Penile bleeding
Q After sex with my girlfriend last night, I was very alarmed to see bright-red blood coming out of my penis after I'd ejaculated. I checked that it was coming from my penis rather than her vagina by squeezing my penis and seeing the blood coming out. This morning, there was some dry, crusted blood around the opening but I couldn't see anything else wrong and couldn't feel any lumps in my testicles. I'm sick with worry. Can you help?
A This is probably one of the most alarming things that can happen to a man. Most men who see blood mixed in with their semen assume that they have a sexually transmitted disease or cancer. In fact, there is no known cause and it's not dangerous. Where no known cause exists, myths abound. So blood in the ejaculate (haematospermia) has been attributed to having sex too often, too enthusiastically, not often enough or in jerky fashion, as in coitus interruptus used as a contraceptive method. What probably happens is that the small blood vessels in the walls of the seminal vesicles that take sperm towards the penis rupture when the vesicles empty suddenly during ejaculation. You should be examined to check your prostate and testicles and have a urine test to check for infection. Further tests are unnecessary if you have no other symptoms. If there's any doubt about the diagnosis, you may be asked to produce some semen to be analysed under a microscope to confirm the presence of blood cells. Don't worry, but be warned - it often recurs!
Snore no more
Q My husband snores so badly that I've moved into the spare room and dread holidays when we'll have to spend the whole night together. He now says that he's prepared to do something about it, partly because of me but also because he says its disturbing his sleep! He tried a nasal spray from our GP but that did no good. We're now thinking about laser surgery but I'm worried that this might be a drastic step for what is, after all, not a life-threatening problem. What do you think?
A There must be spare rooms across the land filled with snorers or their exhausted partners. Snoring is defined as loud breathing during sleep caused by obstruction to the flow of air through the back of the mouth and nose. Excess tissue round the roof of the mouth (soft palate) vibrates, causing the characteristic noise that can drive the most loving partner to thoughts of homicide. The bit of flesh that you can see hanging down at the back of the mouth (uvula) and back of the tongue add to the noise.
Losing excess weight, cutting out alcohol, stopping smoking, avoiding sleeping pills and trying to sleep on your side are all sensible things to try first. Nasal strips and remedies available over the counter are tried by many. CPAP involves going to sleep every night connected to a machine with little tubes up your nose. Surgery to correct crooked noses, remove nasal polyps or chop out large tonsils may help. The current gold-standard surgical treatment is Laser Assisted Uvulopalatoplasty (LAUP), which shrinks the soft palate. It can be done as a one-off under general anaesthetic or over a few sessions sitting upright in a chair under local anaesthetic. Americans quite like the latter; most Brits prefer a general. You could be referred on the NHS to see an ENT (ear, nose and throat) specialist for their opinion. In some areas you can get all the tests and treatments on the NHS, in others the provision is more patchy. Private health-insurance companies don't have the slightest interest in paying for snoring treatment.
My voice lets me down
Q I'm a keen amateur singer and find that at this time of year, just when I want to sing the most, my voice tends to go hoarse and let me down. Any advice?
A Viral coughs and colds cause swelling round the vocal cords and can be helped by a humidifier, cough suppressants and an antibiotic if a bacterial infection is suspected. Back pain makes it hard to sing, so look after your back as well. Avoid dry, smoky or polluted air if possible. Acid reflux from the stomach can spill into your lungs, giving you a dry early-morning cough and hoarseness as well as heartburn and burping. Avoid acid foods and try antacids if reflux is a problem. Avoid gargles and local-anaesthetic throat lozenges, which may encourage you to overuse your voice and damage it further. Recurrent voice problems are best helped by a speech therapist and expert advice is available at the 30 or more voice clinics around the UK.
More details from the British Voice Association, tel 020-7831 1060, www.british-voice-association.com
Should I have the jab?
Q Should I have the jab against pneumonia offered by my GP when I went for my annual flu jab?
A It's a good idea for anyone who has never had one and is particularly at risk if they get pneumonia. This includes anyone without a spleen, with kidney, heart, lung or liver disease, or with diabetes. Arguably, everyone over 65 should have the jab as pneumonia caused by the bacteria pneumococcus kills 9,000 adults a year and does not always respond to standard antibiotic treatment even if diagnosed promptly. You only need the jab once in your life (unless you don't have a spleen, in which case you need it more often) and side effects are rare.
· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.
