Multiple moles
Q I have scores of moles all over my body. More and more have appeared over the years. They may be due to careless sunbathing in tropical climates, where I have spent about 10 years - I am a white male, aged 45. None of the moles looks particularly big or nasty but I worry that they might turn malignant. Might this happen to me?
A Moles appear in childhood or adolescence and can be flat or slightly raised. We all worry about moles becoming cancerous but melanomas, though on the increase, are still rare, with 3,500 cases a year in the UK. However, it's worth being vigilant because the more promptly they're treated, the better the outlook.
Some families are genetically predisposed to melanomas and have moles that differ from normal ones. These moles are called dysplastic naevi, and if you have them you should be under the care of a dermatologist who can photograph and record them so that any changes can be detected. Dysplastic naevi are bigger than most moles and numerous, with over 40 at any time on the body. They are found on parts of the body that ordinary moles don't reach - such as the scalp - and have an irregular outline.
Melanomas are most common on the lower leg of fair-skinned women over 30, but anyone can get one anywhere at any time. If any pigmented (ie brown/black) spot on your skin has one of the following characteristics, you should have it examined by a doctor: asymmetry (ie not round/oval); irregular border; non-uniform colour; diameter greater than 0.5cm (0.2in). If in doubt see your GP anyway.
Sex after children
Q Having had three children, my vagina has stretched, which leads to a decrease in feeling for me and less satisfaction for my husband when we have sex. Is there an operation to tighten the vagina?
A Cosmetic surgery to make the vagina narrower is offered in the US and is fast approaching the UK. But the loss of sensation you are both experiencing may be more due to the exhaustion of parenthood. An examination by a GP or gynaecologist is worthwhile. Pelvic floor exercises are the best way of increasing the tone of your vagina. A physiotherapist or continence nurse can show you how to do these properly. Psychosexual counselling is helpful to explore the psychological aspects of your sex life. Surgery may be useful, especially if the lax muscles are making you leak urine too. Creams claiming to tighten the vagina are a waste of money and mostly full of rubbish.
I can't swallow
Q My mouth is always dry. It's making me very depressed. I can't eat, swallow or talk without discomfort but my GP says there is nothing he can do. Can you help?
A The commonest two causes of a dry mouth (xerostomia) are drugs that reduce saliva, such as the tricyclic antidepressants, and breathing through your mouth because your nose is blocked. If you're taking any drugs, check with your doctor or pharmacist whether they could be the cause. If your nose is blocked, try a nasal spray such as Beconase. Dehydration, a condition called Sjorgen's (in which you also have dry eyes) and irritable bowel syndrome can all be associated with a dry mouth. Drink plenty of water, and use a saliva-substitute spray or lozenges. Chewing gum works a treat in stimulating saliva, and various saliva-stimulating tablets are also available. Acupuncture can get the saliva flowing too. It is essential to have good dental hygiene to prevent decay, so book an appointment with the dental hygienist and see your dentist regularly. You may also want to see an oral surgeon for further advice.
Anti-obesity drugs
Q I am very overweight and want to take the anti-obesity drug Reductil. I have heard that it can be dangerous. What do you think?
A There's no such thing as a free lunch and every drug carries a risk of side effects. The drug sibutramine (Reductil) has been withdrawn from sale in Italy and 34 deaths have been reported worldwide. In the UK, there have been two reported deaths, both in people who had underlying medical conditions that were said to contribute to their deaths. The drug shouldn't be taken if you have heart disease or uncontrolled high blood pressure. If you are going to take it, have your blood pressure checked regularly and preferably make sure that you are under the care of a doctor who has some experience of prescribing it.
· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.
