Ask the Doctor (2017–…): Season 1, Episode 12 - Sex - full transcript

Dr Shalin Naik examines the extent of male infertility, Dr Sandro Demaio reveals the raw truth about sexual disease in our communities and Dr Renee Lim explores the various contraceptives available.

[Dr Shalin Naik] Making love. Intercourse.

Fornication.

Whatever you like to call it,
most adults are doing it.

But it's an activity we still
don't often talk about.

[springs creak]

In this episode, we lift the lid on what's
really going on under the covers

and we answer questions
you didn't even know to ask.

Renee finds out there's more to
contraception than we ever knew.

Most women aren't really aware of them
once they're in there.

Funny that you say that,

because it doesn't look like
it would be that enjoyable!



Sandro reveals the state
of our sexual transmissions.

It's estimated that 1 in 20
now carry the infection.

I discover options available
to men suffering infertility...

It's basically changed
the whole ballgame for men.

You're literally
putting your balls on the line.

That's one way of putting it!

And I meet someone who's found a way
to increase his chances of conception.

I can't wait to see Nathan
holding his child for the first time.

Yeah, the reward's gonna be there
at the end. It's gonna be great.

[Dr Renee] So, sex is a natural
physical activity

that humans participate in regularly

and while its primary purpose
may be procreation,

for many of us, we just do it for fun.

[women laugh]



But sex for fun wasn't always
the socially acceptable norm it is today.

For women in particular,
sex usually meant one thing.

[screaming]

But thanks to a feminist philanthropist

who funded the development
of a hormonal contraceptive,

followed by a sexual revolution,

all women, regardless of marital status,

were given control of their own fertility.

We now know it simply as 'the pill'

but this liberation has come at a cost.

Historically, women have been expected

to bear the burden of preventing
unwanted pregnancies

but for some, the side effects
of the contraceptive pill

actually can outweigh its benefits.

When a woman is pregnant,

her body is flooded with hormones
that prevent her from ovulating.

The combined pill contains

a synthetic form of oestrogen
and progesterone

to mimic this process,

essentially putting ovaries to sleep.

If there's no egg to fertilise,
there'll be no pregnancy.

However, there are side effects,

like cramps, nausea, breast tenderness

and mood swings

and combined with cigarettes,

the risk of forming deadly blood clots
in the lungs is increased.

30-year-old Marli first went on the pill
when she was 14

but stopped taking it a year ago.

So, in hindsight, then,
how did the pill affect you?

The big thing for me, probably,
was it made me feel a lot more down.

Marli isn't alone in feeling this way.

A 2016 study of more than a million women

found an association between
hormonal contraception

and an increased risk of depression.

[Marli] I'm a very social person,

so being depressed
generally equates to me...

drinking a lot, being hung-over a lot.

- Mm-hm.
- On that down-time when I am at home,

probably I'm crying, um,
not getting out of bed.

[Dr Renee] There are lots of
contraceptives available to women

but many of them use the same hormones
as the pill

and therefore are inappropriate for Marli.

Condoms are the only method that prevents
sexually transmitted infection

but they can fail

and a back-up contraceptive
is a good idea.

So I've arranged a visitor who knows
all the options available.

Dr Kathleen McNamee is the medical
director at Family Planning Victoria.

She also rather enjoys...

audio books.

And she's brought along some of her
best suggestions for Marli.

Well, there aren't a huge number
of non-hormonal methods

but this one's a diaphragm.

It's a single size, so it's going to suit
about 85% of women.

It sort of goes in your vagina

and covers the cervix and blocks the sperm
from getting through.

You need to leave it in for about
six hours after having sex,

so the sperm die off in your vagina.

- Wow.
[all laugh]

You also need to use a special gel
with it, every time you use it.

- Yeah. No, yeah. Strange.
- Yeah.

- No.
[all laugh]

[Dr McNamee] Um, this is a female condom.

- Um...
[Marli] I was wondering what it was.

- Like a very, very big male condom.
- Yes.

Um, the ring just helps you insert it.
It doesn't have to go any special place.

So it's fairly strong.
It's pre-lubricated.

The main problem with them is that
sometimes the penis goes in underneath,

- so you have to guide it into the condom.
- Ah, yeah.

But they're around about $3.30 each,

so they're quite expensive
and they're only single-use.

I was gonna say, so they're not re-usable?

- No.
[laughs]

You can put it in quite a few hours
beforehand,

if you think you're gonna have sex
later on in the evening or the day.

And are they comfortable?
Can you feel them?

They're generally pretty comfortable.

Most women aren't really aware of them
once they're in there.

It's funny that you say that,

'cause it doesn't look like
it would be that enjoyable.

[all laugh]

[Dr Renee] But there is a method
that may suit Marli better.

The copper IUD is probably
the best one that's available.

It's, like, a little plastic-and-copper
device, um,

and I know it sounds really weird
but it actually goes into your uterus.

There is a bit of pain and a bit of
cramping for a few days afterwards

but it's an extremely effective
method of contraception.

- Lasts for 5 to 10 years...
- Wow.

...depending on what type we put in, yeah.

- Do you mind?
- Yeah, have a look, yeah.

But the main problem with it is
it does make your periods heavier.

- They're around about 50% heavier.
- Mmm.

How exactly does it work?

Mostly it kills off sperm - the copper's
a bit toxic to the sperm.

If the sperm gets through,
it kills off eggs

and if the egg gets through, it stops it
from sticking to the wall of the womb

but I suppose the big advantage of that,

compared to the other
non-hormonal methods,

- is it's just way, way more effective.
- Yeah.

[Dr Renee] There are other
contraceptives available.

Contraceptive implants,
inserted under the bicep,

and hormonal IUDs

will both last around three years

but for women like Marli,

non-hormonal IUDs are a better option.

- Would you consider it?
- Yeah, I would.

Out of... out of those options,

the IUD is definitely...

probably the most attractive option.

- Yeah. Mmm.
- If 'attractive' is the word.

[all laugh]

[Dr Renee] But as we all know,
it takes two to tango.

Yet there are still a lot more
contraception options for women than men.

So, why the discrepancy between the sexes?

Not many know that actually,

researchers have been looking into
male contraception for a number of years

and yet they've never made it to market.

The question is, why?

One man who is
trying to balance the ledger

is Professor Robert McLachlan.

- Nice to meet you.
- Thanks for coming.

- Thank you so much for your time.
- My Pleasure.

He's a leading endocrinologist
with Monash IVF,

specialising in male contraception.

So, Rob, what do you actually mean
when you say, "male contraception"?

Well, male hormonal contraception

is really quite similar
to the female hormonal approach.

In the case of the male,
we use testosterone,

which is the normal male sex hormone,

plus a little progestin at the same time

and together, they really shut down
the brain's drive to the testicle,

so it stops making sperm
and it stops making testosterone.

Probably 95% of men who get the
testosterone-progestin combination

get a zero sperm count, or close to zero,

which is adequate to give them protection,

so it is effective.

I suppose the big question is, why haven't
we got the male contraception to market?

There have been some issues
in the studies.

There was a very large
international study,

involving Melbourne and Sydney
and eight other places around the world,

about 400 couples

and there were some mood problems
in some of the men, some depression

and one of the committees
that was overseeing that study said,

"You know, I think we should stop."

Now, of course, when I talk to my
female contraceptive colleagues

about mood changes,

they say, "Yes, of course."

You're always going to get
that sort of issue on occasion.

But the extent of that has to be
worked through a bit further.

[Dr Renee] Another stumbling block
is that it would be an injection,

administered every eight weeks.

Although that study was cancelled,

the professor still believes
there's a real need.

Why do think it's important
for us to make this?

The need is for those couples in whom

the female partner can't or is unwilling
to take female methods

and if you are exposing yourself,
a couple, to unwanted pregnancy

because there's nothing available for you,

that's a problem.

From an ethical, a moral point of view,
there's a compelling reason to do it.

[Dr Renee] If you're choosing
a method of contraception,

you need to consider a number of things.

Your general health, lifestyle,
the relationship you're in

and both your current and future needs.

And not all contraception
is created equal.

If male condoms are used perfectly,

they can protect against
sexually transmitted infections

but they still result in 2 in 100
unintended pregnancies each year.

The pill, although effective,

still has around a 7 in 100 chance
of pregnancy,

mostly due to human error.

For diaphragms, it's 18 in 100

and with female condoms, it's 22 in 100.

But with IUD implants, there is
a 1 in 10,000 chance of pregnancy.

It's also important to weigh up

both the benefits and the side effects
of the different methods.

But most importantly, remember,
it's always up to you.

When it comes to contraception,
there's no one-size-fits-all solution

and with so much uncertainty
around the subject,

we took to social media to ask:

[Dr Shalin] Being recently married,
I'm starting to think about the next step,

having children.

But what if it's not just a done deal?

About 15% of couples fail to conceive
in the first 12 months of trying,

making them officially infertile,

according to World Health Organisation
guidelines.

And while we all know there's a relatively
short window of opportunity

for women trying to conceive,

what about the limitations for men?

Dr le-wen Sim is an endocrinologist
and fertility expert,

whose interest in reproduction could
explain his other great love,

Babushka dolls.

As many as half of the patients
Dr le-wen sees

are struggling with male infertility,

something that's as surprising to me
as it often is to them.

So, what are the main barriers for men
seeking help with fertility problems?

The first issue is recognising that the
man can be part of the problem,

so actually looking
and actually thinking about it.

The second aspect is that the men

are not very good at seeking medical help
at the best of times

and especially when you're talking
about manliness and manhood,

that's obviously a very
confronting issue for men.

Yeah.

A man's fertility declines
over a lifetime.

After around the age of 50,

sperm can become less efficient

and carry compromised DNA,

associated with a high risk of autism,
schizophrenia and bipolar disorder.

Plus, men are more likely than women
to transmit mutations to their children.

When the fertility problem
does lie with the man,

what are the most common causes?

The predominant cause, in probably
about 60% of male infertility,

is due to the sperm factory, or the
testis, not producing good enough sperm,

not in big enough numbers,
not good quality sperm.

And then the other issue is sort of
a plumbing, or transport issue,

so you could make good sperm but if the
sperm can't get there for blockages,

so if the tubing, or the vas deferens,
is blocked,

or it doesn't exist -- which,
that sometimes happens --

then obviously, you're not going to get
the sperm to where you need to get it to.

Right.

Since sperm production disorders
can be genetic and difficult to treat,

new technology, called microdissection
testicular sperm extraction,

or microTESE,

is bringing hope.

It works by harvesting sperm
from hard-to-find places

and using it with IVF.

If we think of it, the testicle is
basically a big sperm factory,

so it's basically a long tube.

You can actually go in there
in an operation, unwind the testis

and under a microscope, you can
actually look for the swollen bits

where the sperm's being produced

- and actually take those bits out.
- Wow.

It is an invasive procedure -- it makes
you cringe when you think about it.

You're literally
putting your balls on the line.

That's one way of putting it.

But it is a procedure that means

that men who, you never
see any sperm otherwise

and would never have been
able to conceive,

in fact, now they have a chance.

Wow.

It's one of those procedures

that has basically changed
the whole ballgame for men.

[Dr Shalin] Literally!

But not all treatments
are as confronting as microTESE.

In fact, many of Dr le-wen's patients

are finding a thorough lifestyle overhaul

can have an impact on fertility.

And while changing
everything you eat and do isn't easy,

it might make all the difference.

I'm about to meet someone
who's taken on all of Dr le-wen's advice

and he's happy to share
his encouraging news.

- G'day, mate. How you goin'?
- Good. How are you?

- It's Nathan, is it?
- Yeah, mate. How are you?

- Shalin.
- Come in, mate. Let's go.

So, this is Jessica, my lovely wife.

After unsuccessful attempts
to get pregnant

and with female infertility ruled out,

Jessica and husband Nathan's next step

was a sperm test at Dr le-wen's clinic.

Basically, I had the tests done

and they weren't moving properly -
they were just going round in circles,

instead of making a beeline
to where they're mean to go to.

- Really?
- So... Yeah.

- So they weren't swimming very well.
- Pretty much, yeah.

So you had plenty of sperm,
the little guys. Lots of little guys.

Yeah, lots of little guys but they
just weren't moving properly

or they were a bit deformed.

- Did they have tails?
- Uh, some did, dome didn't.

- Ah, right.
- So, yes.

There was a small percentage
that were okay

but they were just a bit slow, so, yeah.

[Dr Shalin] A large number
of deformed sperm isn't unusual.

Of the 200 to 500 million sperm
in the average ejaculate,

as few as 4% will be functional.

But the numbers and quality
of Nathan's sperm were slightly down,

with a compromise in progressive motility,

the ability of sperm to swim straight.

- He said that it was fixable...
- Yeah.

...which I thought was great,

so, um, he pretty much explained to me,
like, cigarette smoking, heat,

blood flow, um,

eating a bit better as well,
losing a little bit of weight

would be really beneficial towards
making them healthy again.

Yeah.

- But definitely the cigarettes was...
- Smoking?

- Yeah, they were the big one.
- So, what were you smoking

- and what are you doing these days?
- Uh, cigarettes. So...

- Yeah. Oh, sorry!
- Yeah.

- How many were you...
[both laugh]

"What were you smoking?" [laughs]

So, um, the smoking was the big thing

and the one that I always
sort of thought was a myth

was the blood flow and the tight underwear
and tight jeans and stuff like that.

Not that I was a big wearer of tight jeans

but I thought that one was
always a bit of a myth

and also the heat one,
like having the laptop on your lap.

- Right.
- Yeah, I was...

- That's something we all do.
- Didn't know heat was...

Yeah. Yeah, so now I've gotta
have the pillow under it

or have it up on the bench

and, you know, go from there.

[Dr Shalin] Optimal temperatures
for sperm production

are lower than standard body temperature.

That's why testicles hang in the cool,
fresh air to begin with.

- Gotta keep those guys happy.
- Yeah, you do.

- You've gotta keep 'em cool.
[both laugh]

Nathan and Jessica began their
lifestyle overhaul together

and a few months down the track,
are already seeing results.

Tests are now showing Nathan's sperm
is both healthier and more mobile.

And how did you feel when
you saw the fertility improving,

with the lifestyle changes?

- So relieved.
- It was great.

It was really, really good,

so we were happy to see improvement.
We're happy to see reward for our effort.

Like, "Yes, this is working!"

Yeah, and it sort of gave us
more motivation to continue on with it.

And what does having kids mean to you?

[Jessica] Life itself.

Seeing all our friends and family
with kids,

watching them grow up, it's just so much
this...

We've got so much love for them,

we can't imagine how much love
we'd have for our own kids.

[Nathan] Yeah. It's worth
all the lifestyle changes,

it's worth all the waking up cranky
in the morning,

wanting a cigarette
but knowing you can't have one.

[Dr Shalin] And what's the thing you're
most looking forward to, being parents?

I can't wait to see Nathan
holding his child for the first time,

just to see that look on his face.

Yeah, the reward's gonna be there
at the end. It's gonna be great.

[Dr Shalin] It's amazing to think
such simple lifestyle changes

can have an impact on male infertility,

because as many as 1 in 20 of us men
will have problems conceiving.

I honestly didn't realise just how much
fertility problems can be due to the male

but it is good to know that there
are things we can do about it.

[Dr Sandro] If you take
a conservative estimate

and assume the world's 7.5 billion people
are having sex once a week

for around half their lifespan,

then in the time it takes me
to tell you this story,

750,000 of them will begin to have sex.

But how much of that sex is safe?

It's a critical question, because evidence
suggests condom use is in decline

and sexually transmitted infections
are on the rise.

While these figures can be partly
attributed to an increase in testing,

it's still a big cause for concern.

Let's start with chlamydia.

It's estimated that 1 in 20
15-to 29-year-olds

now carry the infection.

And because many people
don't get any symptoms,

72% of all new cases go undiagnosed
and untreated.

But it's not the only STI on the up.

Gonorrhoea rates doubled in men and women

between 2006 and 2015.

Now, it's a disease that's usually
treatable with antibiotics

but with the recent rise of
antibiotic-resistant gonorrhoea,

it could be untreatable in the future,

which is alarming, because this is
a disease that, at its worst,

can cause septicaemia and be fatal.

If there's a bright light in all this,

it's that new HIV infections
are on the decline globally.

So here's the bottom line.

If you're not having safe sex,
you're not safe.

So, regardless of sexual preference,

the best advice is still...

to keep it covered.

But keeping it covered wasn't
always as easy as it is today.

Condoms have come in various forms
for hundreds of years.

The linen sheaths developed
in Ancient Egypt

were eventually replaced with
lamb's intestines,

introduced by King Charles II
in the 18th century.

By the mid-20th century,

the English had developed
a rubber condom...

and it was re-usable.

But it was in the 1920s

latex revolutionised the condom.

The discovery of HIV in the 1980s

increased their popularity

and now around 15 billion condoms
are produced every year.

A far cry from the lamb's intestine,

the latex condom is formed
in a glass mould

before being thoroughly tested.

To pass muster, they need to withstand
the leak test,

where they're filled with water
and suspended for around a minute.

And for the burst test, they're filled
with a minimum of 18 litres of air.

Just one pop and your whole batch fails.

[Dr Shalin] But before we can use a condom
for its intended use,

there's a physical process
that needs to happen.

Hmm?

But did you know that one in five
of us blokes have erectile problems

once we hit 40?

And 1 in 10 can't get it up at all.

And the older we get,
the more of a problem this is.

Some medicines, illness and accidents

can cause erectile problems,

as can stress and depression.

Clogged arteries are also a common
cause of erectile dysfunction

and for many of these cases,

it can be the first hint
of cardiovascular disease.

But it's not all doom and gloom when we
find ourselves 180 degrees shy of heaven.

There are ways we can actually improve
our erectile prowess.

A recent study found that eating
lots of flavonoid-rich foods,

like kale, berries, cherries, grapes,

apples and citrus fruit,

brought about a reduction
in the risk of erectile dysfunction.

Research suggests that flavonoid
consumption improves arterial flexibility

and therefore enhances the blood flow
needed to get an erection.

And it turns out a good, old-fashioned
cardio workout

also helps in a number of ways,

including boosting blood flow

and helping you lose weight
and stress less.

Giving up smoking will also really help.

And if you're really game,
there are always these.

Vacuum pumps use pressure to enhance
blood-flow to the penis.

No, really -- they do.

And I bet you always thought of pelvic
floor exercises as just for women

but it turns out they can also help
improve male sexual performance.

And all you have to do is squeeze,

as though you were stopping a wee,

for three seconds at a time,

any time, anywhere.

[ding!]
- Doin' it.

Doing it.

Doing it.

Still doin' it!

So, once everything is in working order:

[Dr Renee] We've all been through it

but have you ever wondered what's
actually going on in your body

when your heart is broken?

[glass shattering]

To find out, we start with that first
moment we fell head over heels.

When every breath made us sigh
and think of our beloved.

This behaviour is triggered by a flood
of neurotransmitters in our brains.

One of these, dopamine,

makes us feel good

and creates a powerful craving for more.

While this craving for our lover
does settle over time,

when they're taken away in a break-up,

the brain is left looking for its
regular feel-good fix

and the cravings kick back in.

Then there's the pain of a break-up --

and not just the emotional distress.

Studies have shown

that the same parts of the brain that tell
the body how to react to physical pain

become active after a break-up

and can trigger the release
of stress hormones...

[howling]

...similar to when we're in danger.

The overwhelming feeling of longing
created by the lack of dopamine,

combined with these stress hormones,

are a possible explanation for the
distinct feeling of a broken heart.

But the painful feelings do
eventually fade away,

allowing us to move on
and maybe even find love again.

[Dr Shalin] Well, it's good to know the
old saying, "Time heals a broken heart,"

is actually based on scientific evidence.

Sexual health is something
we don't often talk about

but it's reassuring to learn there's many
things we can do

to actually improve
our well-being in this area.

If the hormonal pill isn't for you,

there are alternatives.

- Would you consider it?
- Yeah, I would.

Out of those options, the IUD is
definitely the most attractive option.

One day there may be a male contraception

that doesn't involve latex.

From an ethical, a moral point of view,
there's a compelling reason to do it.

[man] Lift-off. We have lift-off.

[Dr Shalin] And if you find your missiles
aren't hitting your desired target,

quitting smoking, exercising

and improving your diet
will make a difference.

So, how did that make you feel, when
suddenly they were swimming again?

Happier. A little bit more hope. Um...

So they're off the diesel
and onto the rocket fuel.

Yeah, exactly right. Yeah.

The most important thing to remember

is that as consenting adults,

along with the joys of sex,
there can be repercussions,

so remember to protect your health
by practising safely.