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Fistula
Q. I am 46 years old and have problem of fistula. I would like to know more about fistula because I was very surprised to hear about it. Kindly, can you briefly give me some explanation?
Concerned Reader, Mombasa.

A. Fistula is an abnormal connection between two hollow organs (e.g. bladder and intestine) or between a hollow organ and the skin as in anal fistula between the anus and the skin. Fistula can occur for no clear reason, but some conditions are known to cause fistula formation, particularly intestinal diverticulitis (this is the condition caused by infection from the contents of a large intestine, which have accumulated in the diverticula), intestinal cancers, intestinal tuberculosis, etc.
The symptoms of these disorders and effects of the fistula depend on the nature of the connection. Fistulas between the bladder and an intestine can cause feces in the urine, and vice versa. A fistula from an intestine to the vagina can introduce pus or contents of the intestine into the vagina. Anal fistulas usually exude pus to the skin. Internal fistulas are hard to find, and tests for them should always be subordinate to tests to establish the primary cause. X-rays with contrast medium may reveal the fistula. External fistulas usually heal. Treatment is by surgical removal, recovery can be slow and fistulas have tendencies to reoccur.

Down’s Syndrome
Q. I am a 42 year old woman and delivered a baby boy who has been diagnosed to have Down’s syndrome. Can you let us know about Down’s Syndrome?
Worried parents, DMS.

A. Down’s Syndrome is the best known and most common congenital disorder, sometimes called mongolism because of its effect on the set of the eyes. The condition unfortunately is associated with mental deficiency and occurs in 1 in 600 live births. The percentage is higher in babies born to older mothers, as in your case.
Many congenital disorders occur as the result of an error of cell division in the fertilized ovum; in Down’s Syndrome the ovum has received two many chromosomes, 47 instead of the normal 46; chromosome 21 is represented three times instead of twice, although other deviations are possible. Heredity affects only one to two per cent of cases.
The outward signs of Down’s Syndrome are usually clear at birth, but not always recognized, because the baby’s behaviour is not significantly different from normal. After a few weeks or months the syndromes show clearly. The most important characteristics are a slight slant of eyes running from underneath on the inside to above on the outer side; pelicanthus (a fold of the skin over the inner corner of the eyes); small round head flattened at the back; short neck; occasionally misshapen ears; and a large, deeply-grooved tongue, which often protrudes from the mouth. The hands are plump, with a short crooked little finger and fold of the skin in the palm. The children are short and plump, often very listless, particularly in the first year of life, and frequently also have congenital skin abnormalities. They are also particularly prone to infection.
Diagnosis can usually be made with ease from outward characteristic and confirmed by chromosome tests and the study of the folds in the palms of the hands. There is no treatment for the condition. The children are often affectionate and dependent, and can be brought up in their own family for a long time, with the help of the family doctor. Parents with an increased risk of having such children have the opportunity to receive genetic counselling.

Failure of Ejection
Q. I am 18 years and I am in my first relationship. I cannot ejaculate during intercourse. I can go on and on for hours, but that just wears my girlfriend out. I can climax nicely, but only when I masturbate. What is wrong? Also, can stress affect my sex drive?
Concerned Reader, Songea.

A. You are not getting enough friction from intercourse or more likely you are feeling inhibited and this preventing you from letting go. Because this is your first sexual relationship, your reticence may be caused by nervousness or a lack of confidence in your sexual ability. The fact is that these feelings are very common in first time lovers. Spend more time talking intimately with your girlfriend so that you can learn to trust her. If possible try masturbating together so that she can understand what you like and what stimulus you. Then try a combination of masturbation and intercourse. The more you are open with your girlfriend, the more accepted you feel and the easier it will be for you to ejaculate. Secondly, yes stress affects the sex drive. Stress can burn you out so that you become exhausted to do little more than surviving from day to day.