Got a burning question and itching to find out the answer? Dr Ivana Borsky, Sexual Health Week’s resident Dear Doctor will aim to answer all your questions on sexual health.

To submit a question, please email Dr. Ivana at deardoctor@sexualhealthweek.com.au

All questions submitted will receive an email response within 5 days. Each day, we will feature the top 3 questions of the day. So, don't forget to keep coming back to the site as your question may be featured or someone else may have asked the same question as you.

Important: if you require urgent medical attention, you should seek medical advice immediately by visiting your doctor or local family planning or sexual health clinic. For a list of help & advice contacts in your state, please visit Help & Advice

Top 3 Dear Doctor questions for Friday 13 November 2009:

Dear Doctor

My husband and I have 3 beautiful children and have decided that our family is complete. We are thinking about long term contraception or permanent contraception such as a vasectomy. He is of course worried that it will hurt! How does a vasectomy work, what does the procedure involve?

Firstly you can tell your husband that he is not alone in his concerns about vasectomy but the only pain caused by vasectomy is the tiny prick felt from the anaesthetic injection and after that, there is very little sensation. He may feel some sensation during the procedure, but this should not be painful. After the procedure, there may be some discomfort, but ordinary painkillers and cold packs will help and the soreness won’t last very long.

Most vasectomies these days are performed under local anaesthetic. An anaesthetic injection numbs the area and then a very small hole is made in the front of the scrotum. Through this opening, each sperm carrying tube (vas deferen) is cut and sealed off. Once this heals you will have a very small scar on the scrotum which will become invisible over time.

On average, the procedure takes around ten minutes. However, expect to stay at the centre or clinic for about an hour and a half. For more information on vasectomy, visit www.vasectomyinfo.com.au

 

Dear Doctor,

I am a 47 year old bisexual married male who has sex with other men both married and single, my wife is not aware of my activities, what should I do to protect her health has well as mine apart from wearing condoms and having the occasional STI tests, thanks fearful.

Dear Fearful,

The most important and healthiest element to a relationship is open and honest communication between each partner. Although I am not a counsellor, I suggest you perhaps try speaking to your wife about your interests and activities outside of the marriage. If you are having sex with other people and still having sex with your wife, you are putting her (and yourself) at risk of STIs. Remember, condoms do not protect you from all STIs. STIs such as herpes can be spread via skin to skin contact, meaning the area around the genitals can be infected with the virus. Having regular STI checks and wearing condoms at all times are the only way to have safer sex. If you are tested positive for an STI, it is important that you and other sexual partners are tested and treated at the same time to avoid spreading the STI back and forth.

 

Dear Doctor

Me and my partner are both virgins and neither of us masturbate. We are planning to become sexually active in the near future. We plan to use contraception & protection however we still are concerned about STIs. Because we are virgins / don’t masturbate, is the risk of STI diminished at all? Also what is the likelihood of her getting pregnant even with protection & contraception, in the assumption we use the pill & condoms? If both she & I wear condoms will that change anything? Thank you for your time. Lobologo

Dear Lobologo,

Firstly, congratulations for planning your contraception before you become sexually active. It is very important that both you and your partner are comfortable with the options that you choose.

If both you and your partner have never been sexually active (this includes touching, oral, anal and/or vaginal sex) with anyone else, then the chances of either of you having an STI are very low or close to none. If you are unsure then perhaps you should both take an STI test to make sure you are in the all-clear before you become sexually active and for peace of mind.

Remember, condoms are the only type of contraception that can help protect against unplanned pregnancy and STIs. When used correctly, they can be 98% effective. There is a great instruction sheet on ‘How to put on a condom’ in the resources section of the Sexual Health Week website. If used correctly, the Pill can be 99% effective. For more information on other contraceptives, visit Contraception In regards to your question about ‘if anything will change if both you and your partner wear condoms’- it sounds good in theory but in actual fact it is not recommended to double up on condoms. The female condom should not be used at the same time as a male condom because the friction between the two condoms may cause the condoms to break. We like to recommend ‘Double Dutching’ as the best method, which means using a condom and another form of contraception such as the Pill – as you have discussed doing with your partner.

 

Top 3 Dear Doctor questions for Thursday 12 November 2009:

Dear Doctor

Can you please suggest some appropriate ways to ask a person with whom you're about to have sex if he or she has any sexually transmitted infections? Lucky Phil

Dear Lucky Phil,

There is no right or wrong way of asking your partner if he or she has an STI. Sometimes it’s easier to come straight out with it and ask, but first keep this in mind: one of the most common symptoms of an STI is no symptom, so your partner-to-be may not even be aware of infections they carry. For this reason, in addition to asking, you both may want to consider getting tested if you haven't done so recently or if you’ve been at risk of getting an STI. Communicating about STIs before you're in bed together is also a good idea because when you're aroused, and perhaps not thinking as clearly as normal, your partner could be inclined to assure you they had no infections, in the ‘heat of the moment.’ Here are a few tips for when you have the discussion:

• Use language you're comfortable with.
• Be as direct as possible, knowing that it may be a little awkward.
• Be yourself.
• Stress that you care for your own and your partner's health, and you believe that these conversations are an important part of any relationship.
• Ask for details — has your partner ever been tested? How does he or she feel about testing?
• Pick a time and place where you won't be interrupted or disturbed, and when you're not sexually engaged.

 

Dear Doctor,

I’m a 17 year old girl and want to know the difference between genital warts and herpes? Anita

Dear Anita,

For women, genital warts — which are caused by certain strains of HPV (human papillomavirus) — can appear on or around the vulva, anus, vagina, and cervix. (Other strains of HPV on the cervix can cause cell changes that sometimes lead to cervical cancer. Because these types don't usually have symptoms, they are diagnosed by a pap smear rather than a visual exam.) Generally, warts are painless growths that range from hard to flaky in texture — similar to warts that may develop on other parts of the body, such as the hands or feet. When they are found on the moist tissue of the body, they tend to be white, pink, or even gray. In drier areas, they tend to be hard and yellow-gray in color. They can also have a cauliflower-like appearance.

Herpes — another viral STI — can surface in the same areas HPV does, as well as on the mouth. For some people, an outbreak begins with a tingling or itchy sensation. Other people may not experience any symptoms. In the genital area, herpes appear as one or more red bumps that become watery blisters within a couple of days. Shortly afterwards, the sores erupt and leave shallow ulcers that may ooze, weep, or bleed. It is not unusual for herpes sores to be painful (depending on the location). Usually a scab will form after three or four days, and the sores will heal themselves without treatment.

Both genital warts and herpes are tricky STIs because the virus can be present and infectious even if a person does not have any symptoms and/or doesn't know s/he has the disease.

 

Dear Doctor,

I’m 16 and have been sexually active with my boyfriend for 3 months. I want to go on the pill but don’t want my mum finding out. Is there a way around this? Sonia

Dear Sonia,

Girls under 16 can see their doctor in total confidence and go on the Pill if the doctor thinks they are mature enough to make up their own mind. The contraceptive pill (the Pill) contains two hormones that prevent pregnancy. The mini-Pill has only one hormone - progesterone - and comes in a lower dose.

The Pill works by preventing ovulation and is 99% effective if taken properly. The mini-Pill works by causing the mucus in your cervix to becoming thick and difficult for sperm to get through. It is 96% - 99% effective if taken properly.

Alternatives to the Pill include hormonal injections (Depo-Provera), which last for three months, or Implanon (a tiny rod about the size of a matchstick that is inserted into your arm) which lasts about three years.

You also need to think about protecting you and your partner against sexually transmitted infections, including HIV, which can only be done by properly using a condom. Using any of these methods as well as a condom will give you dual protection by making sure both you and your partner are protected against pregnancy and sexually transmitted infections. Condoms can be bought from chemists, supermarkets or vending machines in some toilets.

 

Top 3 Dear Doctor questions for Wednesday 11 November 2009:

Dear Doctor,

I’ve read about chlamydia and how you can get it from sex. I've had sex a couple of times with guys. How would I know if I’ve got it? Shane

Hi Shane,

Chlamydia is one of the most common sexually transmitted infections (STIs) in Australia, yet it is one of the most invisible as well.

A chlamydia infection may go unnoticed in both guys and girls for some time. But if you do experience symptoms these may include (for girls) discharge, pain in the lower abdomen, painful sexual intercourse, bleeding after intercourse, pain on passing urine and urinating more frequently. For guys, symptoms can include groin pain, swelling or burning when urinating and/or a white or cloudy discharge from the penis.

If you are sexually active and are at all worried that you might have been exposed, it’s best to get yourself checked out just in case. Your local family planning clinic or sexual health clinic will see you in total confidence, or you can visit your local doctor. A simple urine test will determine whether or not you are infected, and a short course of antibiotics will be prescribed to treat the condition. You should also confide in your partner and ask him to be tested and treated as well otherwise you risk becoming re-infected.

Unchecked and untreated chlamydia can lead to a number of problems, including infertility for guys and girls alike. So don't risk it - always practice safer sex and use a condom.

 

Dear Doctor,

I am a young gay female and in my first relationship. My partner tells me that sex between two women is safe sex, but I have heard that you can still get STIs. Is this true? Rachel

Dear Rachel,

It's a common misperception that sex between women is without risk. While women who sleep exclusively with women are typically at lower risk for sexually transmitted infections (STIs), including HIV, than their heterosexual and bisexual counterparts, some infections are still common. Because women who sleep with women are at risk for having infections such as HPV, genital herpes, hepatitis, and vaginitis, thinking about safer sex is still a good idea.

There are different ways for infections to travel between women. As with heterosexual and bisexual couples, if you and your partner are monogamous and have both been tested, these STIs may be less of a concern for you. However, when you don't know your partner's status, or aren't in a monogamous relationship, there are a few generally applicable safer sex strategies:

Visit a healthcare provider if you notice any symptoms or think you have been exposed to an STI. The sooner you get the all-clear, the better!

 

Dear Doctor,

I'm twenty years old and have had quite a few sexual partners. I have noticed between my vaginal area and my bottom, a group of sores. I haven't really been using protection the way I should and I am too scared to see my doctor. I think it might be genital warts. I was wondering if you could give me some idea of what it may be.     Georgie

Dear Georgie,

It sounds as though you noticed sores on your perineum — the area between the vulva and the anus. While you may have increased your risk of getting a sexually transmitted infection (STI) by not using protection consistently, it's important to take care of your sexual health by visiting a healthcare provider for proper diagnosis and treatment. I cannot diagnose you without actually physically assessing your symptoms.

As you probably know, there are several different STIs — genital warts and herpes are two types that can cause sores on or around the genitals. Since genital sores are diagnosed by visual examination, it is important to visit a provider when you have them.

    Seeing a doctor when you are concerned about your health can feel scary. This is not an uncommon feeling. Some people are afraid that their suspicions of being diagnosed with an STI will be confirmed. Others are embarrassed because they think that the doctor will pass judgment on them. Trust me, we’ve seen it all before!  It takes courage to see someone when you feel so vulnerable but you should make an appointment as soon as you notice symptoms or if you’ve put yourself at risk of getting an STI. The sooner you get diagnosed and treated, the better and you’ll be able to put your mind at ease.

Top 3 Dear Doctor questions for Tuesday 10 November 2009:

Dear Doctor,

My girlfriend's got a UTI and doesn't want to have sex with me while she's got it. Is it contagious? Dom

Hi Dom,

UTIs (Urinary Tract Infections) are rarely comfortable or fun, which is probably why your girlfriend does not want to have sex! And in fact, I usually recommend that women with a UTI avoid sexual intercourse until symptoms have been gone for at least 2 weeks. Having sex with a UTI may be painful for your partner due to pressure on her inflamed urethra or bladder. Only your partner will be able to tell when she is feeling well again, so communication is key. If she doesn't let you know herself, you may want to ask how she's feeling and if she is ready to have sex again.

Generally speaking, UTIs are not contagious so you couldn't catch the infection from your girlfriend if you were to have sex now. However, if her UTI was caused by a sexually transmitted infection (STI) such as Chlamydia or trichomoniasis, you would be at risk of those infections until she has been treated. Using safer sex practices (condoms, dams, other barriers) may help reduce the risk now and in the future.

 

I read through all the info on contraception and in particular the ‘pill’ but nowhere does it say how much it costs? Rose

Dear Rose,

Firstly, the pill is prescribed to you by your healthcare provider such as your GP or family planning/sexual health clinic. The cost of oral contraceptives depends on the brand and formulation. If you are a student and have a student concession/healthcare card, you may be able to get it at a slightly cheaper cost. Some family planning clinics may charge lower fees, and some services may even be free.

 

There is a lot of stuff on this website about chicks and not enough about the blokes. Isn’t checking your prostate all about sexual health and how do you go about doing this anyway? Emil

1. Stand in front of a mirror and look for any changes, especially swelling, in the appearance of your scrotum (the sac that holds the testes). It's useful to do this immediately after a shower or bath, when the heat of the water relaxes the scrotum.
2. Rotate each testicle between your fingers and thumbs (fingers on the underside the testicle and thumbs on the top).
3. Examine the rest of your scrotum's contents (especially the epididymis) for any changes, particularly hard, small lumps. The epididymis can feel like a cord or rope, and may seem like a lump at first, however it is a normal structure; become familiar with the feel of the epididymis so you can notice actual lumps if they appear.
4. Be on the lookout for hard lumps, masses, or nodules. Often cancerous lumps are painless, but pain can be a symptom of cancer as well as a number of other infections or conditions, so keep note of any discomfort.

 

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