Ask the Doc
Below are answers to many health care concerns. These answers are provided by local Medical Doctors. If you would like to submit a question click on the following link: firstname.lastname@example.org
Robert L. Brandt, Jr., MD AAHIVS graduated with a BS degree Magna Cum Laude from Wright State University in 1975, and MS in 1976. Dr. Brandt graduated in the first class of the WSU School of Medicine in 1980 and was licensed and certified to practice Family Medicine in the State of Ohio in 1983. In 1987 he was certified as a specialist in Addiction Medicine. Over the years since 1983, Dr. Brandt has become a lecturer, educator, advisor, and also certified as an HIV/AIDS medical specialist. He was co-founder of the Dayton Area Aids Task Force in 1983 and is currently a trustee of ARC, Ohio (formerly, AIDS Foundation Miami Valley). He has been an advisor for the Ohio Department of Healthís Ryan White Program since 1983. Currently, Dr. Brandt serves as a member of the local Ryan White Consortium #4 and is an advisor for POZ4POZ, a client based, consumer self help organization. Feel free to contact him through "Ask the Doctors" at this website.
Dr. Barry S. McCorkle, M.D.
of Belmont Physicians Internal Medicine is
a graduate of Wright State University. Doctor McCorkle specializes in Internal
Medicine with the specialty of Adults. His office is located at 2451 Wayne
Avenue, Dayton, Ohio 937-208-7374
Hi, Doctor. Iīm from Argentina; in my worry to find an answer to my problem I found your page in Google.
I had sex three days ago and I was penetrated. At that time I ejaculated normally, but the next ejaculation was red. This is the first time it happens, and one of the rare occasions in which I am penetrated.
I donīt have aches of any kind, either when I ejaculate, my urine is perfectly normal, as well as my depositions... I still have blood in semen, three days after. I suppose my seminal vesicles have been damaged, given the fact that my urine is unaltered...
How long could it take for my body to fix the wound? I am going to see a doctor, but Iīm very worried for the time that has passed without getting better (I had not sex again and I check my semen visually by masturbation).
Thank you very much.
Dear Doctor Bob, I believe I may have been exposed to HIV. How can I get tested? If I am positive, without insurance, where do I go from there? Are there programs out there to help me? Signed: Scared in Dayton
Dear Scared in Dayton;
Believe me, if you are a gay or bisexual man living in Dayton and having sex... you are being exposed to HIV infection whether you know it or not. While a law exists that impels a person to reveal their HIV+ status before having sex with you, that guarantees nothing. One rule you can count on... If someone (not a spouse/sig other that you know well) allows you to have unprotected anal sex with them, you should consider them positive... whether they want you to be top or bottom. There is a risk to oral sex too, though smaller... I canít give you reliable stats on that.
It truly amazes me that there are many gay guys out there that do not know their status... even if they feel fine... EVERYONE should get tested at least once in their lives and more often depending on their risk behavior.
So, you think you may have been exposed... recent or past? You have many ways to get tested. Any primary care doctor that you see can do the test for you. It is a simple blood test. There will be the office fee and the lab fee and it could all cost $50-100 if you donít have insurance. You can buy a home test kit at the drug store for $50-60... it is totally anonymous and reliable. Best bet is to go to your local Health Dept./ STD clinic for free (or cheap)
The main reason being that they are required to give pre and post test counseling and can answer all your questions. The testing. drawback is you can wait up to 2-3 weeks to get your test results. Statistics show that up to 1/3 of the people testing at clinics this way fail to return and get their results.
If you are negative.... great.... BUT... play safe and get tested one more time about 2-3 months later. If negative a second time... you are truly safe unless you have had unprotected sex in between.
If positive... there are many resources for treatment. Consult your primary care doc for an appropriate referral, or contact AIDS Resource Center, Ohio (461-2437), or call the Health Dept. (if you test thru them and are positive they will give you referrals), or call my office at 208-7070. I am a Family Practice doctor who sees patients regardless of their HIV status.... but I do subspecialize in HIV/AIDS care and currently have close to 450 HIV patients. I also have a full time counselor who acts as a social worker in my office who can help you navigate the system to get the help you need. There is a lot of support out there depending on your individual circumstances.
Best wishes and donít be scared about getting tested.. go do it!!
Dear Doctor Barry, I am a 27 year old guy who enjoys a healthy sex life, with frequent masturbation and 3 regular sexual partners. On several occasions I thought that I saw some blood in my semen but wasnít for sure. Then the other night as I was taking off a condom, I saw lots of red in it. I know itís blood. Iím scared and not sure what to do. I was screened for HIV and STDs at the county health department last month and was OK. Iím afraid I have cancer. I donít know a doctor. What should I do?
Signed, Scared Iím a Cancer Kid in Oakwood
What you describe is called hematospermia, or blood in the semen. It is a symptom that provokes great anxiety in patients due to fears of malignancy or sexually transmitted diseases. From what you describe, however, I donít see any reason for alarm.
One could think of blood in the semen in almost the same way one would think of blood in nasal mucus when one has a bad cold or sinus infection. It may be a sign of problems, but itís nothing to panic about. Most often it is caused by inflammation or irritation.
Semen originates from multiple organs, including the testicles, epididymis, vas deferens, seminal vesicles, and prostate. Most of the semen comes from the seminal vesicles and prostate and it is probably from these two organs that most hematospermia cases originate.
Patients with hematospermia report brownish to red discoloration mixed in the ejaculate. More than 90% of patients have no prior genitor-urinary symptoms or significant factors in their history. The ages range from 14 to 75, with an average age in the late 30ís, but it is most common in men between the ages of 30 and 40. About 90% of men who have had hematospermia will have repeated episodes.
In over 50% of patients the cause of hematospermia is not clearly understood or never known. In other cases, it results from nonspecific inflammation of the urethra, prostate and/or seminal vesicles. Infections, including STDs make up the remainder. Cancers are rarely the cause and are usually seen in older men.
I advise you to find a primary care doctor by asking your friends or colleagues who they recommend. A general check up with an exam of your testicles, prostate and urine is needed and perhaps blood work. You should also be screened for STDs again. If all of this turns out OK, no further work up is needed.
Dear Doctor Barry,
When I was 5 yrs old I got 4th degree burn on my shoulder from an iron that fell on me while playing. It became a large Keloid scar. When I was 13 the doctor tried to surgically remove the Keloid but it just came back. With the advances in lasers, is there a chance this could be removed by laser without it coming back? Or am I just doomed to never take my shirt off?
Matt in Sidney
Keloids are heavy thick scars that form after any kind of skin injury. They have two main predisposing factors. The first is the location of the scar and the second is the genetic background of the patient.
Keloid scars are more likely to develop in the earlobe, along the border of the jaw, the shoulder and the skin over the breast bone. They often appear after ear piercing. They are more common in the upper part of the body and are rare in the eyelids, soles of the feet, palms of the hand and genitals. They are uncommon in people with fair skin. In some social groups keloids are deliberately produced as a form of ornamentation of the skin.
Even though there is a genetic tendency for these to form the exact pattern is not known. They are more common in patients with dark skin. Women are more likely to develop them, as are young people under the age of about thirty.
Keloids are more likely to form when the wound is closed under tension (stitches), or where there is an infection or hematoma (blood collection) after surgery. If a foreign body is present in the woundóas may occur after an accidentókeloids also seem to be more likely.
The treatment of keloids is complex and is not always successful, as you have already found out. The main point to remember is that since a keloid forms when skin is cut, revising the scar by cutting the keloid out can result in a new one forming as that area heals.
During revision the doctor cuts out the scar and tries to repair it in such a way as to make an improvement in its appearance. He can use techniques like cortisone injection, radiation treatment, and silicone treatments to help minimize the reappearance of the keloid. Recently, lasers have been used in revision, but the results can be equally as tricky.
But given that, I would still recommend you to consult with a plastic surgeon who can advise you of your options. If you are a true keloid former there is no good treatment. It is fair to think of revision using the 99 rule: that is, you have 90% chance of improvement, 9% chance the scar will be about the same, but a 1% chance it will be worse.
Dear Dr. Bob...... I have a problem every time I shave my nuts or the area in my pubes, I come up with itchy red bumps.... what can I do about that?
Dear Smoothie... Well, shaving is a popular thing still..... either the whole area or just the scrotum.... styles differ with what you are trying to achieve.!!!
If you send me a pic, I can make a style fashion statement about it.. LOL.... On the serious side...... unfortunately, if you do not shave on a regular basis... more than 2-3 times per week....just about everyone comes up with those itchy red bumps that are a consequence of both mechanical irritation and skin bacteria that now have a new place to grow.... the shaven hair follicles. The easiest thing to do is to get an over the counter antibiotic cream like bacitracin... and mix that wih a mild hydrocortisone cream also over the counter... Then apply to the area once or twice daily immediately after shaving . Youíll find that you can prevent the bumps entirely. Then make sure you use a clean razor everytime you shave... I should make clear that these itchy red spots.. should be flat and not raised bumps.... which would suggest a different problem such as molluscom contagiousum or human papilloma warts.. Both of these are viral warts that will be spread by shaving and should be treated medically by your doctor. So, make sure you know the difference.
Let me know how things go... and, oh yeah, ... If you do send me a pic, if you have any red spots on your shaft... pics of both the flaccid and erect state would be best... obviously the skin on an erect penis can be examined more easily. :-) Hmmmm, ;-), I could make a house call..??? LOL
Remember... Play, but Play Safely!!
Dear Doctor Barry,
You always seem to write a lot about guy sex, how about some advice for the ladies? We need an introduction to girl-girl sex 101!
Yes, you are right. So letís cover the basics of lesbian sex for all our readers. And guys, you should read this too!
Lesbian oral-vaginal sex is otherwise known as cunnilingus, going down on her. For some lesbian and bisexual women, oral sex could also include going down on a female loverís prosthetic device. A number of books have been written about lesbian sex and oral sex. The most recent and most comprehensive "how-to" guide is "The Whole Lesbian Sex Book: A Passionate Guide for All of Us," by Felice Newman, which will undoubtedly answer any technique questions you may have.
Vaginal-oral sex may involve sucking or licking on and around the clitoris, as well as inside and around the vagina. Remember that every woman enjoys oral sex differently. Because the clitoris is so sensitive, some women donít like being stimulated directly on the "head" of their clitoris. Experiment with different pressures and techniques with your partner, and donít be afraid to ask what they do and do not like. Try different rhythmic motions and use both your tongue and your lips.
Also, keep in mind that while some women find it easy and pleasurable to come from oral sex, others enjoy it more as foreplay and prefer to orgasm from hands, humping, penetration or other techniques.
Some women may shy away from having their lover go down on them because they fear they may smell unpleasant or taste bad. If this is you, think about taking a bath or shower prior to having sex (your partner might want to join you in the bath or shower, too!). In some instances, a woman may not feel comfortable having her lover go down on her when she has her period. But other women enjoy this, and especially enjoy sex partners who like the taste of menstrual blood (this, however, is something that should be enjoyed only with partners who are HIV-negative and do not have Hepatitis). Remember: all woman smell different at different points of the month and the varying flavors can be part of the fun!
Other card-carrying members of the lesbian and bisexual community donít like giving or receiving oral sex at all. Donít assume a woman you are about to have sex with likes oral sex just because sheís a lesbian or bisexual. Ask.
Now, letís talk a little bit about sexually transmitted diseases (STDs). Although there is little published research on STDs between women, there are documented cases of woman-to-woman transmission of some STDs. And there is every reason to believe that this transmission may have occurred during oral-vaginal or oral-anal sex. These STDs include herpes, hepatitis, HIV, and gonorrhea.
When a woman has an open herpes blister on or near her lips, she can transmit genital herpes to another womanís mouth if she kisses her and to her genitals if she goes down on her. Although herpes can be transmitted even when no sore is present, it is extremely contagious when a woman has an open lesion. Also, if a woman has an open sore, touches that sore with her fingers, and then touches her loverís genitals, she can transmit the virus via her fingertips. Because one in five people have genital herpes, it is likely that you may come into contact with a woman who does.
If you or your girlfriend have herpes, you can still kiss on the lips and enjoy oral sex-you just have to be aware of when you do so. The herpes sores only appear occasionally, and medication is available to help reduce the length of the outbreak. It is when the sores are visible that oral sex should be avoided completely, because this is when herpes is most transmissible. Even when the sores arenít present, though, herpes can still be transmitted. So any woman who has herpes or has a female sex partner who does should always use dental dams or other barrier methods during oral sex.
Hepatitis A and B can also be transmitted during oral-vaginal and oral-anal sex. Hepatitis A can be transmitted during oral-anal sex while Hepatitis B can be transmitted through the exchange of blood or body fluids during oral-vaginal or oral-anal sex. There are documented cases of both Hepatitis A and B transmission between women, so if you enjoy oral sex, and rimming in particular, you may want to consider talking to your health care provider about the vaccinations available for both Hepatitis A and B.
There are a handful of documented cases of HIV transmission between women, but because there is little research in this area and because of how HIV and AIDS statistics are kept, the exact number of female-to-female HIV transmission cases isnít known. The known cases, however, most likely occurred through the transmission of the virus via menstrual blood or other blood play. Even though little research has been done on HIV transmission between women, all lesbian and bisexual women who have sex with a woman who is HIV-positive or who are HIV-positive themselves should use barriers during oral sex.
Although no research has yet been done, there is reason to believe that gonorrhea could be transmitted from a womanís vagina or anus to her partnerís throat during oral sex. Thus, if gonorrhea is present, dental dams or other barrier methods should definitely be used during oral sex.
All women who have sex with women should learn how to reduce their chances of contracting or spreading an STD. These techniques include placing a dental dam, plastic wrap (although, it has not been tested for effectiveness in preventing HIV and other STDs), or a condom cut in half between your mouth and her vagina or anus; starting with a new piece of plastic wrap or dental dam when you switch from the vagina to the anus; and getting vaccinated for Hepatitis A and B.
Dear Dr. Bob.....
A buddy of mine wants me to try poppers when we have sex. I know some about what they do for you, but what I want to know is does this show up in a urine drug screen. I get these at work a lot because of my security position. What is your take on that sir???
signed, a Recruit.
Well... dear RECRUIT SIR ! yourself.... !!
Excellent question.... you should have no worries about a urine drug screen (UDS). Amyl or Butyl Nitrates.... the drug in poppers.... is actually a derivative of nitroglycerine.... a vasodilator used by physicians to open up blood vessels to get oxygen to the heart whenever a heart patient is having heart related chest pain (angina).
As this is not a mood altering or particularly addictive drug, it is not routinely screened in a UDS.
However, though you did not ask this, long term and chronic use can, in my opinion do harm. This is a vasodilator drug. It acts by opening up blood vessels of both arteries and veins. It has a fairly short half life and the warm feelings and headaches as side affects and the direct affect of lowering your blood pressure donít cause immediate problems. However, if you consistently use a drug that lowers your blood pressure "set point", then your body becomes accustomed to it. Chronic use can lead to rebound hypertension... which means that after your blood vessels have been dilated so long, they snap back and become narrow again (raising your blood pressure). This back and forth reaction is not good for you in the long run.
I am not talking about weekend, recreational use... I am talking, regular use of more than 4-5 times per week...and of course the amount or length of time you use them (poppers) would make a difference. I would also expect that you should know that poppers should NEVER be mixed with viagra. Viagra also dilates your blood vessels and lowers blood pressure. You could lower your blood pressure to deadly levels when mixing both and risk a heart attack or lack of oxygen to your brain and suffer a stroke. Iíll talk more on viagra in the future. Look for a future column.
Take care.... best wishes.