How do I reduce vaginal dryness after a hysterectomy?

I am 34 years old and in 2020, I underwent a hysterectomy (uterus removal). Since then, I suffer vaginal dryness and pain during sex. Are these effects of the surgery? Sabina

Dear Sabina,
A woman’s vaginal canal is naturally kept cleansed, moist and well lubricated from a discharge produced by the cervix. During sexual arousal, more fluids from the Bartholin’s glands and vagina are produced for increased lubrication and if the fluids are minimal or lacking, one may feel dry and the couple will experience painful sex. 
The hormone oestrogen is important in production of the lubricating fluids and it is not surprising that towards, during and after menopause when women experience lowered oestrogen hormone levels, vaginal dryness during sex is common. 

Most of the reasons women undergo a hysterectomy include complications related to fibroids or cancer of the womb and these happen towards menopause when oestrogen is declining, hence risking dry sex. Sometimes, it is not only the womb which is removed but also the ovaries; the main source of oestrogen, further risking dryness.

A number of women experience vaginal dryness during sex because they have not had enough foreplay to properly arouse them, are stressed, anxious or are low on sex drive. A woman’s womb is her natural treasure and if it is removed, the psychological trauma that follows may last a lifetime, hence causing vaginal dryness. 

Here, continued counselling before or after the operation, having enough time for foreplay, using water-based lubricants and if in menopause, vaginal creams that contain oestrogen can help. 

Women have both male and female sex hormones whose balance may be affected by the menstrual cycle, menopause, breastfeeding, pregnancy, childbirth, use of hormonal contraception, stress, hormone disrupting toxins, body weight and many other factors.
After menopause, women will suffer physical and psychological problems related to low female hormones. 

They may also suffer cosmetic and other issues including deepening of the voice, balding and growth of beards but coming at a time of menopause (natural/when the ovaries are removed together with the womb) might make one think she is turning into a man due to lack of a womb, which is not  the case.
Please visit your doctor for counselling and reassurance.

Treating varicose veins at home

Varicose veins develop when small valves inside your veins stop working properly. There are multiple things that can cause varicose veins such as age, long periods of standing or sitting, pregnancy and genetics, among others. Here is how to treat them at home.

Garlic, lemon, and olive oil
Garlic is used for many conditions that are related to the heart and the circulatory system. Garlic produces allicin and ajoene, which are sulfurous compounds that have the ability to improve blood circulation. They contribute to the prevention of inflamed blood vessels and to the prevention of blood clots. Garlic has very powerful anti-inflammatory properties that are ideal for reducing the swelling of varicose veins, as well as, the discomfort that they can cause. In addition, garlic has quercetin, which is a flavonoid that helps strengthen the veins and blood vessels, preventing them from suffering any damage.

Lemons are high in vitamin C, B6, A, E, folate, niacin, thiamin, riboflavin, pantothenic acid, copper, calcium, iron, magnesium, potassium, zinc, phosphorus, and protein. The large amounts of vitamin C helps protect cells from damaging free radicals and prevent oxidative damage. In addition, it helps to prevent varicose veins, high blood pressure, and skin wrinkling according to a study done by the American Society of Clinical Nutrition.

Cayenne pepper
Cayenne pepper is considered a miracle treatment for varicose veins. It is a rich source of vitamin C and bioflavonoids (an antioxidant which is used to treat allergies, viruses, or arthritis and other inflammatory conditions). It also helps reduce atherosclerosis, encourages fibrinolytic activity, and prevents factors that lead to the formation of blood clots, all of which can help reduce varicose veins. 
Add one teaspoonful of cayenne pepper powder to a cup of hot water and stir it. Drink this mixture three times a day for one to two months.

Cabbage 
Cabbage, is rich in insoluble fibre, beta-carotene, vitamins - B1, B6, K, E, and C, and a number of minerals such as calcium, iodine, magnesium, iron, and sulphur. Cabbage is also loaded with antioxidants and phytochemicals. When these antioxidants and phytochemicals touch the affected area they reach the veins through the pores and help the blood clot, thereby stopping the seepage of blood.

Get three leaves of cabbage, chop them into small pieces and blend. Get a strainer and empty the mixture into it in order to extract the juice from the cabbage leaves. Apply topically at least three times a day.
Source: brightside.me

What happens if I miss a hepatitis B  vaccine dose?
I got one dose of hepatitis B immunisation and missed the last two. Can I restart and have the three doses again? Sandra

Dear Sandra
Hepatitis B is a virus that infects humans when blood, semen, or other body fluids from a person infected with the virus enter the body of someone who is not infected. The virus can damage the liver leading to liver cirrhosis, liver cancer, liver failure or death. Prevention of Hepatitis B involves addressing the transmission through immunisation against the virus.

Among adults, if the first Hepatitis B vaccine is given say today, the second dose will be given one month after the first dose while the third dose is given six months after the first dose. This may protect one for 30 years or more or even for life.

If one took the initial dose but did not take the second and third scheduled vaccine doses, they need not restart but can have the second dose as soon as possible followed by the third dose after an interval of at least eight weeks. If one missed only the third dose, it can be given as soon as possible without starting afresh.

What are dental sealants?

Dear doctor, my dentist told me to place sealants on my teeth. What are they and how do they work? Alice
Dear Alice,
Sealants are a form of preventive dentistry. We recommend sealants for both adults and children with deep grooves, pits and fissures on their teeth. Sealants are thin coatings that are placed on the chewing surfaces of back teeth to protect them from bacterial attack. They do this by keeping germs and food particles out of the grooves.

Permanent molars are the most likely to benefit from sealants. The first molars usually develop around six years of age and the second molars at around12 years. It is best to apply sealants immediately the teeth erupt before they have a chance to decay.

Applying sealants does not involve drilling or removing tooth structure. The process is short and easy. After the tooth is cleaned, a special gel is applied on the teeth for a few seconds. The tooth is then washed off and dried and the sealant is painted onto the tooth surface. The dentist may shine a light on the sealant to make it harden. It takes about a minute for the sealant to form a protective covering.
As with anything new, the child may feel the sealant with his tongue. Although very thin, the sealant can only fill the pits, fissures and grooves. 

A sealant can last five to 10 years. Still, there is need for regular dental appointments so that the dentist can replace the sealant if it is wearing away. 
For more information concerning sealants, visit our website at www.ugadent.org

Dental Surgeon
Dr Biren Yajnik