Help, I was told painful sex could be cancer! NHS GP, Dr Zoe Williams answers your questions
AT this time of year, A&E gets extremely busy.
The last Friday before Christmas has been previously nicknamed “Black Eye Friday” due to the higher alcohol and violence-related incidents.
Hospital admissions for viruses such as norovirus and flu are rising, on top of increased pressures due to strikes.
The most recent NHS figures show that nine per cent of people arriving at hospital by ambulance have to wait more than an hour to get in, rising to more than 60 per cent at the most hard-pressed trusts.
The public can help ease the burden on hospitals by calling 999 only in an emergency, such as for signs of a possible heart attack or stroke, severe breathing difficulties, choking, sudden severe confusion, heavy bleeding or injury, sudden swelling of the lips, mouth, throat or tongue, a seizure or suicide attempt.
Use NHS 111 for less urgent health conditions.
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Pharmacists can advise for minor ailments and offer over-the-counter medicines. You can check online to see which pharmacies are open over Christmas in your area.
Here is a selection of what readers have been asking me this week.
Q) MY husband and I were shocked to see he had been diagnosed with chronic kidney disease stage 3.
It was in the medical notes of a referral letter for osteoporosis.
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We rang the surgery, and were told it was very mild but it has left us very worried.
My husband is 86. Is he in danger of dying of kidney failure?
A) I understand why this sounds alarming but it’s not something to worry about too much.
CKD Stage 3 actually means moderate impairment of kidney function.
The stages start at 1, which is considered normal, and go up to 5 which is established renal failure.
It’s based on the rate at which the kidneys filter urine and a measurement of how much protein is leaking into the urine.
As we age, our kidneys tend to become less efficient, and this is more likely in some people such as those who have high blood pressure, diabetes or if kidney disease runs in their family.
Only a minority of patients with CKD stage 3 go on to develop more serious kidney disease, and it’s usually at this stage that a referral to a kidney specialist would be made.
Your husband should be monitored with an annual blood and urine test, and his GP may want to alter medication, if required, to strictly control associated issues, such as high blood pressure, diabetes and high cholesterol.
It’s better to be aware of it, as kidney disease can mean you’re at higher risk of cardiovascular disease, heart attacks and strokes.
The great news is there are plenty of lifestyle changes that support kidney and cardiovascular health.
Ensure a balanced diet with plenty of fresh vegetables, fibre and minimally processed foods.
Restricting salt intake will reduce the workload on the kidneys, as will limiting alcohol.
If he smokes, stopping will make a huge difference, as will regular exercise.
Q) I AM a 30-year-old man with dull lower-back pain.
It’s usually worse on the right-hand side and sometimes a sudden sharp pain goes up my back which lasts a couple of seconds.
I also feel confused and disoriented a lot of the time.
I’ve been to see my GP on several occasions and haven’t been given a diagnosis.
They seem as puzzled as me. The symptoms aren’t getting any better and are starting to dramatically affect the quality of my life.
A) While you have explained your symptoms, this is not straightforward and therefore impossible for me to know what is going on without having you in front of me for a full examination and to take a full medical history from you.
What you are describing here does warrant further investigation though.
If you were my patient, I’d be ordering an X-ray, considering the need for an MRI or scans, and a full set of blood tests including a PSA test which will assess your prostate health too.
The pain that you’re describing needs to be looked into. While it could be nothing or something musculoskeletal, it could also be something a little more serious, especially if it’s getting worse with time and linked to this confusion.
So please do pursue it and request tests if they haven’t been done already.
You’re a young man and while you don’t say whether you’re carrying extra weight, your level of activity or what you can comfortably do, it’s certainly unusual to have symptoms that are this debilitating at your age.
Q) DURING Covid, I went to the GP many times regarding painful sex. I was initially given pessaries, lubricants and Vaseline, but nothing helped.
There were no face-to-face appointments and it was embarrassing calling the GP about it.
At one point I was told I needed to relax and not tense up, which wasn’t helpful advice.
When I eventually got a face-to-face appointment I was told it was lichen sclerosus, which was a shock.
I was told it could turn cancerous and to keep an eye on it. I have no idea what is meant by that.
My vulva has changed shape and the labia has shrunk which has made me anxious.
I am 68 and happily married but now I worry about having sex.
I have steroid cream clobetasol but am unsure how often to use it.
A) I’m so glad you’ve written in about this.
It may well help other people with this condition so thank you.
Lichen sclerosus is a chronic inflammatory skin condition, the cause of which is unknown.
There’s certainly nothing you’ve done to make it happen and there’s nothing at all to be embarrassed about either.
It mostly affects genital skin and the skin around the anus and it’s most common in women after menopause.
It’s not fully understood why it happens but we know it’s associated with the immune system – although it doesn’t affect how your immune system works otherwise.
It’s not contagious and it’s not related to allergies.
Friction can make it worse though, as can irritation caused if you leak urine.
The most common symptom is intense itching and there can also be some loss of tissue – which you describe.
It can’t be cured but it can be controlled with potent steroid ointments like clobetasol.
The usual advice is to use it every day for the first month, then every other day for the second month, then twice weekly for the third month.
Your GP should give you a check-up at that point to advise on continued use.
Avoid scented products and use an ointment-based emollient for washing.
It sounds as though they initially suspected vaginismus, which is a completely different condition.
If sex is painful, use lubricants, and if things are getting difficult due to the tissues tightening the vagina, then ask for a referral to a gynaecologist who can advise on vaginal dilators and rarely surgical procedures are advised.
There’s a less than five per cent risk of vulval cancer and that risk is further reduced if the symptoms are managed well.
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It’s important to know the signs, so if there are any skin changes that do not respond to steroid ointments – such as thickening, ulcers, or soreness lasting over two weeks – then consult your GP as you may need to be referred for a biopsy.
You’re not alone with this so please talk to your family and don’t feel embarrassed.
Got a question for Dr Zoe?
Email her at [email protected]