The Goods

Embarrassing health questions answered by a doctor

From hemorrhoids to body odour, Dr. Melissa Lem is helping answer some of your medical questions that you might be too embarrassed to ask your doctor.
B.C.'s Office of the Information and Privacy Commissioner audited 22 medical clinics and found a lack of patient privacy protection. (Getty Images)

From haemorrhoids to body odour, certain health issues can go untreated for far too long because we're too mortified to seek help. But, have no fear! Dr. Melissa Lem is here to answer some embarrassing medical questions from viewers who may be too embarrassed to ask their doctors.

1. "My butt is constantly itching. I know it's not because I'm not wiping thoroughly.  What else could be causing this, and how do I make it stop?"

Dr. Lem says: First of all, know you're not alone. Almost 50% of people experience this condition, known as "pruritis ani," at some point in their lives. Many causes exist, but the most common ones are irritation from leftover stool after wiping and certain foods in your diet, but that doesn't sound like it's the case here. It could be something you're eating. Spicy and acidic foods, coffee and alcohol are all known to bother your bum. Note that over-cleaning can also be problematic, so at the end of a bathroom visit rinse the area with plain water and pat gently with toilet paper to dry off.

2. "I'm a 34-year-old woman, and I don't think I've ever had an orgasm. How do I know for sure?"

Dr. Lem says: When it comes to orgasms, we are all like snowflakes — no two people are alike, so it's not always the earth-shattering experience pop culture would have us believe. An orgasm typically releases the muscular tension that builds up in your pelvic organs during sexual activity through a series of 3 to 15 rhythmic contractions. This may be accompanied by breathing changes, flushing, sweating, trembling or the urge to cry out. If you've experienced this, you've likely had one. A lot of emphasis is placed on reaching the finish line, but just try to enjoy the process and you might find it easier to get there.

3. "My snoring is getting out of control to the point my wife is now sleeping in the guest bedroom. I'm worried this will affect our relationship.  Is there anything I can do?"

Dr. Lem says: Many snoring treatments exist, from special pillows to throat surgery, but one easy home remedy you can try is the "tennis ball technique". When you lie on your back, gravity collapses your throat and neck tissues together, which often increases air turbulence and snore volume. To train yourself to become a side sleeper, put a tennis ball in a sock, safety pin it to the back of a t-shirt, then wear it to bed. The tennis ball is just uncomfortable enough to get you to roll back onto your side if you land on your back. Keep in mind that this this may not be a long-term solution, because some patients report back pain if they use it for too long. Be sure to see your doctor to rule out any snoring-related health problems.

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4. "I recently noticed more hair than normal around my nipple area.  Is this normal for a 40-year-old woman, and is it safe to remove it?"

Dr. Lem says: This can be quite normal, as about ⅓ of women naturally have some form of nipple hair. Assuming you have just a few sparse hairs without other signs of increased androgens or "male hormones" like acne or increased hair growth elsewhere, it's probably just due to the natural hormonal changes that occur as we age. In terms of hair removal, remember that the surrounding skin can be sensitive, so avoid depilatory creams and opt for physical methods like shaving, waxing or plucking instead.

5."I've been dating a new guy for a few months and the sex is great, but I've been getting a lot more yeast infections lately. Is there anything I can do to prevent them?"

Dr. Lem says: Unfortunately, having a new partner is a known risk for yeast infections, possibly because you're being exposed to new fungal strains. Research also shows that receiving oral sex can triple your risk of recurrent infections. To prevent them, avoid exposure to anything that might disrupt your natural balance, like spermicides, or cleaning with anything other than water and mild, unscented soap. Keep the area cool, airy and yeast-unfriendly by wearing loose, breathable clothing. One home remedy you could try is applying a tablespoon of natural, unflavoured yogurt internally and externally to boost local levels of good bacteria and fight off yeast.

6. "I'm constantly painting my toenails to hide how disgusting they actually are - my actual toenails are yellow, discoloured and breaking off. What is going on?"

Dr. Lem says: Onychomycosis, or nail fungus, is a common problem that affects 5-6% of North American toenails at any given time. The top two locations for picking it up are from the floor at the gym or pool, because fungus love to grow in warm, moist environments, or poorly sanitized tools or foot baths at nail salons. Keep your feet fungus-free by ensuring that they're as cool and dry as possible — dry off well after showering and wear breathable, natural-fibre socks and shoes. Also, never go barefoot in public areas and avoid cheap pedicures.

7. "I'm a healthy 28-year-old guy, and although I'm really attracted to my girlfriend, I've had trouble maintaining an erection since our first time together. I've never had this problem before and am really worried that this could be an early sign of impotence. How can I fix this?"

Dr. Lem says: Remember that the brain is your most important sexual organ — if you're worried about performing, this can lead to more awkward sexual encounters and worsening anxiety. If you have a normal morning erection and can perform well on your own, these are both good signs that your plumbing isn't a problem. One thing you could consider is talking to your doctor about getting a prescription for a blood-flow-enhancing little blue pill to help you get your confidence back. Also, check in with your doctor about possible risk factors for cardiovascular disease like cholesterol issues and high blood pressure, because clogged arteries can worsen blood flow.

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8. "I keep getting little red, painful bumps all over my vulva. I haven't slept with anyone in quite some time so I don't think it could be an STI. What else could this be?"

Dr. Lem says: It's hard to say for certain without seeing the rash, but this sounds most like a case of ingrown hairs, especially if they're happening after waxing or shaving. When an ingrown hair grows sideways into the skin instead of upwards, inflammation and sometimes infection result. You can try to prevent this by gently exfoliating before and after hair removal to loosen hairs from the skin, and applying over-the-counter or prescription medications that kill bacteria and open up your pores.

9. "I've had the worst body odour ever since I was a teenager. It's getting worse and worse no matter how much I bathe or use deodorant and antiperspirant. It's made me become super self-conscious about being around people. What's wrong with me?"

The first thing you should do is ask someone you trust to tell you if you really smell, because it's not uncommon to believe you stink when you actually don't. If your suspicions are confirmed, first try forgoing diet-related B.O. culprits like red meat, alcohol and strong spices. Consider seeing your physician to discuss prescription-strength antiperspirants, anti-anxiety medications or even Botox to reduce sweating and food for bacteria. Last but not least, practise relaxation techniques — anxiety can worsen body odour by increasing the secretion of fatty, protein-filled sweat that smelly bacteria eat and thrive on.  

10. "If I have a cold sore and I perform oral sex on my girlfriend, will it give her herpes?"

Oral and genital herpes are essentially the same disease, but in different locations — both are caused by the herpes simplex virus. Therefore, your partner's risk of acquiring genital herpes from you when you have a visible cold sore is very high, because that's when the amount of infectious herpes virus in your skin cells is at its peak. Keep in mind that research shows that most cases of genital herpes are transmitted during periods of "asymptomatic shedding," when your body is producing the virus without visible sores, so be responsible and discuss the risks with your partner.

11. "I've obviously heard of hemorrhoids, but I don't know exactly what they are. I just found out I'm expecting and have heard it's common for pregnant women to get them. How can I avoid them?"

External hemorrhoids happen when the veins around your anus and lower rectum bulge and swell, forming those characteristically itchy, irritated lumps. Whether you get them or not comes down to a combination of genetics and things that increase pressure below the belt, like frequent coughing, weightlifting and, yes, pregnancy. To keep them at bay, remember the three pillars of constipation and hemorrhoid avoidance: fibre, fluid and exercise to keep things moving along. Also, avoid sitting and straining on the toilet — if you're unable to go within two minutes then get up and try again later.