Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Douching, bleeding after sex and other problems

Dear Dr Margaret
I was wondering if douching towards the end of my period will get rid of the end of the period stuff, like tissue and blood.

The vagina has a very efficient self-cleaning mechanism. Glands on the cervix (neck of the womb) produce moisture, which passes down your vagina and clears away dead cells and bacteria and the remains of your period. This moisture has just the right amount of acidity to prevent infections. Therefore douching (which means squirting a soapy or antiseptic liquid into the vagina to ‘clean’ it) is not necessary. In fact, it can be harmful. It destroys the ‘friendly’ bacteria that live in the vagina, gets rid of the healthy acidity and may damage the lining, allowing thrush and other infections to take hold easily.

Dear Dr Margaret
I think I have thrush but I am too embarrassed to see my doctor. I have been on tablets for my acne which I think may be the cause. I get really itchy and thick white discharge.

The itchiness and thick white discharge does sound like thrush. You can buy various treatments for thrush from a pharmacy without a doctor’s prescription. You would probably need internal treatment with a pessary (which you insert into the vagina), as well as a cream to use on the outside itchy area. However, I think it would be a good idea to consult your doctor to check that you really do have thrush. If you really are too embarrassed, you could talk to the practice nurse at the surgery or, if you are in the UK, you could attend a genitourinary medicine clinic instead.

If your acne tablets are antibiotics, they could be partly responsible. A study published in the American Journal of Obstetrics and Gynaecology in 1999 showed that taking antibiotics almost doubled the likelihood of getting thrush, especially for women who had thrush in the past. So treatment will probably get rid of it, but it might recur if you continue to take the acne tablets.

Dear Dr Margaret
Recently I have noticed that if I go swimming or lie down in the bath I actually take water into the vagina, then afterwards I trickle water out. It doesn’t seem anything to do with urination , as I have perfect bladder control.

There is no tight muscular seal at the entrance of the vagina (as there is at the anus and at the entrance of the bladder). Therefore it is perfectly normal for water to seep in when you are in the bath, and drain out when you stand up.

Dear Dr Margaret
My right testicle has no epididymis. It is just a loose testicle with spermatic cord. On left side I can feel the epididymis. It feels swollen. Why don’t I have an epididymis on the right side? I am 22.

Just to recap on the normal anatomy of this area – behind and slightly above the testicle it is often possible to feel the ‘epididymis’, which is a storage tube. It feels soft and maybe slightly tender. Normally you can also feel the ‘spermatic cords’, which lead upwards from the epididymis and behind the testicles. The spermatic cord contains arteries, veins and nerves and a tube for the sperms to reach the penis.

I think it is very unlikely that the epididymis is missing on one side. It is more likely that on the left side you are feeling swollen veins (which is called a ‘varicocele’), and by comparison you think there is nothing on the right. Varicocele is quite common in young men, especially on the left side. However, I am only guessing about your situation; ask your doctor to check.

Dear Dr Margaret
The last time we had sex I woke up in the morning and there was blood everywhere, lots of it. I thought, I must have started my period or something, but I hadn’t.

This is something you really do need to see your doctor about. Anyone who has vaginal bleeding between periods needs to have it checked. There are many possible reasons. One of the commonest is called ‘ectropion’ (previously called ‘erosion’) of the cervix (neck of the womb). The cervix is velvety and bleeds easily, instead of being smooth and shiny. Ectropion is normal, not a disease. Bleeding after sex can also be a sign of cancer; this is unusual, but is the reason you must see your doctor for a check. The doctor will insert a speculum (like having a smear) so that he or she can inspect the cervix.

Any more questions?
Do you have any questions about embarrassing problems? If so, send an email to info@healthpress.co.uk. I am sorry that I cannot send you an individual reply, but I will try to answer some of them on this page.

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