is weakened by illness, malnutrition, stress or medications like oral pills, these fungi multiply and cause symptoms. Pregnancy and frequent douching can also promote fungal infection. The symptoms are: Vaginal itchiness Vaginal discharge: this is typically creamy, white and thick with a texture similar to that of soft cheese or mashed tofu. Burning sensation around the vaginal opening, especially during urination. Pain or discomfort during sexual intercourse. Fungal infection is usually quite obvious to the doctor on physical examination. If the diagnosis is in doubt, the discharge may be smeared on a slide and examined under microscope. A swab from the vagina may also be taken to the laboratory to culture the fungi. If an underlying medical illness, such as diabetes, is suspected, blood tests or other investigations may be necessary. Fungal infection can be treated easily by oral tablets or topical treatment (vaginal cream or insertion of vaginal suppository). You can reduce the chances of getting the fungal infections by doing the following: Stop the oral contraceptive pills. Keep your vagina clean and dry: After urinating or passing motion, try to wipe the private parts gently from front to the back. Having a healthy lifestyle, including proper nutrition. Keeping the blood sugar under control if you are a diabetic. Avoiding foods with high sugar content Do not douche the vagina. Do not wear tight jeans or undergarments. Cotton is the most suitable material. Taking yogurt and probiotics tablets may help.

Q. I have 3 children. My husband is thinking of a vasectomy. Can you tell me how vasectomy works? Are there any risks for the procedure? Will the operation affect his sexual performance? How soon can we resume sex without using contraception? A. A vasectomy or male sterilization, is a surgical procedure in which the tubes (vas) that carry the sperm from the testicles to the penis are tied and cut so as to permanently prevent pregnancy. It is usually done under local anaesthesia where a tiny incision is made on each side of the scrotum to reach the vas which is then cut and a small segment removed. The ends of the vas are then closed with sutures. This procedure works by preventing the sperm from entering the semen. The amount of semen ejaculated is not affected after the operation, as sperm accounts for only 2-5 per cent of the total volume. The sperm, which is still produced by the testicles but cannot travel along the tied vas, are reabsorbed by the body. The risks of operation are minimal with occasional bleeding, infection or an inflammatory reaction to sperm leakage.  Discomfort such as pain, bruising or swelling may occur for a few days after the procedure. Vasectomy will not affect an individual's sex drive or ability to enjoy sex. Erections and ejaculation are not affected. You can have sex again as soon as your husband finds it comfortable to do so. However, you need to use other methods of contraception for at least the first 8 to 12 weeks, as there may still be sperm present in the vas leading to the penis. To make sure that the vasectomy works, the semen should be analyzed twice to make sure that no sperm are present. Vasectomy is 99.9% effective at preventing pregnancy.  In about 0.1% or less, the vas may re-join naturally and the man may become fertile again. Surgical reversal of vasectomy is possible but the procedure is difficult and complex. If a reversal is carried out within 10 years of vasectomy, the success rate of impregnating the wife is about 55%. This falls to 25% if the reversal is carried out more than 10 years after.

I am 40 years old and have 2 children. I have suffered from endometriosis for the past 7 years. 5 years ago, I had a “chocolate cyst” removed by open surgery and another one on the opposite ovary removed by key-hole surgery 3 years later. Recently, I started to have menstrual pain and backache again. Is there anyway of preventing endometriosis from recurring? What are my treatment options? Endometriosis is a chronic and progressive disease where the lining of the womb (endometrial tissues) is spilled into the surrounding organs-- fallopian tubes, ovaries and the back of the womb. These endometrial tissues respond cyclically every month to the female hormone, oestrogen, from the ovary and bleed during menstruation. The surrounding areas become irritated by the blood and form scars in the pelvis causing backaches, abdominal cramps during menstruation and pain during sexual intimacy. There is no definitive cure for the disease which will only regress after menopause when there is little or no circulating oestrogen The treatment for endometriotic cystslis surgical removal. But the recurrence rate is high, ranging from 20-50% within 5 years after surgery. How fast the disease recurs depends on the following factors: • Severity of the disease at the time of surgery • Completeness of the surgery • Use of suppressive hormonal treatment after operation There are a number of hormonal treatment options that may be used to delay the recurrence. Which option is right for you will depends on your condition. By reducing the levels of blood oestrogen, the chances of endometriosis recurrence are reduced. This can be done using oral contraceptive pills or a GnRH agonist. Recent studies have shown that insertion of Mirena, a hormone impregnated intrauterine contraceptive device (IUD) can be effective for delaying the recurrence. Some women may also choose to use an aromatase inhibitor to stop all production of oestrogen. If medical treatment fails, the surgical removal of the uterus (hysterectomy) with or without removal of the ovaries (bilateral oophorectomy) may be the last resort. See also the articles“ How does GnRH agonist work and what are the side effects under Q&A and “Endometriosis” under Gynae conditions

Q. I am 34 years old and have been married for a year. Every time I am intimate with my wife, I feel pain as the skin over the penis cannot be stretched completely. I am very keen to have a baby. What should I do? A. You may have phimosis, a medical condition where the foreskin is tight and unable to retract over the head of the penis during erection. It is caused by a tight band or a ring in the foreskin. If retraction is possible when the penis is flaccid, it is termed partial phimosis; if retraction is not possible at all, it is known as full phimosis. To relieve the pain during sex and improve your chances of conception, you could try: 1. Gradual and gentle stretching of the foreskin with or without using the steroid cream 2. If this fails, you should consult an urologist for surgical treatment which includes cutting the band or ring, or performing a circumcision.

I am 25 years old, single. Recently, I found a lump in my left breast when bathing. It is mobile and not painful. What should I do? A. Eighty percent of breast lumps are not cancerous. They usually have smooth edges and can be moved slightly when they are pushed against. However, you should be checked by a doctor to make sure the lump is benign. The doctor will confirm • The presence of the lump • The size, shape , contour, mobility and sensitivity of the lump • The presence or absence of other lumps • Whether there are any changes in the feel or appearance of the skin on the breast or nipple (whether there are any dimples, whether the skin is puckered, scaly or inflamed) • The presence of any bloody discharge from the nipples • Any lumps in the armpits

“When I feel hungry, I like munching on cookies and potato chips.” “I love burgers, ice-cream, chocolate and sweets. Eating these foods with my friends is fun. Whenever we go out, we enjoy eating these foods together.” “I don’t like milk, yogurt and oatmeal because I don’t like the taste.” “I hate fish because they are smelly‼ “I only eat fruits and vegetables if I am forced to!” These were the responses I got with regards to H’s dietary habits when we talked about how to manage her weight. She was a 15-year-old plump adolescent who had irregular periods for the past one year. Her first menses (menarche) was at the age of 11. Initially, her cycles were slightly irregular occurring once in 30 to 45 days and lasting for 3 days. They became more regular at monthly intervals when she was 12. For the past one year, her menses became erratic. They were getting longer and longer, occurring once in 2 to 3 months. The bleeding could be scanty with spotting or heavy with clots at times. The duration of menstruation could last up to 2 weeks occasionally. Her BMI was high at 28 and her hormonal investigations indicated that she was suffering from polycystic ovarian syndrome or PCOS (please refer to the article PCOS and its health implications in this website). How does diet affect PCOS? Many patients with PCOS have increased levels of insulin, a hormone produced by the pancreas that helps regulate sugar in the body. In these patients, the body is resistant to insulin. This results in the pancreas producing more insulin in order to maintain a normal blood sugar level. High levels of insulin will cause the ovaries to produce more male hormones (androgens) and body fat, the hallmarks of PCOS. As a consequence, patients are usually overweight and have difficulty controlling their body weight. A diet that promotes good insulin production will help in the management of PCOS. What are the foods to eat? Foods that help PCOS patients include: A low glycemic index (GI) diet GI is a rating system that measures how much and how quickly a food raises blood sugar levels after being eaten. With a low GI diet, the body digests the foods at a slower pace. As a result, blood insulin and sugar levels will rise and fall gradually instead of in erratic spikes. Patients will feel full for a longer period of time. Appetite is thus better controlled and body weight becomes more manageable. Foods with a low GI diet include whole grains, legumes, nuts, seeds, fruits, and vegetables. Anti-inflammatory foods Foods that boost our immune system will lower the risk of inflammation in our body. They are found to be beneficial in PCOS patients. They include berries, fatty fish, leafy greens, olive and other vegetable oils. The DASH (Dietary Approaches to Stop Hypertension) diet This is an eating plan to lower or control high blood pressure. It is useful in PCOS women who are obese. Research studies have shown that it helps to reduce insulin resistance and belly fat. The DASH diet includes many vegetables, fruits and low-fat dairy products, as well as whole grains, fish, poultry and nuts. It has limited small portions of red meats, sweets and sugary beverages. What are the foods to avoid? Foods that may cause an inflammatory response in our body include: · Refined carbohydrates, such as white bread and pastries · French fries and other fried foods · Sugary beverages and snacks · Excess red meat (burgers, steaks) and processed meat (hot dogs, sausage) · Margarine, shortening, and lard Like most adolescents, H had an inactive lifestyle with very little exercise. She would sleep late and often skipped breakfast as she had to rush to school early in the morning. It was challenging initially to coax her to exercise and change her dietary habits. However, with parental support and encouragement, she began to eat a balanced and healthy diet and took up dancing as a form of exercise. Her menses are getting more regular now.

Myth: The older you start menstruating, the older you are when you go through menopause Fact: The age of the onset of menopause is unpredictable. There are many women who start menstruating late and have menopause earlier. There are some factors that may affect the onset of menopause: · Smoking leads to earlier menopause. · Drinking alcohol is associated with later menopause. · Having more babies may be linked with later menopause. · If the mother has an early menopause, the daughter may follow suit. Please also refer to” timing of menopause “under the article “Menopause” Myth: You can still get pregnant after menopause. Fact: During the phase leading to menopause called peri-menopause, your ovary may still release the egg once in a while and you can get pregnant as a result. It is important to note that peri-menopause can last from a few months to a few years .You should consult your gynaecologist regarding methods of contraception. Once menopause sets in, i.e. after menstruation stops for 12 months, you will not get pregnant anymore. Myth: Weight gain is inevitable in menopause. Fact: As you transit from peri-menopause to menopause, your ovaries produce less sex hormones resulting in hormonal imbalance. Fat starts piling up especially around the waist, hips, and thighs. Studies have showed a change in body composition after menopause, including increases in body fat percentages and decreases in lean body mass. But if you eat a balanced diet and exercise regularly, you can still maintain a healthy weight. Myth: All women experience unpleasant symptoms during menopause. Fact: Menopausal symptoms vary from woman to woman. Some may have severe and unpleasant symptoms such as hot flashes, insomnia, night sweats, depression and mood swings. Others may have mild, or no symptoms, except for the absence of a period.

1. The human egg is a giant compared with the sperm: The human egg is the biggest cell in the body. It has a diameter of about 100 micron (millionths of a meter), or about the thickness of a strand of hair. The sperm is the smallest cell in the body. It is only 5 micron by 3 micron in size, excluding the tail. 2. Eggs are made early in life and they age fast. Immature eggs start to form in the female foetus at around 2-3 months of conception. By the time it is five months old, there are about 7 million eggs in the ovaries. At birth, majority of these egg cells have died and only about 4 million are left. When a woman reaches puberty, about 400,000 eggs remain. With each menstrual cycle, she loses a thousand and releases only one mature egg. Throughout her reproductive life, about 300 to 400 eggs are released. The quality of the egg changes with age. About 90 percent of the eggs in a 20-year-old woman are healthy and viable compared with only about 10 percent in a 40-year-old. 3. The Egg Has a Short Life span Once the egg has matured and is released from the ovary during ovulation, it goes into the fallopian tube where it lives for 24 to 36 hours. If it is not fertilized, it will degenerate and get absorbed by the body. 4. Eggs are quite picky and monogamous While many sperm are trying to get into the egg, eggs have a special mechanism of releasing certain proteins and enzymes to ensure that once a sperm gets inside, no others are allowed in. What decides which sperm will be allowed in remains a mystery.