“Dear Dr. Shieh...”

How many times you need to have sex to have a baby and does anal sex transfer HIV?

Mon, 2 Nov 2009 12:01:25 -0800

Dear Dr. Shieh,
How many times do you need to have sex to have a baby? If you have anal sex, will you get HIV?
-Freshman
Dear Freshmen,
You just have to have sex once to get pregnant. So many teens think that having sexual intercourse once or twice or three times will be fine and that it won't happen to them. Wrong.
As a teen, your timing of ovulation can be irregular, what that means is that your follicle containing an egg can be released at odd times during your menstrual cycle. So if you had sex even just once and it was during the time of your ovulation, you could get pregnant even if it was your first time.
This same question can also be asked with regard to any of the sexually transmitted diseases from human papilloma virus (HPV) to the HIV virus. All it takes is once to catch these viruses that will stay with you for the rest of your life
Yes, you can catch HIV from anal intercourse. In fact, anal intercourse is considered a high-risk sexual behavior that can affect both sexes. Engaging in anal intercourse can increase the possibility of developing fissures, abrasions or cuts from the trauma. These breaks in the mucosa can allow the HIV virus to gain access directly into your body easier. The same can be said of open cuts or sores on the penis.
The transfer of the HIV virus can occur between both partners. If the non-infected partner puts his penis in the HIV infected partner, he can catch the virus through the opening of his penis called the urethra.
If you choose to have oral, vaginal or anal sex, you should use a latex condom to decrease your risk. However, you should be aware that condoms tend to break easier during anal intercourse because of the lack of elasticity of the anal canal. This is one of the reasons that anal sex is considered a risky behavior.

Do I need to take meds for a bladder infection even if I have no symptoms?

Mon, 24 Aug 2009 11:20:47 -0700

Dear Dr. Shieh,
I am 7 months pregnant. Last month I was treated with antibiotics for a bladder infection. My symptoms are gone now, but after my most recent urine sample my doctor said I still have an infection. He wants me to take the pills for seven days now, instead of my previous one day. I don't feel any pain or have any symptoms now; do I really need to take these antibiotics?
Thank you,
Ann
Dear Ann,
Bladder infections are quite common in women and especially during pregnancy. The treatment varies with patients and how they present and their prior medical history.
There have been attempts to make it easier for patients to take pills just for one day, but it may not be as effective. For those patients who are not good at, or are forgetful in taking their medications, the benefits of taking a one-day treatment can be justified.
However, in general, I prefer the traditional seven-day treatment, especially in pregnant women. A new study just released by the American College of Obstetricians and Gynecologists noted in a randomized controlled trial concluded that a one-day regimen was significantly less effective than a seven-day regimen with a specific type of drug called nitrofurantion, which is the most common medication used to treat pregnant moms who have tested positively for bacteria in their urine, but show no symptoms.
Sometimes, with persistent urinary-tract infections, patients may require daily doses of antibiotics. It is important to be treated for a bladder infection, even a subclinical infection with only bacteria in the urine, because it can progress to a kidney infection, which may land you in the hospital, and that's a place you don't want to be.

Does birth control pills cause severe migraine headaches?

Sun, 19 Jul 2009 18:03:01 -0700

Dear Dr. Shieh,
I am only 40 years old and still taking birth control pills. I was wondering if birth control had anything to do with my severe migraine headaches? When it comes, it just knocks me out all day. I don’t want to get pregnant, so I do need the pills.
Sincerely,
Amy
Dear Amy,
Women get migraine headaches more than men, and about 15% of all women from early teens to the elderly experience migraines chronically.
The classic symptoms of migraines can last from hours to even days. The pain is severe, and usually on one side only with associated nausea, vomiting, and or loss of vision. Some patients will have no visual symptoms, but just a really bad headache that does not go away or take a very long time to go away if treatment is not instituted.
In general, estrogen-based birth control pills have an effect on migraines in certain women.
Now, whether the birth control pills serve as a cause/trigger for migraines is controversial. There are women who do not take any pills and they still experience migraines. With that said, I do think that if you are experiencing severe migraines often, I would suggest stopping the pills. Take a rest period and see if your migraines subside.
You should know that women with chronic migraines are at higher risk of strokes compared to those without. Within this population of women with a strong history of migraines, adding estrogen pills adds to their risk of a stroke. Thus, I usually recommend them getting off of these pills, or switching to pills that don't contain estrogen.
I know you do not want to get pregnant, and I would suggest you talk to your doctor about contraceptive pills without estrogen, other methods and if desired, permanent surgical options as well.

Did my cheating husband infect me with HPV?

Mon, 13 Jul 2009 01:17:53 -0700

Dear Dr. Shieh,
I recently had an abnormal pap smear and later my doctor said that I have HPV. I discovered that my husband had been unfaithful after he admitted to sleeping with several women in the Philippines during a “business” trip. He was surprised by all of this since he said he had used condoms and that he didn’t think anything would happen to me. In fact, he is insisting that I “fooled around” since he couldn’t have given me anything. I have always been faithful to my husband. My question is, can I get HPV even if my husband used a condom?
Signed,
Pretty Pi**ed Off

Dear Pretty Pi**ed Off,
I can understand why you are upset.
Your husband needs to know that wearing a condom does not prevent him from catching the Human Papilloma Virus (HPV). If you indeed have always been faithful to your husband, then the source of your HPV infection is from him.
HPV is now the most prevalent sexually transmitted virus in women and men.
There are many types of HPV, some cause genital warts, and some cause cancer. Particularly in women, HPV is the top cause in majority of cervical cancer cases. Usually HPV are not picked up until an abnormal pap smear is discovered and follow up studies reveals a positive result.
You should talk to your doctor about what types of HPV you tested positive for. If you got the high-risk types, then you’ll need closer surveillance to prevent cervical cancer from developing. Your husband should also know that HPV cause cancer in men as well.
Additionally, you should also have your doctor consider testing you for other sexually transmitted diseases, to ensure that you did not catch something else.
Since your husband has admitted that he was unfaithful during his trip, he is probably nervous about this whole situation, and feel that he not only betrayed you but also may have caused you to catch something that can affect you for the rest of your life.
You and your husband need a good heart-to-heart talk and I hope all will work out for the best for both of you.

Are pregnant women more prone to bladder infections? What are the causes?

Mon, 22 Jun 2009 03:46:38 -0700

Dear Dr. Shieh,
When I pee, I experience this burning sensation, which may mean that I have another bladder infection. When I was not pregnant I usually don't get them and now that I am, it seems like I would have at least three infections through the entire term of my pregnancy. Are pregnant women more prone to bladder infections? What are the causes?
Thank You!
Evelyn

Dear Evelyn,
Bladder infections or Urinary Tract Infections (UTI) are more common in women than in men and more common in pregnant women.
Women get UTIs more than men do because of simple anatomy: A women's urethra is shorter and more prone to contamination of bacteria from the vagina and lower bowel, and usually these bacteria are more prone to enter the bladder during intercourse.
The reason pregnant woman are more likely to get these infections than non-pregnant women is because the hormones in pregnancy affect the bladder and urethra which places them at a higher risk.
Added pressure
Additionally, as the uterus (womb) grows with the baby, it pushes on the bladder and makes it difficult to completely empty the urine from the bladder. Also, especially during her last trimester, a woman may have a difficult time wiping after using the restroom without contamination.
Some studies reveal up to 10% pregnant women get bladder infections without having any symptoms. Associated symptoms are usually pain during urination, the constant urge to urinate, or vague aching cramping pain over the lower abdominal area. Usually about 3% will show these signs and get treatment. Some of these infections will resolve by themselves with lots of hydration, but if untreated can lead to a bad kidney infection.
Mostly E. Coli
Approximately 75-85% of all UTIs are caused by bacteria called E. Coli, and can be easily treated with antibiotics. Usually, if the initial antibiotics fails, the doctor will look at the urine culture to see if there are other antibiotics more fitted to treat the specific bacteria. Patients who constantly get recurrent infections may benefit from daily antibiotic therapy.
It is important to treat urinary tract infections early. If symptoms persist after antibiotic treatment, especially pain after urinating, I usually will rule out the possibility of a sexually transmitted disease such as chlamydia which can have similar symptoms to a urinary tract infection.

What should I do if my Pap smear result indicates that I may have cancer?

Sun, 24 May 2009 23:40:42 -0700

Dear Dr. Shieh,
I am very worried about my Pap smear result. My doctor said that I may have cancer and wants me to get another pap smear in a few months. I do my pap smears every year and never had one that was bad. I am really worried about this, what should I do? I am 52 years old only.
- Julie

Dear Julie,
The fact that your doctor is telling you that you should repeat your Pap smear in a few months tells me that you probably do not have any cancer on your cervix.
If your pap smear revealed precancerous changes, your doctor would have recommended another procedure called "Colposcopy," which is an in-office procedure that involves using a high powered microscope to inspect your cervix, and biopsy taken to rule out any cancer.
This procedure is quick, but it can be painful at times and slight bleeding due to the biopsy itself. But it is well worth it, because you actually get a tissue diagnosis. Pap smears are good, but it only scrapes the surface of your cervix and remains one of the best cervical cancer screening tools.
I would not worry about this, just listen to your doctor and repeat the Pap smear, and when in doubt, he or she will schedule the colposcopy.
Lastly, women in their 50s are actually taking better care of themselves compared to many years before, so I am glad you are getting your pap smears done and hopefully you will also be getting your mammogram, colonoscopy and consider a bone density scan to ensure that you are not approaching osteoporosis.
Exercise, good dietary habits and calcium supplements are good ways to maintain your bone structure and cardiovascular health.

What different forms of birth control are there?

Sun, 10 May 2009 23:09:01 -0700

Dear Dr. Shieh,

I don’t want to get pregnant right now and I am not good in taking birth control pills. I do not want the depo shot either. I heard of the IUD? Are there other forms of birth control?

C

Dear C:

Birth control pills are used more often now for other gynecological issues than just strictly for “birth control.” Since you have noticed that you are not a good pill taker, let’s talk about other options.

As you have mentioned, the IUD or intrauterine device is an option, but is not fitted for everyone, there are certain risks that comes with it, such as infections, and the possibility of lost or retraction of the string that goes at the end of the IUD. However, with all things said, some women do feel comfortable with the device.

There are other forms of contraception that goes inside the vagina. Some examples are the Nuva Ring, the sponge, and cervical cap.

Another device called the Implanon. Several years ago, there was the implant called “norplant,” which is a six capsule implant that goes under the skin of your arm. Now with the implanon, it is just one capsule and is easily placed. There are risks involved as well such as irregular menses, and slight discomfort during insertion and removal. Implanon provides you up to three years of birth control protection.

Finally, you can always resort to condoms. This will allow you to be protected against sexually transmitted diseases; however, certain ones such as human papillomavirus even condoms cannot protect you. Also remember that no contraceptive is 100% proof, so use your best judgment and talk to your ob-gyn about your best option of contraception that best suits your medical history.

How can I protect my unborn baby from the swine flu? Can I get a flu vaccine?

Sun, 3 May 2009 23:06:21 -0700

Dear Dr. Shieh,

I am pregnant and will be traveling to California next week, but because of this swine flu outbreak should I just cancel my trip and stay home? If I decide to go, how can I protect my unborn baby? My doctor recommended that I get the regular flu vaccine, is that okay?

Sorry about these questions, but just wanted a second opinion.

Mel

Dear Mel,

As of this past weekend, the Centers for Disease Control and Prevention (CDC) currently have not recommended that people avoid domestic travel. However, prior to your travel off island, I would check the CDC website to see if there are any updates on travel restrictions.

Pregnant women are at higher risk of contracting the flu, and CDC reports that pregnant women in previous pandemics had a higher death rate and increased risk in bad pregnancy outcomes.

I would agree with your doctor in getting the currently available influenza vaccine. This is not to say that it will prevent you from contracting the Swine (H1N1) flu, but at least you’ll be protected from the seasonal flu.

Current controversy exist regarding whether the H1N1 is a variant strain of the seasonal influenza virus, and differing experts give mixed opinions on whether the seasonal flu vaccine would offer some protection or not. Regardless, the best way to decrease your risk is to follow good hygiene with frequent hand washing, avoiding people who appear to be ill, coughing, and sneezing.

To protect your unborn baby, the best way is for you to stay healthy. If mom is healthy, the baby should be fine.

I cannot tell you whether you should cancel your trip or not, because you need to know your priorities. California is a state on alert because of the Mexican border, but they currently do not have the highest cases. Instead, places like New York have higher confirmed cases. This tells us that the influenza virus can affect anyone and have no borders. The statistics of H1N1 flu cases are increasing everyday, so I would keep a vigilant watch on any new developments of this flu virus prior to your planned travel.