Embarrassing Problems

Anogenital (anal or genital) warts

Anogenital warts are small lumps that develop on the genitals and/or around the back passage (anus). They are caused by a virus called the human papillomavirus (HPV). There are over 100 types of this virus. The virus is passed on by sexual contact. You need close skin-to-skin contact to pass on the virus. This means that you do not necessarily need to have penetrative sex to pass on infection. Sharing sex toys may also pass on infection. Very rarely, anogenital warts may be passed on from hand warts. They may also rarely be passed on to a baby when a woman gives birth.

Treatment options include chemicals or physical treatments such as freezing to destroy the warts. If you have anogenital warts, you will usually be advised to have tests to check for other sexually transmitted infections.

See the separate leaflet called Anogenital Warts for more details.

Bad breath (halitosis)

In most cases of persistent bad breath, the smell comes from a build-up of germs (bacteria) within the mouth - for example, in:

• Food left hanging around the mouth.
• Plaque and gum disease.
• A coating on the back of the tongue.

Good oral hygiene will often solve the problem. That is, regular teeth brushing, cleaning between the teeth, cleaning the tongue, and mouthwashes. Other causes of persistent bad breath are uncommon.

See the separate leaflets called Bad Breath (Halitosis) and Oral Hygiene for more details.

Body odour

Body odour (BO) is caused by germs (bacteria) on your skin breaking down sweat into acids. Sweat in itself without the bacteria working on it does not usually smell. However, sweat may smell if you eat and drink certain foods such as garlic, spices and alcohol. Antidepressant medicines may also make your sweat smell. Being overweight or having certain medical conditions such as diabetes can also make BO more likely.

The best way to avoid BO is to keep the areas of your skin that tend to sweat clean and free of bacteria. You should wash armpits, genitals and feet with soap every day. Clothes should be changed and washed regularly. Antiperspirants reduce the amount of sweat you produce. Deodorants mask the smell of BO. Shaving armpit hair can help reduce BO, as hair can trap sweat and bacteria.

Crabs (pubic lice)

Pubic lice are tiny insects that live on humans, usually in the pubic hair. They are passed on through close body contact, such as when having sex. Infestation with pubic lice can cause itching; however, not everyone affected has symptoms. Treatment involves killing the lice by using an insecticide lotion or cream.

If you have caught pubic lice from a sexual partner, you should be tested for other sexually transmitted infections.

See the separate leaflet called Pubic and Body Lice for more details.

Curving penis (Peyronie's disease)

This is a condition in which patches of scar tissue (fibrous plaques) develop along the shaft of the penis. This can result in bending or changes in the shape (deformity) of the penis. It can be mild and cause no problems. For some people, erection may be painful, or there may be difficulties with sexual intercourse. The options for treatment include medicines which may be taken by mouth, applied to the surface of the penis or injected into the scar tissue. Stretching, electrical treatment, lasers and surgery are other options. In rare cases, the condition may clear up completely but most men find that it either stays the same or becomes worse over time.

See the separate leaflet called Peyronie's Disease for more details.

Dandruff (seborrhoeic dermatitis)

Seborrhoeic dermatitis is a skin condition which causes bad dandruff and sometimes a rash, commonly on the face and upper body. An antifungal shampoo and/or an antifungal cream will usually clear the dandruff and rash. The condition tends to recur. If it recurs frequently, regular use of an antifungal shampoo and/or cream can help to keep it away.

See the separate leaflet called Seborrhoeic Dermatitis (Dandruff) for more details.

Erectile dysfunction

Erectile dysfunction (ED) means that you cannot get a proper erection. There are various causes. However, many cases are due to narrowing of the arteries that take blood to the penis. This is due to a build-up of patches of fatty material (atheroma) in these arteries. This is similar to the way the heart arteries are affected in people with heart disease. As with heart disease, smoking and heavy alcohol drinking are important risk factors. Most cases of ED can be treated. The common treatment is to take a tablet before you plan to have sex. There are also various other treatment options. If you have ED, you may also be advised on lifestyle factors and treatments to minimise your risk of developing heart disease.

See the separate leaflet called Erectile Dysfunction (Impotence) for more details.

Premature ejaculation

This is the term used when a man comes (ejaculates) more quickly than he and/or his partner would like during sex. It means you ejaculate very soon after putting your penis inside (penetrating) your partner, or even before penetration if you are very excited. It is not really known what causes premature ejaculation.

Many men do not seek help from their doctor for this problem so it is not known how common it is. Research suggests it affects about one to three out of every one hundred men. Some studies suggest it can be as common as thirty men in a hundred.

There are tablets which may be helpful, either taken regularly or as needed. Creams or sprays that numb the penis may also be used. Other treatments include certain techniques used during sex, and psychological treatments.

See separate leaflet called Premature Ejaculation for more details.

Excessive sweating (hyperhidrosis)

Excessive sweating is a common problem, especially of the palms, armpits and soles. It can be distressing and can have a serious impact on your life. In some cases, affected people avoid social contact with others because of embarrassment about the problem. However, the condition is usually treatable. If you have armpit sweating:

• Try using normal antiperspirants regularly.
• Avoid clothes that more easily show up sweat marks.
• Wear clothing which is loose under the armpits.
• Avoid clothes made with man-made fibres such as Lycra® and nylon.
• Consider using dress shields (also known as armpit or sweat shields) to absorb excess sweat and protect delicate or expensive clothing.

There are some stronger antiperspirants available at pharmacies or on prescription from your doctor if these measures have not helped. Other treatment options are available.

See the separate leaflet called Excessive Sweating (Hyperhidrosis) for more details.

Hair loss (baldness or alopecia)

Male pattern baldness affects over half of men to some extent over the age of 50 and affects most men at some stage in their lives. Typically, at first the hair starts to become thin (recede) at the front. At the same time, the hair usually becomes thin on the top of the head. A bald patch gradually develops in the middle of the scalp. The receding front and the bald patch on the top (the crown) gradually enlarge and join together. Most affected men do not wish to have any treatment. If required, treatment can usually prevent further hair loss and often cause hair regrowth. These treatments are not available on the NHS.

A similar condition affects women but in a different pattern. In women it tends particularly to affect the top of the head. It may also be a more general thinning of hair all over the head. Hair thinning in women is much more common after the menopause. Around a third of white women in the UK have some hair loss once they reach the age of 70.

Alopecia areata is another type of hair loss that typically causes patches of baldness. In some cases, total baldness develops. The typical pattern is for one or more bald patches to appear on the scalp. These tend to be round in shape, and about the size of a large coin. They develop quite quickly. A relative, friend or hairdresser may be the first person to notice the bald patch or patches. Apart from the bald patch or patches, the scalp usually looks healthy and there is no scarring. In many cases, the hair re-grows, typically after several months. In some cases, the hair loss is permanent. Treatments to promote hair re-growth work in some cases.

See the separate leaflets called Male Pattern Baldness and Alopecia Areata for more details.

Itchy bottom (pruritus ani)

Pruritus ani means a persistent (chronic) itchy feeling around the bottom (anus). The main symptom is an urge to scratch your bottom, which is difficult to resist. The urge to scratch may occur at any time. However, it tends to be more common after you have been to the toilet to poo, and at night (particularly just before falling asleep). The itch may be made worse by heat, wool, moisture, leaking, soiling, stress and anxiety.

If the itch is persistent and you are not sure of the cause, it is best to see a doctor. As there are a number of possible causes, it is best to be examined and checked out by a doctor to diagnose or rule out known causes. Treatment depends on the cause.

Scabies

Scabies is a contagious, extremely itchy skin disorder that leads to a rash. It is caused by an infestation with a parasite - the scabies mite. The mite lives on the skin and burrows into it. Scabies is spread to others through close skin-to-skin contact. You need close skin-to-skin contact with an infected person to catch scabies. This is because the scabies mite cannot jump or fly. Most cases of scabies are probably caught from prolonged hand-holding with an infected person. The hand is the most common site to be first affected. Close skin-to-skin contact when having sex is another common way of catching scabies. It is easily treated with an insecticide lotion applied to the skin. Two applications of treatment are needed, one week apart.

See the separate leaflet called Scabies for more details.

Smelly feet

This problem is usually caused by excessive sweating and wearing the same shoes every day. The following measures may help:

• Keep your feet clean and dry your feet well, especially between your toes.
• Wear dry shoes. Try to let the shoes dry out (from sweat) before you wear them again. Wear a different pair of shoes on alternate days, so you don't wear the same pair every day. Avoid boots and types of sports shoes which are less breathable. These keep the sweat in, which means the shoes dry less well.
• Change your socks (which should be cotton or wool) every day. It may help to change them twice a day or more.
• You can use normal antiperspirants on your feet. Absorbent foot powders may help.
• You can buy medicated insoles for shoes.

Vaginal discharge

Vaginal discharge is common for many women. Most of the time the symptom is part of the normal cycle of monthly changes for women. Common causes of abnormal discharge are bacterial vaginosis (BV) and thrush (candida, a fungal infection). BV may clear without treatment but some cases may need to be treated with antibiotics.

See the separate leaflet called Bacterial Vaginosis for more details.

The discharge from thrush is usually creamy white and quite thick; however, it is sometimes watery. You usually have itching around your vagina. Thrush can be treated with medication bought from a chemist. The pharmacist will be able to help you.

See the separate leaflet called Vaginal Thrush (Yeast Infection) for more details.

If you have a smelly vaginal discharge, or soreness in that area which is not clearing up, see your GP or go to your nearest genitourinary medicine (GUM) clinic.

Wetting yourself (urinary incontinence)

Urinary incontinence is a common problem, affecting women more commonly than men. Stress incontinence and urge incontinence are the most common types of incontinence. It can range from a small dribble now and then, to large floods of urine. Incontinence may cause you distress as well as being a hygiene problem. Having a urine infection can make the problem worse. Treatment depends on the type of incontinence. Men with enlargement of their prostate gland may have a feeling of urgency, meaning if they don't get to the toilet in time, they may wet themselves.

See the separate leaflets called Stress Incontinence, Urge Incontinence, Prostate Gland Enlargement and Bedwetting (Nocturnal Enuresis) for more details.

Wind (flatulence, gas)

Most people fart (pass wind) around 5-15 times per day. Gas collects in the gut in two ways. Small amounts of air are swallowed at the same time as you swallow food or drink; or by gas being produced as a result of the process of digesting food. Some foods produce more gas than others, such as beans, cauliflower and cabbage. The body removes the gas by burping and farting. These are normal processes like breathing. An unpleasant smell is usually caused by a gas called sulphur. This is produced when food isn't digested properly and begins to decompose. Excess wind may be a symptom of an underlying problem such as constipation or irritable bowel syndrome.

Most of the time, changing diet and lifestyle will help. Keep a food diary so you can see which foods make the problem worse. Then you will be able to adjust your diet accordingly. Having plenty of exercise also helps your bowel work better. Stopping smoking can help, as smokers tend to swallow more air than normal. Smoke can also irritate your gut. Occasionally, medication may be needed. Some remedies are available from your chemist. Ask a pharmacist for advice.

See the separate leaflet called Wind/Gas and Bloating for more details.