DOCTOR'S ADVICE: Is it my age?

Q I am about to get married for the second time. I love my fiancé, and he loves me.

But last week, we slept together for the first time and it was so difficult for him to penetrate me, as I was so dry. It was very painful for me and uncomfortable for him.

Does this have anything to do with my age, Doctor? I am in my mid-50s.

A I would guess that this dryness is probably linked to the fact that your female hormone levels have fallen in the last few years. This results in less lubrication and the vaginal walls become thinner and rather tender.

This does not happen to all women in your age group, but it could be what has happened to you. However, do not worry, it can be fixed.

As a temporary measure, I suggest you get a vaginal lubricant, either from a pharmacy or online. Some good brands include K-Y Jelly, Senselle, Astroglide and Liquid Silk. You should apply one of these to the interior of your vagina each evening, and especially before having sex.

I think that these lubricants may only give you temporary relief. You need to consult a doctor who will examine your vagina and decide whether a hormone deficiency is present.

If so, it will be quite easy to remedy by regularly applying a small amount of a female hormone cream or jelly. That will restore the vaginal walls and will also replace your natural lubrication. Good luck.

Q I am a 44-year-old man and I believe I had gonorrhoea when I was young.

Can I assume that it has totally gone away, and that it cannot possibly hurt me now?

A Provided you got adequate treatment when you were young, you could assume that you are okay now.

However, if it was not fully treated, you could still get late complications. For instance, you could develop a narrowing of the urinary tract, which is called a stricture. If you are in any doubt, get a thorough medical examination.

Q I am a 34-year-old woman and I'm engaged to be married soon. But I do not know much about sex. So I would be grateful if you could explain something to me.

Doctor, what is a 'cream pie'? I know it is something to do with sex. I overheard my fiancé talking to his best friend on the phone last week, and they were clearly discussing me. I think that my fiancé said something like: "I hope we can get her in a cream pie situation," or something like that.

Afterwards, I asked him what he meant. But he just laughed, and would not tell me.

A I find this conversation troubling. You see, 'cream pie' is an American term. It usually refers to a woman having unprotected intercourse with one man, and then immediately after with another man.

They call it 'cream pie' because of the fact that after the first act, the woman is oozing creamy fluid, which is, of course, the first man's semen.

Some men are into threesomes like this, though it is a little difficult to see why. Sometimes they claim that the first man's seminal fluid lubricates the woman's vagina for the second man.

Frankly, I would say that cream pie sex, which is always done without condoms, is a good way of spreading chlamydia and other genital infections. And obviously, there is a considerable risk of pregnancy. If that occurred, the woman would not know which of the men fathered her child.

What is extremely worrying is that your fiancé, who is supposed to love and cherish you, is apparently lining you up to have unprotected sex with him and his best friend. That is no basis on which to get married!

I suppose there is a chance that you misheard or misinterpreted his phone conversation. But that does not seem very likely, in view of his reaction when you asked him about cream pie.

You said that he laughed and would not tell you what the expression meant. So I think you have to sort out this matter urgently. Please insist that he discuss the problem with you. After that discussion, you may well feel that his sexual plans for you are not those of an honourable fiancé. In that case, you should definitely put a halt to your wedding plans.

Q Some years ago, I lost a testicle in an accident. Fortunately, my sex life has remained intact.

But I am thinking of having a child with the woman I love. Do you think I am fertile, despite having only one testicle?

A You are probably fine. It is likely that your remaining testicle has taken on the work of two.

But if you wish, you could get a good indication of your probable fertility by asking a doctor to arrange a sperm test for you at a lab.

Q Six months ago, after having sex with a man, I found that I bled on the sheet.

I ignored it, but now I have a new boyfriend, and the same thing has happened four times in the last week.

A This is almost an emergency. Repeated vaginal bleeding in anyone over the age of 25 could be linked to cancer of the cervix.

There are less serious causes, but you must see a doctor this week. Do not delay.

Q I am now 30 and I recently discovered that when I drink alcohol, I now need more to feel good than I used to when I was a teenager. Why is that?

A This is a phenomenon called tachyphylaxis, and it is seen with many drugs, including alcohol.

The word tachyphylaxis really means that the body has become so used to the drug, it needs more and more of it in order to produce the same effect.

Many people find that when they were young, a bottle of beer made them feel happy. But as they get older, a single bottle has little or no effect, so they have to drink two or three.

You need not be alarmed. But it does indicate that it would be wise to cut down on your drinking in order to protect your health.

Q My oldest son has just written me from England to say that he is a homosexual. Is this my fault, as his mother?

A No. It is nobody's fault. The causes of homosexuality are still not understood by medical science. No blame is attached to you.

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