Despite the unfortunate results of your first two pregnancies, there’s no reason your next one shouldn’t have a happier outcome. Yes, your doctor’s advice is correct – you should have a cervical cerclage (to tie a ligature around the mouth of the uterus) by the 15 or 16th week, after checking the fetus for any congenital abnormality. Initially, after the stitch is taken, you will have to be on a strict bed rest for at least 1 month. After that period you can go to the toilet and also have a quick bath. Then a repeat sonography should be done to check how the stitch is holding and depending on that, your activity level will be decided. Most women do well and have a 36- or 37-week pregnancy uneventfully.

I’m 28 years old and unmarried. There is white fungus in the skin folds of my penis, which I have to clean every day. I’ve become frustrated having to do this daily, because it increases if I don’t. What is the problem?
The white “fungus” that you refer to, is a normal secretion that accumulates under the foreskin, called smegma. If the foreskin is not retracted and the smegma not washed off during the bath every day, the secretion will accumulate and develop a stony consistency over a period of time. You need to wash off this smegma daily.

I am very keen to breastfeed my baby. I am eight months pregnant. Is there anything I can do to increase the quantity of breast milk once the baby is born?
Breast milk production starts as soon as the baby is born. You can start breastfeeding the child immediately after delivery; in fact it is very much encouraged. Breast milk contains all the nutrients a baby needs for healthy growth and development during the first six months of life, as well as substances that help protect a baby from many illnesses. Breastfeeding provides health benefits for the mother, including an early return to her pre-pregnancy weight. And there are emotional benefits for mother and baby from the special bond that develops between them. Take a breastfeeding class before you give birth. ASK your hospital for a referral. Some lactation consultants (experts in breastfeeding) will meet you before your baby is born. The quantity of milk depends very much on the mother’s diet. Food absorbed by a nursing mother not only 1 fulfills her own nutritional needs, which are greater during the postnatal period, but also enables her to produce milk. Include fenugreek, milk, spinach, rice, pulses and green vegetables in your diet.

I have severe vaginal itching. I usually wear synthetic undergarments. Do you think this could be causing the itch? And what do I do to relieve the itching?
Stop wearing synthetic undergarments. Keep your genital area clean and dry. Use plain, unscented soap and always wear cotton panties. Also, cleanse by wiping or washing from front to back (vagina to anus) after urinating or having a bowel movement. It is also helpful to avoid scratching, which will only aggravate the problem. Avoid overexertion, heat and excessive sweating. You can use a calamine lotion to ease the itching. If there is a rash, you need to see a dermatologist. Using a moisturizing cream regularly will help you.

I will be getting married soon, but when I was courting my fiancée, I found that she was not getting aroused. In spite of my best efforts, I was not able to arouse her and she was not affected by my touch. Is it normal?
It seems that you are entering into an arranged marriage. If this is so, then what you are facing is a common problem. You are probably going too fast. The sexuality of a woman is predominantly heart-centered. She needs to feel emotionally close to you for her to get aroused. I would advise you to go slow with your caressing as she maybe feeling shy and awkward. Instead, you could win her heart by romancing her. Instead of being hasty physically, try to understand her hesitation. This will make her feel emotionally close to you. When this happens, she will be more than willing to share intimacy with you. If, after implementing my advice, you still feel that things are not warming up between the two of you, then a counseling session with a good sex counselor would be in order. This would take care of any myths or misconceptions that she may be carrying about physical intimacy. Also give her an opportunity to come up with her queries, if any.

I am 24 and my wife is 19. We are married for one year. How can I change my wife who always finds excuses to evade physical intimacy on the pretext of being busy?
It is important to understand why she needs to evade physical intimacy. Is it because she has been left unsatisfied or has had painful experiences of the sexual act with you? Is it because of fear of pregnancy? Is it because she disapproves of the kind of sexual behavior you demand? Is it because she considers the sexual act sinful or dirty? Is it because she has been a victim of sexual abuse? Is it because she has unresolved emotional issues with you and so cannot give in to intimacy without resolving them? Is she unwell? Is she overworked and too busy with the home and children? Is she involved with someone else? Does she have lesbian tendencies? All this needs to be explored with your wife. I suggest that both of you approach a relationship counselor to get to the bottom of the matter.

What exactly are ovulation kits? I have read that there is a choice between urine ovulation kits and saliva ovulation predictor tests. Which one is better? Or should I just give up on these kits and start charting Basal Body Temperature (BBT) and conduct cervical mucus examination? I know that ultrasonography (USG) is the best way to determine ovulation, but one cannot do it month-to-month. Can you throw more light on the ovulation kits available in the market?
You have already stated that the USG is the best way to determine ovulation; but you do not like the idea of doing it every month. But believe me; you have to go for a USG only 4 -5 times in a month. Ovulation kits available in the market are very expensive and not always accurate. Out of the kits described, the urine ovulation predictor kit is the best, which detects the LH surge. Usually, after 24 – 36 hours of the LH surge, an egg is released from the ovary and there is a high chance of pregnancy during this period. Basal Body Temperature (BBT) is the temperature of your body at rest. To take your BBT, you need a digital thermometer. Taking your temperature first thing in the morning, before you get out of bed, eat, drink or go to the bathroom will give you the most accurate temperature. Use a notebook or a BBT chart to record your temperature. During the first part of your menstrual cycle, the BBT will be lower. Right before ovulation, you will have a slight drop in temperature followed by a sharp rise in temperature. Also, for pregnancy to occur, the mucus should be slippery and copious.

I am 66 years old and the report on a recent X-ray of my chest says that ‘the aorta is unfolded’. Could you please explain in a good old-fashioned way what takes place with this complaint, and are there any exercises that could help?
There is absolutely no reason for you to be concerned about this problem, and there is no need to undertake any specific exercises, as I will explain.
The aorta is the main artery of the body and is about 2 cm across. It starts from the top of the heart, bends (or folds) over, and then runs down the back of the chest and belly along the inside of the backbone. It looks like an upside down ‘J’. Just below your umbilicus (tummy button) it splits into two slightly smaller arteries that continue through the pelvis and down each leg.
In an X-ray of the chest, the heart and aorta can be seen quite clearly. As you age, the bend in the aorta as it curls around from the top of the heart to run down the back of the chest becomes a less sharp bend. The aorta does not fold over on itself as much as it did before, and so in medical jargon, the aorta is said to be ‘unfolded’.
In your case it is a sign that you are no longer 21, and nothing more. In some people the aorta is unfolded and dilated by an aneurysm, which is quite a serious condition, but this can usually be seen on the X-ray and there is no sign that this was the case with you.

I’ve had two ectopic pregnancies leaving me with two ’stumps’ for Fallopian tubes. What is the danger of having another one?
‘Ectopic’ means ‘in the wrong position’, so an ectopic pregnancy is one in which the baby is developing in the wrong position.
The Fallopian tubes run from each ovary to the womb (uterus) and transport the egg from the ovary to the womb, where it can be fertilised by a sperm and grow into a baby. If the baby starts growing in the Fallopian tube instead of the uterus, then you have an ectopic pregnancy. As the baby grows, the tube eventually bursts, causing an internal haemorrhage in the mother, and the almost inevitable death of the baby. An operation is then performed to remove the damaged Fallopian tube and the remains of the pregnancy. This operation leaves you with a ’stump’ of Fallopian tube.
To have two ectopic pregnancies is extraordinarily unlucky. Your chance of having a pregnancy of any sort is not good, probably 1:1000, but if you do beat these very long odds and become pregnant, it is possible for you to have a normal pregnancy, although an ectopic pregnancy in some other abnormal position cannot be ruled out.

I will be having my baby by Caesarean section, and the obstetrician said he would arrange for a spinal anesthetic. What is a spinal anesthetic? Why do doctors use them?
The spinal cord inside the vertebrae of your back carries all the nerve impulses to and from the lower part of your body.
If a needle is inserted between two vertebrae in the back and an anesthetic agent injected, the nerves below that level will cease to transmit the pain sensations from the legs, pelvis and abdomen to the brain. The nerves that control your muscles and their movement are not affected. This is a spinal anesthetic. Doctors use this type of anesthesia in a difficult childbirth and Caesarean section because it has no effect on the baby. They are also used in elderly and debilitated people who may be at risk with a general anesthetic.
A tube is left in your back during the operation, so that the anaesthetic can be topped up as required, and you have to lie flat in bed for a day or two afterwards. A severe headache is the most common complication.

I am eight months pregnant, but I am worried that my beautiful breasts will be ruined if I feed my baby. Why is breast feeding better than bottle?
‘BREAST FEEDING IS BEST’. This admonition features prominently on cans of infant formula and on advertising for breast milk substitutes in many third world countries, and there is little doubt that it is true. The advantages of breast feeding include the obvious convenience of avoiding the need to sterilise bottles and prepare formulas, but more significant is the advantages it gives the child in protecting it from some childhood infections, and stimulating the mother’s uterus to contract to its pre-pregnant size more rapidly. Being a cost-free food, it can also help the strained budget of a young couple.
Breast feeding does not necessarily mean that your breasts will become saggy or alter adversely. You will have to decide upon the relative benefits to your baby and yourself.