Dear Doc | Help I have sagging breasts from breastfeeding

Q Doc, after breastfeeding my baby, my breasts are no longer firm, and I am uncomfortable with it. Is there a cream I could use?

A There are many different brands of 'firming' creams available in most pharmacies and beauty shops. Technically they cannot repair the stretched ligaments and reduced skin elasticity which causes sagging breasts - the only solution for this is surgery.

However, these creams do provide moisture to the skin which makes the breasts appear firmer. Many of them also contain vitamin E and other antioxidants which improves skin tone and texture so there is some benefits in using them.

Be careful of products that contain steroids and retinue, as they are not meant for long-term use, and should only be prescribed by a physician.

Home made pastes such as cucumber blended with an egg yolk or some aloe vera applied to the breasts for half-hour, also provides moisture and improves skin tone and texture. These have the advantage of not containing any artificial ingredients, so they can be used on a daily basis.

Exercises that strengthens the chest muscles, also improve breast support. Invest in high quality well fitting bras, and take care of your overall health and this will overtime improve the appearance of your breasts.

Worried about constant bleeding

Q Doc I have a problem I have been bleeding for about three months none stop with heavy clotting in between. I did a Pap smear and it came back normal. My gynaecologist put me on birth control to stop the bleeding, but it just helps a little for a few days then the bleeding is back again. I don't know what to do! Do you know what is wrong with me? I am getting very depressed.

A So sorry to hear about what you have been going through. There are numerous factors that could be causing this. The most common encountered locally include:

-Withdrawal bleeding from incorrect use of oral contraceptives/emergency contraceptive.

Uterine fibroids

-Hormone problems such as polycystic ovarian syndrome (PCOS)

Ovarian pathology

Retained products from incomplete abortion.

There are other possibilities such as liver disease, blood disorders and thyroid problems. As you can see, the list is exhaustive, and this is just a few. You need to go back to your gynaecologist who will do the necessary blood and imaging studies which should give more clarity as to the cause of your problem.

Never had an orgasm

Q I'm 23 years old and my boyfriend is 27. I've been having sex since I was 17, but I've never had an orgasm. We have been together for two years now, and my boyfriend and I are worried that I may never climax when he makes love to me.

What can I do to get myself relaxed and empty my mind of other thoughts when having sex? He always try clitoral stimulation, but I just can't seem to have an orgasm. Maybe I could orgasm if I had more time with intercourse, but my boyfriend doesn't last more than 10 minutes. I am beginning to think that I won't ever get to experience that 'good feeling' that others describe. How can I get relax completely and what else can my boyfriend and I try?

A This is an issue which is very common, and has been addressed several times in this column. The factors which play a role in female orgasm are multiple, complex and poorly understood. For many women, psychological factors are significant, and the comfort level with the partner as well as with their own bodies are also very important.

Providing there are no medical conditions, many women require about half-an hour of foreplay (kissing, cuddling, caressing, etc) before they are fully excited and ready for vaginal penetration.

The clitoris has a lot of nerve endings, so sometimes direct stimulation may defeat the purpose. The best is to communicate with your partner be honest about your sexual needs, and take the time to get comfortable with each other before direct intercourse. Examine your own attitudes towards sex - if nothing changes, then visit your doctor who will give you a check up and if necessary, refer you to a sex therapist for counselling.

My friend is worried about being pregnant

Q Dear doc, my friend thinks she is pregnant because recently her boyfriend ejaculated on her dress. I try to tell her that it is not possible, but she does not believe me. She is talking about abortion, what should I tell her?

A Sperms do not survive long in outside of the body. They die once the semen has dried out. They can survive up to an hour if the ejaculate is not dry. Theoretically, the dress would have to be resting firmly against her vulva for even a slight chance of pregnancy to occur. It is highly unlikely but not impossible, so get a pregnancy test done instead of making assumptions and have her consider using condoms when having sex if she is not ready to become pregnant. She should visit her doctor if she misses her next period.

Boyfriend says he can't get me pregnant at 20

Q Dear Doc, I have been dating a young man whom I have recently begun to have sexual intercourse with. I am very concerned about getting pregnant, however, he insist that he cannot get me pregnant in his 20s and doesn't want to wear a condom. He is 25, and he says his father and brothers either have children in their teens or 30s. I find this unbelievable, and therefore have taken my own precautionary measures. Tell me if what he is saying makes sense. Is it possible for him to be sterile/infertile in his 20s only?

A It is good that you have taken precautions to prevent unwanted pregnancy, but bear in mind that condoms are the only contraceptive method which also reduces the risk of contracting a sexually transmitted infection. I am sorry to tell you that what he is saying is absolute nonsense. There is no medical condition which makes a man fertile in his teens, then infertile once he hits his 20s and then fertile again at 30!

For sure there are genetic conditions which interfere with sperm development, but this causes infertility throughout the reproductive years and not selectively to a particular decade.

Many men use this ploy because they do not want to wear a condom because it reduces the sensitivity of the penis to an extent in different individuals, and many men (and women) derive more pleasure from going "bareback". Have an open and honest discussion with your partner. Tell him your concerns about getting pregnant, and I am sure you can reach a reasonable compromise.