Dear Doctor: In Buganda culture, an heir (omusika) has to be a male child, but my wife always gets girls yet I want a boy. As a result, I have made a different woman pregnant. At what age of the pregnancy can I visit a doctor to find out the sex of the baby? For my last two children, the doctors said the babies were boys but they turned out to be girls.
Dear Byoona: Determining the gender of your child with ultrasound scanning depends upon seeing the penis and scrotum in the case of a boy, and the labia in the case of a girl. The absence of the penis should not always be taken as sufficient evidence that the foetus is a girl because this is likely to cause inaccuracies since the one doing the scan may not always get a good view of the private parts.
The correct visualisation of any foetal part depends on many factors including how the foetus is lying (foetal position), whether the external genitals of the baby are abnormal or not, the amount of waters (liquor) and thickness of the abdominal wall. Sometimes, even at 28 weeks the sex may not always be easily determined since the accuracy may depend on the sonographic machine with many in Uganda lacking good precision. The accuracy may also depend on the expertise of the operator.
In Uganda, most equipment will determine sex at around 20 weeks (5 months). With more modern equipment, the gender may be determined as early as 11 to 12 weeks though the earlier it is done the more inaccurate it may be. So depending on these factors, the sex determination in many centres in Uganda may be inaccurate and unfortunately may give false hope in some parents.
Sex of an offspring depends on many factors though literally, it is the man who determines the sex of the baby. If a man gives sperm with X chromosomes, the baby will be a girl, and if he gives Y chromosomes, it will be a boy.
You may cheat on our partner looking for a boy and end up with a girl instead. This might cause you to cheat even more, ending up with an unexpectedly big number of children you may not be able to look after.
Dear Doctor: I am a man but my breasts are developing, what could be the problem?
Dear Richard: Development of big breasts in males (gynaecomastia) can be a source of distress in adolescents and especially when the breasts produce milk.
Breast prominence can result from increase in fat or breast tissue, chest skin or a combination of all these. Today, many boys have big breasts because of obesity with excessive fat in the breast area (pseudogynaecomastia).
Gynaecomastia can occur physiologically in newborns, adolescents, and in the elderly due to related imbalances in sex hormones. Female hormones (oestrogens) lead to development of breast tissue and male ones (testosterone) suppress them. If male hormones reduce, as happens with aging, castration and obesity (fat changes male to female hormones) or female hormones increase, breast development inevitably occurs.
Breast enlargement is mostly benign requiring only counselling. That said, the enlargement has to be investigated and addressed appropriately according to the cause. Where gynaecomastia is related to puberty but not due to obesity, the breast development shrinks or disappears with time.
With obesity, one has to reduce weight to manage the problem, though even then, a person may never regain a flat man’s chest. In cases where the breasts are causing much distress, surgery to remove excess breast or fat tissue may be appropriate.
Dear Doctor: I am a married woman but from the time I started getting my periods, it happens for two months and then miss the next two. Is this normal and will I be able to get pregnant in future? I have been told it could be hormonal imbalance, but I have also recently been on goitre treatment. Please prescribe any possible treatment for me
Dear Reader: There are various causes of irregular or reduced periods, the most common being hormonal imbalances due to lack of regular ovulation. This usually happens in young women who have just begun their periods (puberty), and sometimes at the start of menopause. With irregular ovulation during these times, the inner lining of the womb which is shed as a period fails to develop normally.
Later in puberty, the ovulation becomes regular and so do the periods. Sometimes a woman may have conditions unrelated to puberty hormones. For instance, problems with other hormones including that of the thyroid gland or insulin can lead to irregular periods.
Insulin-hormone problems related to small water filled areas in the ovaries, male hormone excesses and obesity can also appear at any time and cause irregular periods.
This polycystic ovarian syndrome is particularly associated with infertility. Use of hormonal contraceptives especially injectaplan or organon device on the underside of the arm can also make periods irregular.
Until the normal hormone balance is restored, this may continue to happen regardless of whether one has gone over puberty or not.
Since you say you are on treatment for goitre, problems with your thyroid gland hormones could be responsible and only when the thyroid hormone is stabilised, will you get regular periods again.
Prescribing treatment for you requires proper investigations first, so visit your doctor for advise.