Thursday May 9 2013

DOCTOR’S COLUMN: Help! I cannot sustain an erection

Help! I cannot sustain an erection


By Vincent Karuhanga

Dear doctor, since I was found with HIV/AIDS, I have erection problems and if I do it takes me a little while and my manhood shrinks. But my wife does not know that I am HIV positive. I used Viagra once but this has not helped. What can I do? I am now on drugs.


Dear Jamil, this raises questions whether you were counselled before HIV tests and treatment. You need counselling about how to conduct yourself so that you do not infect those you love and also to live without fear that you are likely to die.

Sexual health depends on one’s general health. So that if one is stressed, or physically drained by disease he is likely to have sexual problems. Being diagnosed with HIV infection alone apart from fear that your wife could be uninfected and you could infect her, can stress you leading to erection problems, or even sustaining one during sex. Viagra may not help in such cases resulting from psychological problems.

Since you are on treatment for HIV, explain your sexual problems to your doctor. The doctor will also counsel you about how to tell your wife the truth so that she is also tested. If she is negative, you have to use condoms to prevent infecting her.

Then the guilt and erection problems will be history. Sometimes, drugs for HIV infection may have side effects but you need not to abandon treatment.

HIV infection or associated opportunistic infection or even tumours may affect the brain, nerves, muscles and the penis hence affecting sexual health. You still need to visit your doctor for further examination.


Dear doctor, after my periods, I get thick dark brown mucus-like discharge. It causes itching at times and stains my knickers. This has happened for some time now.I have never given birth. What could be the cause?

Dear madam, vaginal discharge is natural and apart from lubrication, it cleanses the female reproductive system by carrying away dead bacteria and worn out lining cells.
Depending on the timing of the menstrual cycle, normal vaginal discharge is usually like white wheat flour in water but may be like clear mucus at around the time of ovulation.

Immediately after a period, vaginal discharge may come from reddish to brown then white. Reddish due to blood content (haemoglobin pigment which contains iron) and the inner lining of the womb, which chiefly make what we see during the periods.

Blood and membrane when retained longer in the womb will undergo changes and appear brown just like rust.Therefore, a brown discharge may be harmless when it follows periods. However a brown discharge may follow any bleeding from the womb or vaginal canal.

So, if bleeding takes longer the discharge will also persist like in your case. Do not take it lightly, visit a doctor for medical tests. The harmful causes include infections such as STDs, injury, blood disorders, fibroids and cancer of the cervix.The non-harmful causes include use of contraceptives and ovulation.

A rusty discharge happening around two weeks usually points to ovulation and here one may have red blood staining the pants as well. Since you say the problem has continued from the end of your periods, this may not be merely due to ovulation but may be due to a continuing harmful bleeding process.

When the discharge is accompanied by other symptoms like pain or itching, it may indicate an STD as the cause. Itching may have other causes especially Candida or an allergic reaction to panty liners or pads.


Dear doctor, why does my baby have a rash in his private parts all the time? My doctor told me it is diaper rash. I stopped using nappies but it still comes!

Angella Nabuto
Dear Angella, nappy or diaper rash is common in babies, and usually affects areas that come in contact with wet diaper. Despite being called diaper rash, this is not usually due to the diaper itself, but due to irritation by faeces, urine and sweat trapped by the diaper.
In a few circumstances however, the areas in contact with the diaper may get a rash due to an allergy in which case changing the type of diaper may help.

Diaper rash mostly happens in infants nine–12 months old, perhaps in response to dietary changes that affect faecal composition or increased use of antibiotics. These cause changes in intestinal bacteria. It is not surprising that breast-fed babies, do not tend to get nappy rash, possibly because their stools have less acidity, lower enzymatic activity and undisturbed intestinal bacteria. Associated diarrhoea due to dietary changes at the time may also lead to nappy rash.

The most effective treatment is to discontinue use of diapers, allowing the affected skin to air out and use of moisture absorbing powders. When the rash does not cure, it is likely that there is associated infection or even an allergy to other things including soaps. If the rash affects the folds (intertrigo), it may be due to friction.

But having a diaper rash is a normal part of being a baby. Even with the best treatment, from time to time, the rash may come up.


Dear doctor, why is it that water does not quench my thirst but only alcohol. When I am thirsty, I take one and I am okay.

Agatha Agasa

Dear Agatha, much as many people say they take alcohol to quench thirst, this is just temporary. Thirst is the body’s way of compelling us to take water because the body is short on water or blood salts have become more concentrated than normal. Thirst is less prominent in some people especially the elderly.

Alcohol initially quenches thirst since its water content is high and water is absorbed faster compared to alcohol. This depends on many factors including presence of food in the stomach. Eventually one starts to pass lots of urine and also loses a lot of water through sweating, diarrhoea, overtalking, and “over breathing”!
Alcohol denies the brain hormone, ADH, opportunity to direct the kidney to concentrate urine hence the copious amounts of urine passed as people drink.

Alcohol makes people feel warm because it causes blood vessels near the skin to enlarge taking more blood to sweat glands to manufacture and expel more sweat.
It is not surprising that many people who take alcohol also enjoy a glass of water the morning after to quench associated thirst.


Dear doctor, I have blocked tubes. Is there a way that fallopian tubes once blocked can become open and I get pregnant?

Lilian Apio, Tororo

Dear Lilian, a common cause of infertility in Ugandan women is blocked fallopian tubes. This may be due to adhesions outside the tubes (like after appendicitis) or scars inside the tubes from untreated STI’s.

Salpingolysis is the surgery done to release the tubes from such adhesions while salpingostomy is the one done to repair the scars to allow pregnancy to take place.
The success depends on many factors including extent of scarring and age. Sometimes, the tubes may open up without conceiving because of factors like fibroids.

It is therefore necessary to first look for other causes before embarking on surgery.This helps avoid having many surgeries.

Patent tubes may have had the inner hairs (which propel fertilised eggs to the womb) damaged leading either to pregnancy in the tubes or no pregnancy. But this should not make you pessimistic and deter you from seeking the operation because it may be successful.

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