Dr. ABBAS 

Stress & Fear
Q. I am 33 years old and my wife has developed some kind of stress. She gets scared by dogs and cats and has developed fear. Why is she acting like this? What is the cause and what can be done?
Concerned reader, Dodoma.

A. Anxiety and fear are normal human emotions and are often found as reaction to stress. Stress is a difficult word to define because it includes both the things that makes you anxious, such as working too hard or becoming ill, and your reactions to them. Normal anxiety becomes abnormal when the symptoms are so intense that they stop us from coping well with daily activities because they are so painful and distressing. Abnormal fears, some times called phobias are intense fears of things, which would not make the average person frightened. If we are terrified even by a small dog sleeping in the corner of a room, or don’t climb down even a short flight of stairs as the height bothers us, then we have a phobia.
When there is an obvious stress such as a car accident or job interview the cause of anxiety is evident. Usually it will go away when the cause is removed, but in some cases it will persist long after the event like in the case of a train crash, fire, etc.
People who are anxious and feel fear can be helped in many ways: talking about the problem can help when the anxiety comes from recent knocks, like a spouse leaving, a child becoming ill or a job folding up. Psychotherapy is more intensive talking treatment, which helps patients to recognize and come to terms with the reasons for the anxiety. Learning to relax is a great help and your doctor can help you. In extreme cases, a variety of medications can also help some patients. Exposure therapy has brightened the outlook in the past few years for those with severe cases of phobias.

Premenstrual Syndrome
Q. I am 19 years old and have problems with my menstrual period. I get pain and discomfort when the period is about to start. What is it? Let me know if contraceptive pills can ease the problem?
Concerned Reader, DSM.

A. Many women experience this to a mild degree; the only consolation that can be offered is that a normal cycle is an essential prerequisite, and thus the syndrome is a sign that all is well. Possible symptoms include fatigue, irritability, hypersensitivity, painful breasts, (sometimes with painful innocent tumours in the breast), a distended feeling in the abdomen, constipation, flatulence, retention of a few litres of fluid and headache. The symptoms usually disappear when menstruation begins. They are caused by sex hormones and their natural fluctuations. Naturally discomfort and pain are difficult to measure and any genuine complaint should be taken seriously.
If a contraceptive is needed the combination pill or mini pill should be chosen. The sequence pill is less suitable, because it imitates the normal cycle. In some cases progesterone therapy is prescribed. If the major problem is fluid retention, then diuretics may be taken once or twice.

Intermittent Impotence
Q. I am 56 years old. I would like to ask if all men become impotent eventually? Secondly, I am suffering from intermittent impotence. Is there anything I can do to improve my sex life?
Concerned reader, Songea.

A. Research conducted found that in the over 70 age group, 59 per cent was still having sex with their partners. A further 22 per cent reported sexual activity, which was assumed to consist of masturbation. Men over 80 years are more likely to be impotent. There is a natural and gradual decline in sexual activity over the years.
People who have lots of sex in young age continue to have sex in old age.
Different causes require different treatments and so you need to find out the reason for your impotence. You should have thorough medical to rule out health problems such as diabetes or blocked and narrowed arteries. One of the most common causes of impotence is venous leakage - this means that although blood flows into the penis making it stiffen and stand up, it also drain away again because the natural locking system that keeps blood in erection is faulty. In some case it can be corrected by penis ring or penis pump. This can be repaired surgically. Intermittent impotence may also have a psychological origin, in which case your best option is to seek help from your doctor.