My skin is smelly
Q: If I do not scrub fiercely behind my ears every day, the skin there gets very smelly. Would this have anything to do with the fact that my neck and shoulders have erupted into small, soft, yellow pustules? What can I do?
A: I wonder whether you are sweating a great deal. A man I saw recently in the surgery had taken up cycling long distances, wearing a helmet with Velcro pads. He had erupted in little pustular blisters on his neck and shoulders, which I thought was probably folliculitis - bacterial infection in the hair follicles. The smelly skin could also be due to sweat build up and perhaps a fungal infection, which often happens in damp, warm crevices. Solutions include avoiding excess sweating by wearing loose layers of cotton clothing, wiping off excess sweat as soon as it forms, showering with an anti-bacterial soap or shower gel and using an antibiotic cream such as Fucidin - available on prescription - on the spots. An antifungal cream such as Canesten, available over the counter, may help the smell behind your ears.
Which drug beats Viagra?
Q: I have found Viagra useful but have heard that there is a new drug that is even better. What is it and can I get hold of it?
A: It is true that there is a new drug, called Cialis, to help gain and maintain an erection. It stays in your system for longer - so you can have sex within a 24-hour period after taking Cialis, - than Viagra, which works for only four hours.
Sexual stimulation sends a message to the brain which responds by sending a nerve signal to the penis. A chemical messenger is produced by the nerve endings which makes the blood vessels in the penis open up, causing an erection. Cialis blocks an enzyme, known as PDE5, which usually breaks down the chemical messenger. The higher levels of chemical messenger encourage an erection. The most common side effects are headache and indigestion.
Like Viagra, Cialis can help up to 80% of the 2.3million men in the UK who have erectile dysfunction. Sadly, fewer than 10% seek treatment. You can get Viagra, and probably Cialis, on an NHS prescription if you have one of a number of specified medical conditions, such as diabetes.
I have a weak bladder
Q: I'm a 50-year-old woman who had three children in her 30s. I'm beginning to leak urine when I walk quickly, cough or sneeze. I'm worried that I smell and this is damaging my self-esteem. I saw a specialist who talked about major surgery but would rather avoid that. What other options are there?
A: Your problem is stress incontinence and there is lots you can try. Physiotherapy, to strengthen your pelvic floor muscles, can work wonders. This has gone beyond sitting on the toilet and trying to make yourself stop weeing while in full stream. Specialist continence clinics provide excellent advice about exercises. They may suggest vaginal cones, which are weights you keep in your vagina, causing your pelvic floor muscles to stop them dropping out. The evidence is that exercise works better than cones or techniques such as electrical stimulation. Or you may want to consider having collagen or silicone injected into the exit from your bladder. This can now be done using a local anaesthetic injection so you remain awake throughout. The collagen narrows the exit from the bladder, giving better control. It can work well in up to 80% of cases but after two years, you tend to be back at square one. If you decide you need surgery, discuss the TVT (tension-free vaginal tape) technique with your surgeon as it is less traumatic than traditional operations.
· 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.
