Dear Dr G,

I read with interest your argument that men are the weaker sex when it comes to immunity against HPV infection.

I am a woman in my late twenties, well protected against HPV through early vaccination.

However, as a woman, I cannot help but point out that HPV-related cancers affect more than half a million women globally every year.

Although you argue that men also suffer from HPV-induced cancers, the number of male-related cancers is significantly lower than in women.

I would imagine that women suffer more from HPV-related cancers largely because men constantly infect women with the disease.

Am I wrong to assume that transmission of HPV from men to women is higher?

I chose this opportunity to put Dr G on the spot for some clarification.

Is it true that HPV is a sexually transmitted disease?

Do men transmit HPV to women more than women transmit it to men?

Is it also true that men have a higher risk of promiscuity, which puts women at risk?

Lastly, am I also wrong in assuming that men have a higher disease burden of HPV and put more women at risk of cancers?

I look forward to your rebuttal.

Regards

Finger-pointing Florence

Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide, and a complex interaction of biological, anatomical, and behavioural factors shapes its transmission dynamics. Although HPV spreads efficiently in both directions between sexual partners, research has explored whether transmission from female to male differs in likelihood compared to male to female transmission.

Transmission of HPV occurs primarily through direct skin-to-skin or mucosa-to-skin contact during sexual activity. In female-to-male transmission, the virus is typically shed from infected mucosal surfaces of the cervix and vaginal lining. These tissues are composed of non-keratinised epithelium, which supports viral replication and can release viral particles into genital secretions. During intercourse, the penile epithelium comes into contact with these secretions, allowing the virus to access susceptible cells, particularly through microscopic abrasions that occur naturally during sexual activity. This continuous shedding from a relatively large mucosal surface area may increase the likelihood that a male partner is exposed to an infectious dose of the virus.

In contrast, male-to-female transmission involves viral presence on the penile shaft, glans, foreskin, or surrounding genital skin. These areas are more keratinised, meaning the outer layer of cells is thicker and less conducive to viral shedding compared to mucosal tissue. However, transmission remains highly efficient because the virus can be transferred to the cervix, especially to the transformation zone, a region where two types of epithelial cells meet and which is particularly vulnerable to HPV infection. Even a relatively small viral inoculum can establish infection in this biologically susceptible area, which helps explain why male-to-female transmission is also clinically significant.

Differences in observed transmission rates between the two directions may partly reflect variations in viral load and shedding patterns. Women with active HPV infection can exhibit higher short-term viral loads in the cervix, leading to increased shedding and potentially a higher probability of transmitting the virus to male partners during that period. Men, on the other hand, often exhibit lower peak viral loads but may carry the virus for longer durations. This persistence may not always produce symptoms, allowing HPV to remain undetected and transmissible over extended periods. As a result, while men may not always transmit the virus as efficiently with a single exposure, their longer infectious period can sustain transmission within a population.

Immune response differences also contribute to these dynamics. Women tend to mount stronger localised immune responses in the cervix and are more likely to clear HPV infections within one to two years. In men, immune responses in penile tissue appear to be less robust or less durable, which may allow the virus to persist longer. This difference does not mean that men inevitably carry high viral loads throughout life, but it does suggest that persistent, low-level infection is more common in men than in women. The absence of routine screening programs for men, comparable to cervical screening in women, further contributes to the perception of prolonged infection, as many cases go undiagnosed.

Behavioural and environmental factors further influence transmission in both directions. Frequency of sexual contact, number of partners, and condom use all play significant roles in determining risk. Circumcision status has also been associated with differences in acquisition and persistence, with uncircumcised men showing higher rates in some studies, possibly due to the microenvironment under the foreskin. Additionally, the presence of microabrasions, coexisting infections, and individual immune status can modify susceptibility.

It is important to emphasise that HPV transmission is fundamentally bidirectional and highly efficient regardless of direction. While certain studies suggest that female-to-male transmission may occur more readily in some contexts due to higher viral shedding from mucosal surfaces, male-to-female transmission is equally important, particularly because of the higher likelihood of persistent infection and serious outcomes such as cervical cancer in women. Therefore, differences in transmission should not be interpreted as a simple imbalance but rather as variations influenced by timing, biology, and context.

Women exhibit higher viral shedding during active infection, increasing short-term transmission risk to men, while men may experience longer persistence of infection, sustaining transmission over time. Both directions of transmission are efficient, and both contribute significantly to the global burden of HPV. Preventive strategies such as vaccination, safe sexual practices, and appropriate screening remain essential for reducing transmission and its associated health consequences. Albert Einstein famously said, “You cannot blame gravity for falling in love!” Dr G is often put on the spot by finger-pointing spouses demanding to find out who should take the blame for the higher risk of HPV transmission. His view is: “It’s definitely not helpful to blame this virus of Love!”

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Dear Dr G,

I read with interest how you highlighted the possibility of men having of cancer following human papillomavirus (HPV) infection.

You did note HPV-related cancers are far more common in women and fully agree that raising public awareness is important.

However, I am concerned by the suggestion that men, as what some refer to as the “stronger” sex, may need less protection than women.

I read a study that found there was a higher HPV prevalence in men and lower rates of lasting immune response after natural infection.

If this is the case, is it true HPV infect men and women equally?

Do men carry the virus more than women as they age?

Lastly, is there evidence that men develop stronger natural immunity to HPV than women?

Yours truly,
Weaker William

HPV is one of the most common sexually transmitted infections worldwide, affecting both men and women across all age groups.

Despite this shared exposure, important differences exist in terms of immunological response.

While HPV has traditionally been framed as a major women’s health issue due to its association with cervical cancer, growing evidence shows that men have weaker natural immunity to HPV.

This reduced immune response contributes to persistent infection, repeated exposure and a significant burden of HPV-related disease throughout life.

The burden of HPV infection in men is substantial and remains relatively constant across the lifespan – unlike women, whose HPV prevalence typically peaks in early adulthood and declines with age.

Men continue to acquire new infections throughout life, indicating a lack of effective protective immunity. As a result, men serve as both reservoirs and transmitters of the virus.

Clinically, HPV infection in men can manifest as genital warts caused by low-risk HPV types, as well as more serious conditions such as penile, anal and oropharyngeal cancers linked to high-risk types. Notably, the incidence of HPV-related oropharyngeal cancers has been increasing in men and often presents later in life, reflecting the long-term consequences of persistent infection.

A key explanation for this sustained disease burden lies in the differences in immune response between men and women following natural HPV infection.

Women are more likely to undergo seroconversion, meaning they develop detectable antibodies against HPV, particularly high-risk types such as HPV16 and HPV18.

These antibodies can provide partial protection against reinfection, suggesting the development of some level of immune memory.

In contrast, men exhibit lower rates of seroconversion and produce lower levels of antibodies. Even when antibodies are present, they do not appear to offer significant protection against subsequent infections, indicating a weaker and less durable immune response.

The reasons for this disparity are both anatomical and biological. The female genital tract is primarily composed of mucosal epithelium, which allows for greater exposure of viral antigens to the immune system and promotes stronger immune activation.

In contrast, much of the male genital epithelium is keratinised, limiting antigen presentation and reducing the effectiveness of immune recognition.

Additionally, broader immunological differences between sexes play a role, as females generally mount stronger innate and adaptive immune responses. Hormonal influences such as estrogen enhance immune activity, while testosterone in males has been associated with relatively immunosuppressive effects, further contributing to weaker immunity in men.

As a consequence of these factors, men often clear individual HPV infections without developing lasting immune protection. This leads to a cycle of infection, clearance and reinfection rather than the development of durable immunity.

Over time, repeated exposure increases the likelihood of persistent infection with high-risk HPV types, which is a critical factor in carcinogenesis. The inability to effectively eliminate the virus or prevent reinfection places men at a higher cumulative risk of developing HPV-related cancers.

The implications for cancer are significant, particularly given the absence of routine screening programs for men. While women benefit from cervical screening that allows for early detection and intervention, men typically lack comparable preventive measures. This often results in HPV-related cancers being diagnosed at later stages, when treatment is more challenging and outcomes are poorer. The rising incidence of oropharyngeal cancers in men highlights the growing importance of addressing HPV as a men’s health issue.

In conclusion, men can be considered the weaker gender in terms of natural immunity to HPV infection due to their lower rates of seroconversion, weaker antibody responses and lack of effective immune memory.

These immunological disadvantages, combined with anatomical and hormonal factors, lead to persistent susceptibility, repeated infections and an increased lifetime burden of disease. Recognising this disparity is essential for informing public health strategies, particularly the promotion of vaccination and awareness, to reduce the impact of HPV-related diseases in men and the broader population.

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Dear Dr G,

I am a father of two boys who is keen to highlight the lack of awareness for cancers in men induced by HPV.

I have two teenage boys who are 13 and 14 years old. Both of them recently came home with HPV vaccination consent forms.

Initially, I found it amusing as I thought the boys had brought back the consent forms by mistake, since I assumed HPV only affects women.

As the boys explained to me that HPV-induced cancer is a serious condition that affects both boys and girls, I began to pay attention.

I realized HPV is so serious that it causes many types of cancers, including cancers that can affect men too.

I am not sure what I read is true and hope to put Dr G on the spot for clarification.

Can you tell me what HPV is and how it is transmitted?

What is the scale of HPV induced cancers affecting both men and women?

What sorts of cancers can HPV cause in men?

Can HPV affect different races differently?

Look forward to your valuable responses.

Yours truly,

Worried William

Human papillomavirus (HPV) is one of the most prevalent sexually transmitted infections globally and a well-established cause of multiple malignancies. It plays a significant role in the global cancer burden, contributing to approximately 690,000 cancer cases each year and accounting for about 4.5–5% of all cancers worldwide. HPV is unique among infectious carcinogens because of its widespread transmission and its ability to cause cancers in both women and men.

Cervical cancer represents the most significant manifestation of HPV-related disease and remains the cornerstone of its global impact. It is the fourth most common cancer among women worldwide, with an estimated 660,000 new cases and approximately 350,000 deaths annually.

More than 90% of cervical cancer cases are attributable to HPV infection, particularly high-risk types such as HPV 16 and HPV-18, which together account for about 70% of cases. The disease disproportionately affects women in low- and middle-income countries, where nearly 90% of deaths occur. The geographical distribution of cervical cancer reflects broader global health disparities. Regions such as sub-Saharan Africa, South Asia, and parts of Latin America bear the highest burden

This stark inequality is largely due to limited access to preventive measures such as HPV vaccination, regular screening through Pap smears or HPV testing, and treatment. In men, HPV-related cancers present a different epidemiological profile. Unlike women, men do not experience a single dominant cancer equivalent to cervical cancer. Instead, HPV contributes to cancers of the oropharynx, anus, and penis, with oropharyngeal cancer emerging as the most common HPV-related malignancy in men.

Although the overall number of HPV-related cancers in men is lower than in women, the incidence of certain cancers, particularly oropharyngeal cancer, has been increasing in many parts of the world. In some high-income countries, the incidence of HPV-related oropharyngeal cancer in men now surpasses that of cervical cancer in women.

The rising burden of HPV-related cancers in men can be attributed to several factors. Unlike cervical cancer, there are no widely implemented screening programs for HPV-related cancers in men, resulting in later detection and poorer outcomes. Additionally, HPV vaccination programs initially focused on girls, leading to lower vaccination coverage among males, particularly in older cohorts.

Behavioral factors, including changes in sexual practices, have also contributed to increased transmission of oral HPV infections. Studies indicate that approximately one in three men worldwide is infected with genital HPV, highlighting the widespread nature of the virus in the male population.

A comparison between HPV-related cancers in women and men reveals important differences in disease burden, prevention, and trends. Women bear a significantly higher overall burden due to the predominance of cervical cancer, but benefit from established screening programs that enable early detection and treatment. In contrast, men experience a lower overall burden but face increasing incidence rates of certain cancers, particularly oropharyngeal cancer, and lack comparable screening strategies.

As a result, while cervical cancer incidence is declining in many high-income settings, HPV-related cancers in men are rising, suggesting a potential convergence in disease burden between genders in the future.

Looking ahead, the global trajectory of HPV-related cancers will depend heavily on the implementation of effective prevention strategies. HPV vaccination has the potential to prevent more than 90% of HPV-related cancers caused by vaccine covered strains and represents a cornerstone of cancer prevention efforts. The World Health Organisation has set ambitious targets for the elimination of cervical cancer as a public health problem, emphasizing widespread vaccination, screening, and treatment.

However, achieving these goals will require addressing disparities in vaccine access and healthcare infrastructure, particularly in low and middle-income countries. Expanding vaccination programmes to include boys and improving awareness of HPV-related risks in men will also be critical in reducing the overall burden of disease.

HPV has a profound and multifaceted impact on global cancer epidemiology. Cervical cancer remains the dominant HPV-related malignancy, particularly affecting women in low-resource settings, while other HPV-related cancers, especially oropharyngeal cancers in men, are increasing in incidence. Without significant global efforts, the burden of HPV-related cancers is likely to rise, particularly in underserved populations.

Conversely, with comprehensive vaccination and screening strategies, there is a realistic opportunity to substantially reduce the most devastating consequences of HPV infection.

Malala Yousafzai famously said: “We cannot succeed when half of us are held back.”

Admittedly, this is in reference to discrimination against women. However, when HPV-induced malignancy indiscriminately affects both genders, awareness is crucial to ensure equity.

Men surprised by the fact HPV can cause cancer in them often put Dr G on the spot. His opinion is: “We cannot succeed in fighting cancer when anyone is held back by lack of knowledge!”

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Dear Dr G,

I am a 30-year-old man who is really stressed about parenthood.

My wife and I have been married for the last three years and we have been trying for a baby since day one.

During the last three years of festivities during balik kampung, I have been seeing my wife interrogated by well-meaning uncles and aunties about babies.

In truth, we have a dark secret that nobody in the family knows.

My wife had actually undergone medical examinations and was given an all-clear.

My semen analysis revealed my sperm quality being suboptimal is the real reason behind the delay in conceiving.

My approach in the last few years has been avoiding conversation.

However, I have decided to face the issues and hope to enhance my sperm quality in the years to come.

I have done some online searches and was horrified by how many recommendations for fertility enhancement in men.

I am somewhat confused and hope to put Dr G on the spot to debunk the myths.

First of all, can you confirm whether the type of clothing will influence the quality of sperms?

Will frequent ejaculations also cause male infertility?

Will a certain diet influence the sperm quality? What about alcohol intakes?

Lastly, I hear stress can reduce sperm counts? How is that possible?

Please help.

Yours truly,

Stressed Saiful

Male fertility is influenced by a wide range of biological, environmental, and lifestyle factors. In recent years, increased awareness about declining sperm quality has led to the spread of both scientifically supported information and widespread myths. Misunderstanding these factors can create unnecessary anxiety or cause men to overlook important habits that genuinely affect reproductive health.

One common myth is that wearing tight underwear or certain clothing completely destroys sperm production. In reality, the testes require a slightly cooler temperature than the rest of the body for optimal sperm development, and prolonged heat exposure can reduce sperm quality.

However, clothing alone is rarely a major cause of infertility. More significant contributors include frequent use of hot tubs or saunas, placing laptops directly on the lap for long periods, and extended sitting without movement. Addressing these habits can help maintain a healthier environment for sperm production.

There is also a belief that frequent sexual activity significantly lowers sperm quality. While very frequent ejaculation may temporarily reduce sperm concentration, the body continuously produces new sperm. For most healthy men, regular sexual activity does not harm fertility.

In fact, moderate ejaculation frequency may help reduce the accumulation of damaged sperm cells. Problems arise only when underlying health conditions or hormonal imbalances interfere with normal sperm production. Dietary myths are particularly common.

Some people assume that consuming specific “superfoods” or supplements can rapidly restore fertility. While nutrients such as zinc, selenium, omega-3 fatty acids, and antioxidant vitamins play important roles in sperm health, no single food or supplement can reverse fertility problems on its own. Sustainable improvement usually depends on long-term dietary patterns that support overall metabolic and hormonal health.

A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats provides the foundation for better reproductive function. Alcohol consumption is another area where misconceptions exist.

Moderate intake may not significantly impair fertility in otherwise healthy individuals, but chronic heavy drinking can reduce testosterone levels and interfere with sperm production.

Similarly, smoking is sometimes underestimated as a fertility risk. Scientific studies consistently link tobacco use to reduced sperm count, impaired motility, and increased oxidative damage. Quitting smoking can lead to gradual improvements in sperm quality over several months, as sperm production cycles renew.

Stress and sleep are often overlooked lifestyle factors. Many men believe psychological stress has little physical impact on fertility.

However, chronic stress can disrupt hormonal balance, particularly by increasing cortisol levels that may suppress testosterone production. Poor sleep further compounds this problem by affecting metabolic health, immune function, and cellular repair processes. Together, these factors can reduce the efficiency of sperm development and contribute to reduced fertility potential.

Physical activity is generally beneficial for reproductive health, but another myth suggests that more exercise is always better. Moderate exercise supports hormonal regulation, improves circulation, and helps maintain a healthy body weight. Excessive or extreme endurance training, however, can lead to hormonal suppression and increased oxidative stress.

Striking a balance between activity and recovery is therefore important for maintaining optimal sperm quality. Medical evaluation can play a critical role when lifestyle changes alone are insufficient. Conditions such as hormonal disorders, infections, or varicocele may require targeted treatment. Fertility specialists can provide semen analysis and personalised guidance based on individual health status.

Early intervention often improves outcomes and reduces the emotional burden associated with fertility challenges. Many myths about male fertility persist despite growing scientific knowledge about sperm health. While certain lifestyle factors do influence sperm quality, the effects are usually gradual and modifiable. By understanding the difference between misconceptions and evidence-based facts, men can take proactive steps to improve their reproductive health.

Sustainable lifestyle improvements, combined with appropriate medical care when needed, offer the best chance of overcoming obstacles and supporting fertility. The philosopher George Santayana once said: “Myth is the truth which is imagined”.

As far as the causes of male infertility, the myths are certainly widely imagined. Men who are ready to face both myths and truths about problematic male fertility often put Dr G on the spot for advice. His view is: “Healthy living is the only truth that is imaginable for healthy sperms.”

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Dear Dr G,

I read with interest the focus in the last few weeks on female impact on fertility. I guess you did not elaborate on the impact of men and fertility due to overwhelming importance of female factors.

My wife and I have been married for more than a decade; we focused on our careers so that our offspring will have a better quality of life.

Although I often bank on my wife being 10 years younger than me to mitigate the impact of age-related infertility, I still cannot help but wonder about the negative implications of ageing and its effect on a man’s sperm quality.

As I venture into the fourth decade of my life, I hope to embark on the journey of parenthood with my wife this year.

Despite most doctors’ assurance of zero negative impact of my older sperm on the next generation, I still would like to put Dr G on the spot for his opinion.

Firstly, are there any changes in the quality of sperm in ageing men?

If so, what are the changes, and why?

What measures can a man take to improve the quality of his sperm?

Lastly, should I really be concerned with my ageing sperm above 40?

Yours truly,

Ageing Alan

Male fertility has long been considered relatively stable compared to female fertility, which declines more sharply with age.

However, growing scientific evidence shows that advancing paternal age is associated with gradual changes in sperm quality, reproductive outcomes, and potential risks to offspring health.

Research over the past few decades has demonstrated that several key semen parameters decline as men grow older. Studies have reported reductions in semen volume, sperm concentration, motility, and the proportion of normally-shaped sperm.

These changes often begin gradually after the mid-30s and may become more pronounced after the age of 40. Although many older men remain fertile, the probability of impregnation may decrease, and the time required to conceive can increase.

This decline is partly attributed to reduced efficiency of the testes and changes in hormonal regulation, particularly a gradual decrease in testosterone production.

One of the most significant age-related concerns involves the integrity of sperm DNA. As men age, sperm are more likely to exhibit DNA fragmentation and genetic mutations.

These changes are thought to result from cumulative exposure to environmental toxins, oxidative stress, and natural cellular aging processes.

Damage to sperm DNA can reduce fertilisation potential, impair embryo development, and increase the likelihood of miscarriage.

Some research also suggests a link between advanced paternal age and a higher risk of certain genetic or neurodevelopmental conditions in children, although the absolute risk remains relatively low.

Chronic illnesses such as diabetes, hypertension and obesity are associated with hormonal imbalance and increased oxidative stress, both of which can negatively affect sperm production and function.

Environmental exposure, including smoking, excessive alcohol consumption, and contact with pollutants or heat, may also contribute to declining fertility.

Thus, age-related fertility changes often reflect a combination of intrinsic biological factors and modifiable lifestyle influences.

Despite these challenges, there is strong evidence that certain measures can help improve sperm quality and fertility potential in older men. Adopting a balanced and nutrient-rich diet plays a central role in supporting reproductive health.

Nutrients such as zinc, selenium, omega-3 fatty acids, folate and vitamins C and E are particularly important for maintaining sperm motility and protecting DNA integrity.

Maintaining a healthy body weight is also crucial, as excess body fat can disrupt hormonal balance and reduce testosterone levels.

Regular moderate physical activity contributes positively to male fertility by improving cardiovascular health, metabolic function and hormonal regulation.

Exercise enhances blood flow, including to reproductive organs, and may help reduce inflammation and oxidative stress.

However, extremely intense or prolonged endurance training can have the opposite effect by suppressing testosterone and impairing sperm production.

Therefore, balanced exercise routines are generally recommended.

Lifestyle modifications such as quitting smoking, limiting alcohol intake and avoiding recreational drugs can lead to measurable improvements in sperm parameters over time.

These substances are known to impair sperm concentration, motility, and genetic quality.

Similarly, minimising exposure to excessive heat is important, as sperm production requires a temperature slightly lower than core body temperature.

Simple habits such as wearing loose-fitting clothing, avoiding frequent use of hot tubs or saunas, and reducing prolonged sitting can help maintain optimal testicular function.

Sleep quality and stress management also play important roles in reproductive health. Adequate sleep supports hormonal balance and overall cellular repair processes. Psychological well-being and lifestyle stability may therefore indirectly enhance fertility.

Medical evaluation is particularly important for older men who are attempting to conceive. Semen analysis, hormonal testing, and screening for conditions such as varicocele or reproductive tract infections can identify treatable causes of reduced sperm quality.

Management of chronic diseases and appropriate medical or assisted reproductive interventions may significantly improve the likelihood of successful conception.

While male fertility does not decline as abruptly as female fertility, advancing age is associated with measurable reductions in sperm quality and reproductive efficiency.

Biological ageing, increased DNA damage, hormonal changes and lifestyle factors all contribute to this process.

Nevertheless, many of these influences are modifiable. Through healthy nutrition, regular exercise, avoidance of harmful substances, stress reduction and appropriate medical care, older men can improve their reproductive health and enhance their chances of fatherhood.

Understanding these factors allows individuals and healthcare providers to make informed decisions about fertility planning in later life.

Legendary American actor Fred Astaire famously said: “Old age is like everything else. To make a success of it, you’ve got to start young.”

Older men hoping to make a success of parenthood often put Dr G on the spot for an opinion on their ageing sperm. His view is: “If you couldn’t start young, start now!”

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Dear Dr G,

I read with interest your explanation about getting the timing right for a successful pregnancy.

However, I was disappointed that you did not elaborate on how some couples face uncertainty when the woman has irregular periods.

My wife and I have been married for more than a decade.

We have grown used to the awkward questions from well-meaning relatives who expect my wife to be pregnant by now.

Although Artificial Reproductive Technology is available, we are determined to conceive as naturally as possible.

Doctors have ruled out polycystic ovarian syndrome (PCOS) and have attributed the issue to stress.

However, we were not offered any guidance on how to predict ovulation naturally.

First, why do some women have irregular periods, and how does this affect their chances of getting pregnant?

Are there ways to identify the fertile window for women with irregular periods?

Lastly, how can my wife regulate and improve her menstrual cycle?

Thank you in advance.

Yours truly,

Uncertain Eugene

Women who experience irregular menstrual cycles while trying to conceive may feel uncertain and frustrated. Unlike those with predictable monthly patterns, irregular cycles make it difficult to estimate when ovulation will occur and when the chances of pregnancy are highest.

However, understanding how fertility works and learning to observe the body’s natural signals can significantly improve the likelihood of conception. With patience, consistency and the use of complementary methods, it is possible to identify fertile periods and increase the chances of becoming pregnant, even when cycles vary in length.

Ovulation is the key event that determines fertility in any menstrual cycle. It is the moment when an ovary releases an egg that can be fertilised by sperm. The egg survives for about a day, but sperm can live inside the female reproductive tract for several days. As a result, the fertile window includes the few days before ovulation and the day ovulation occurs.

In regular cycles, this window can often be predicted by counting backwards from the expected start of the next period. In irregular cycles, however, ovulation may occur earlier or later than expected, or sometimes not at all.

Because of this unpredictability, relying only on calendar calculations is often ineffective. One helpful way to recognise approaching fertility is to pay attention to changes in cervical mucus.

Hormonal fluctuations throughout the cycle affect the amount and texture of this natural discharge. After menstruation, many women notice dryness or very little mucus. As oestrogen levels rise in preparation for ovulation, mucus usually becomes more noticeable and eventually clear. A clear, egg-white-like consistency is often a strong sign that ovulation is near and that the chances of pregnancy are highest.

Regular observation can provide valuable clues about the body’s reproductive rhythm, even when cycles are irregular. Another useful method is tracking basal body temperature, which is the body’s resting temperature measured immediately after waking. After ovulation, progesterone causes a slight but sustained rise in this temperature.

Although this rise confirms that ovulation has already occurred, charting temperature over several months can help identify patterns and estimate timing in future cycles. When combined with cervical mucus tracking, basal body temperature monitoring becomes more effective in predicting fertile days.

Ovulation predictor kits can also be especially helpful for women with irregular periods. These tests detect a surge in luteinising hormone in urine, which usually happens shortly before ovulation. Because irregular cycles may require longer monitoring, some women begin testing earlier and continue until a surge is detected.

When used alongside physical signs such as mild pelvic discomfort, increased sexual desire or slight breast tenderness, these kits can increase confidence in identifying fertile timing. Improving the chances of pregnancy involves more than identifying ovulation.

Having regular sexual intercourse during the suspected fertile window increases the likelihood that sperm will be present when the egg is released. Many healthcare professionals recommend intercourse every two to three days throughout the cycle for couples trying to conceive with irregular periods. This approach reduces the pressure of precise timing while still maximising opportunities for fertilisation.

Lifestyle factors also play an important role in supporting fertility. Maintaining a balanced diet, achieving a healthy body weight, managing stress and getting enough sleep can help regulate hormones.

Excessive exercise or sudden weight changes may disrupt ovulation, while ongoing stress can affect hormone production and menstrual regularity. Avoiding smoking, limiting alcohol intake and ensuring adequate intake of nutrients such as folic acid and iron can further support reproductive health.

Irregular cycles may be linked to underlying medical conditions such as hormonal imbalances, thyroid disorders or reproductive syndromes.

Healthcare providers may offer tests, treatments or medications to stimulate ovulation or regulate cycles, which can improve the chances of conception. Conceiving with irregular periods often requires persistence and a better understanding of the body’s signals. By combining careful observation, consistent tracking and healthy lifestyle habits, many women can identify their fertile windows and improve their chances of pregnancy.

Although the journey may sometimes feel uncertain, knowledge and proactive care can turn unpredictability into informed hope.

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Dear Dr G,

I am glad the whole CNY celebration is over.

As we venture into another Hari Raya, my wife and I cannot help but think about having another child.

I read with interest how you described the ideal timing for conception. Clearly, your focus was on women, when ovulation occurs within a small window, and how intercourse should be timed around that period.

On the other hand, I was disappointed that there was no mention of how the frequency of ejaculation should be incorporated into the timing of intercourse.

I am sure that certain days of abstinence should enhance the number and quality of sperm ejaculated. What I am uncertain about is the number of days or weeks of abstinence that will optimise sperm quality.

My wife consulted the gynecologist and was somewhat surprised by the advice. Instead of asking me to refrain from frequent ejaculations, the doctor actually asked us to engage in daily intercourse during the ovulation period.

We are somewhat confused and are wondering whether such frequency will deplete the sperm and defeat the purpose of fertility.

We are keen to put Dr G on the spot for some clarification.

Is frequent ejaculation good or bad for the quality of sperm? Would frequent ejaculation increase or decrease the overall number of sperm?

Apart from the numbers, what other parameters should be measured for better sperm quality?

Regards,

Frequent Freddie

The relationship between ejaculation frequency and sperm quality becomes clearer when we examine detailed quantitative data on specific sperm parameters such as motility, morphology, DNA integrity, and viability. These aspects of sperm quality are crucial because they directly influence the ability of sperm to reach, penetrate, and successfully fertilise the egg.

One of the most studied parameters is sperm motility, particularly progressive motility, which refers to the ability of sperm to move forward. Research consistently shows that shorter abstinence periods are associated with higher motility. For example, studies comparing one day versus three to five days of abstinence have reported increases in progressive motility of approximately 5 to 15% age points with shorter intervals. In contrast, when abstinence exceeds seven days, motility begins to decline more noticeably, and in some cases, progressive motility has been observed to drop below 20 % after extended periods of 10 to 14 days. This decline is thought to result from oxidative stress and ageing of sperm during storage in the epididymis.

Sperm DNA integrity is another critical factor that has gained attention in recent years. The DNA fragmentation index (DFI), which measures the proportion of sperm with damaged DNA, tends to increase with longer abstinence. Studies have shown that DFI can be reduced by as much as 20 to 30% when ejaculation occurs daily or every other day, compared with longer abstinence periods. Lower DNA fragmentation is associated with higher fertilisation rates, better embryo development, and a reduced risk of miscarriage, highlighting the importance of frequent ejaculation in maintaining genetic quality.

Morphology, or the structural normality of sperm, appears to be less sensitive to ejaculation frequency but still shows some variation. Research indicates that the percentage of morphologically normal sperm may improve slightly, often by a few percentage points, with shorter abstinence intervals. Although these changes are generally modest, they can still contribute to overall fertility, especially in individuals with borderline semen parameters.

Sperm viability, which refers to the proportion of live sperm cells, is also influenced by ejaculation frequency. Studies comparing short and long abstinence periods have found that viability can be 5 to 10% higher with shorter intervals. This finding is consistent with the idea that prolonged storage leads to cellular ageing and reduced membrane integrity, making sperm less likely to survive the journey through the female reproductive tract.

In addition to these parameters, biochemical markers of sperm function provide further insight. Reactive oxygen species (ROS), which can damage sperm membranes and DNA, tend to accumulate with longer abstinence. Frequent ejaculation helps reduce ROS levels, thereby protecting sperm from oxidative damage. Similarly, mitochondrial activity, which powers sperm movement, has been shown to be higher in sperm obtained after shorter abstinence, contributing to improved motility.

Taken together, these data reinforce the concept that sperm quality is optimised with moderate ejaculation frequency. While longer abstinence increases sperm count, it often does so at the expense of motility, DNA integrity, and overall cellular health. Conversely, shorter intervals between ejaculations promote the production of fresher, more functional sperm, even if the total number is slightly reduced.

A deeper examination of sperm quality parameters demonstrates that frequent ejaculation has measurable benefits beyond simple sperm count. Improvements in motility, DNA integrity, viability, and cellular function all contribute to a higher likelihood of successful fertilisation. These findings support clinical recommendations that emphasise regular ejaculation, particularly during the fertile window, as a key strategy for enhancing reproductive outcomes. An American motivational speaker, Marie Forleo, once said: “Success doesn’t come from what you do occasionally, it comes from what you do consistently.” Dr G is often put on the spot for his view on whether ejaculation frequency enhances reproductive outcomes. His verdict: “Consistency is the only way to optimise outcome!”

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Dear Dr G

First of all, Gong Xi Fa Cai, and happy new year to your family and all readers who are celebrating.

My wife and I are newlyweds and are contemplating starting a family soon. We are a bit superstitious, and our Feng Shui master has informed us that our Zodiac signs would be complemented perfectly by having a Horse baby.

During the Chinese New Year, we have received various tips from well-meaning uncles and aunties on ways to enhance pregnancy. You wouldn’t believe some of the suggestions, including specific timing and positions for sexual intercourse to ensure the perfect union of egg and sperm. Some even suggested that certain timings are ideal for conceiving a boy or a girl.

Although we believe in and will follow some of the tips suggested, I am still keen to hear from an expert. Therefore, I am hoping to put Dr G on the spot for some clarifications.

Firstly, why is the timing of intercourse crucial for a successful pregnancy?

What is the scientific basis for such timing?

Can sexual position and post-coital position enhance the chances of pregnancy?

Lastly, are there any other tips to ensure we have a Horse baby?

Regards

Timing Tim

The timing of sexual intercourse plays a central role in enhancing fertility because human conception depends on a very narrow biological window. Unlike many other processes in the body, the opportunity for fertilisation each month is limited to a few days surrounding ovulation. Understanding this timing allows couples to maximise their chances of conceiving naturally, without unnecessary stress or overly complicated interventions.

The menstrual cycle is typically around 28 days, although it can vary from person to person. Ovulation, the release of an egg from the ovary, generally occurs about 14 days before the next menstrual period. Once released, the egg remains viable for fertilisation for only about 12 to 24 hours. In contrast, sperm can survive within the female reproductive tract for up to five days under optimal conditions. This difference creates what is known as the fertile window, which includes the five days leading up to ovulation and the day of ovulation itself. Intercourse during this window significantly increases the likelihood that sperm will be present when the egg is released.

Rather than attempting to predict ovulation with absolute precision, many healthcare professionals recommend having sexual intercourse regularly throughout the fertile window. Engaging in intercourse every one to two days during this period helps ensure that viable sperm are consistently available. This approach reduces the risk of missing ovulation due to slight variations in cycle timing, which are common even in individuals with otherwise regular cycles. It also avoids the pressure of trying to time intercourse to a specific hour, which can sometimes create anxiety and negatively affect the experience.

Several natural signs can help identify the approach of ovulation. One of the most reliable indicators is a change in cervical mucus, which becomes clear, stretchy, and egg-white-like during the fertile phase. This type of mucus supports sperm survival and movement. In addition, ovulation predictor kits, which detect a surge in luteinizing hormone, can provide a more precise indication that ovulation is likely to occur within the next 24 to 36 hours. Some individuals also track basal body temperature, although this method is more useful for confirming ovulation than predicting it.

Despite the availability of scientific information, many myths about timing intercourse for conception continue to circulate. One common misconception is that specific sexual positions can significantly increase the chances of pregnancy. In reality, there is no strong scientific evidence to support this claim, as sperm are capable of reaching the cervix quickly regardless of position. Similarly, the belief that a person must remain lying down or elevate their hips after intercourse to aid conception is largely unsupported; while it may seem logical, it has not been proven to meaningfully affect outcomes.

Another widespread myth is that couples should abstain from intercourse for several days before ovulation to “build up” sperm count. Although sperm concentration can increase slightly with abstinence, longer gaps between intercourse can actually reduce overall chances by missing parts of the fertile window. Regular intercourse, rather than infrequent but strategically timed encounters, is generally more effective. There is also a misconception that ovulation always occurs on day 14 of the cycle. While this may be true for some individuals, many experience natural variations, and relying strictly on this assumption can lead to mistimed efforts.

Additionally, some people believe that conception is only possible on the exact day of ovulation. This overlooks the fact that sperm can survive for several days, making intercourse in the days leading up to ovulation equally, if not more, important. Another persistent myth is that stress alone can completely prevent pregnancy. While extreme stress may influence hormonal balance, everyday stress is unlikely to be the sole cause of difficulty conceiving. However, reducing stress can still be beneficial for overall well-being and relationship health.

In conclusion, enhancing fertility through the timing of sexual intercourse is largely about understanding and working with the body’s natural reproductive cycle while avoiding common misconceptions. By focusing on the fertile window, maintaining regular intercourse, and relying on evidence-based methods rather than myths, couples can significantly improve their chances of conception. This approach emphasises consistency, accurate knowledge, and a balanced perspective, helping to reduce unnecessary anxiety and promote a more informed and confident journey toward pregnancy.

English philosopher Francis Bacon once said: “To choose time is to save time.” Couples in a hurry to get pregnant for a preferred zodiac baby often put Dr G on the spot for the perfect conception timing. His response is: “As time is running out, better waste no time and gallop into the bedroom with good timing!”

The post Galloping to conception: Beating the clock for a Horse baby appeared first on George Lee.my.

Dear Dr G,

First of all, Gong Xi Fa Cai and Happy New Year to your family and all readers celebrating.

I have read with interest all the articles you wrote about “love pills”. I agree that the medication is unavoidable when ageing or unhealthy men are affected by erectile dysfunction.

Although you have provided reasonable scientific evidence that the blue pills are safe, I have several concerns.

You may think these concerns are myths, but I need to put you on the spot to debunk them before

“Chinese Valentine’s Day” or Chap Goh Meh.

First of all, is there evidence that taking too many of the pills at an early age can result in dependency?

Secondly, by taking the pills earlier in life, does it mean higher doses will be needed as we age?

Also, can too many blue pills cause renal failure?

Lastly, I often hear about sudden death associated with taking the pills. Has this happened?

Mythical Mike

Despite decades of clinical use and extensive research, phosphodiesterase type-5 inhibitors (PDE5 inhibitors) remain surrounded by persistent myths. These medications influence blood vessels and sexual function, so they often cause anxiety and attract misinformation.

Concerns about dependency, tolerance, kidney damage and sudden death continue to circulate, even though there is scientific evidence that clears the air. One of the most common fears is that people who use PDE5 inhibitors will become dependent on them. This belief likely arises from confusion with medications that affect the brain’s reward system, such as opioids or sedatives.

PDE5 inhibitors, however, do not act on addiction pathways in the brain. They do not produce cravings, withdrawal symptoms, or chemical dependence. Their action is purely physiological, as they enhance blood vessel relaxation.

When the medication is stopped, the body does not experience withdrawal. Instead, in some cases, individuals may develop psychological reliance because they feel more confident or comfortable when the medication works reliably.

This form of reliance is comparable to using glasses for vision correction rather than a sign of drug addiction. The underlying condition remains unchanged, and the medication simply helps manage its symptoms.

Another widespread misconception is that long-term use inevitably leads to tolerance, meaning the body becomes accustomed to the drug and requires increasing doses. This idea is common with substances such as alcohol or certain pain medications, and it is often incorrectly applied to PDE5 inhibitors.

Long-term clinical studies have shown that these medications maintain their effectiveness over many years without the need for progressively higher doses. When patients report that the medication seems less effective over time, the most likely explanation is progression of the underlying health condition rather than tolerance to the drug.

Erectile dysfunction is frequently linked to ageing, diabetes, high blood pressure and cardiovascular disease. As these conditions worsen, symptoms may become more severe, creating the impression that the medication is losing effectiveness. In reality, the disease may be progressing while the drug’s pharmacological action remains stable.

Concerns about kidney damage represent another enduring myth. Many people think that any medication processed by the body must place strain on the kidneys. PDE5 inhibitors are primarily metabolised by the liver and are then eliminated through both urine and stool.

In individuals with healthy kidney function, these medications are not known to cause kidney damage when used as prescribed. For patients with severe kidney disease, physicians may recommend lower doses because the drug can remain in the bloodstream for a longer period. This adjustment reflects careful medical practice rather than evidence of toxicity.

In fact, ongoing research is exploring whether or not PDE5 inhibitors might offer protective benefits in certain cardiovascular and kidney conditions because of their positive effects on blood vessel health and circulation. Perhaps the most alarming myth is the claim that PDE5 inhibitors can cause sudden death.

This fear gained attention shortly after the first medication in this class became widely available, when media reports highlighted isolated cases of heart attacks occurring during sexual activity. The crucial context often overlooked is that sexual activity itself is a form of physical exertion.

Many individuals who use PDE5 inhibitors are older and may already have cardiovascular disease, which increases the risk of heart events regardless of medication use. Large studies have demonstrated that PDE5 inhibitors do not independently cause sudden death when prescribed appropriately.

The primary safety concern involves combining these medications with nitrate drugs used to treat chest pain. This combination can cause a dangerous drop in blood pressure and is strictly avoided. Some research even suggests that they may improve cardiovascular health by enhancing blood vessel function and circulation.

These myths persist partly because the medications were highly publicised when introduced, and because they are associated with sensitive topics such as sexual health and heart disease. Public discussions often lack the nuance of scientific research, allowing fear to spread more easily than accurate information. Over time, repeated misconceptions can become accepted as fact despite the lack of supporting evidence.

In conclusion, the myths that PDE5 inhibitors cause dependency, tolerance, kidney damage, or sudden death are not supported by scientific research. These medications work by enhancing natural vascular processes and have been studied extensively for decades. When used under proper medical supervision and with attention to contraindications, they have an established safety profile.

Understanding the difference between myth and evidence allows patients to make informed decisions based on science rather than fear. American astronomer Carl Sagan once said: “Extraordinary claims require extraordinary evidence.”

When Dr G is put on the spot to debunk love pill myths before “Chinese Valentine’s Day”, his response is: after 28 years of overwhelming evidence, why are there still extraordinary claims?

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Dear Dr. G,

I am a sixty-year-old man who is reaching an age where it is becoming difficult to achieve a satisfactory erection for regular intimacy with my wife.

I accept that Erectile Dysfunction (ED) is a fact of life for an ageing man and is likely related to diabetes, hypertension and high cholesterol.

My wife agreed for me to try blue pills, and frankly, the pills have saved our marriage.

As our sex life is very regular, the frequent consumption of the pills has become cumbersome and quite expensive.

I recently went to the GP and discussed another ageing problem with my prostate.

He noticed that my frequent blue pills could be replaced by daily pills that can treat my prostate too.

The doctor also highlighted that daily pills can reduce the ups and downs of drug concentration, thereby reducing fluctuations in side effects.

I was curious, as he mentioned the daily dose is also good for other medical conditions.

I would like to put Dr G on the spot for some clarifications.

Firstly, can you please tell me how the daily dose of the hard pills works?

What are the pros and cons as compared to on-demand dosing?

Can the medications truly be used for other medical conditions?

Lastly, if I choose to take the pills on a daily basis, will I suddenly have Happy Valentines every night?

Regards

Valentine Vincent

The history of phosphodiesterase type-5 (PDE5) inhibitors began in the late twentieth century, when research initially aimed at treating angina unexpectedly prompted a shift in focus toward sexual medicine and vascular physiology. In 1998, sildenafil became the first PDE5 inhibitor approved for erectile dysfunction, marking a turning point in both medical treatment and public awareness of sexual health. PDE5 inhibitors are widely associated with the treatment of erectile dysfunction, yet their medical significance extends far beyond this original purpose. Over time, their use has evolved from occasional, “as-needed” dosing to daily low-dose therapy designed to provide continuous physiological benefits.

Understanding the mechanism of PDE5 inhibitors helps explain why daily dosing can be effective. These medications inhibit the phosphodiesterase type 5 enzyme, which normally degrades cyclic guanosine monophosphate (cGMP). This molecule plays a crucial role in relaxing smooth muscle and widening blood vessels. By preventing the breakdown of cGMP, PDE5 inhibitors maintain blood vessel relaxation for longer periods, thereby improving circulation and tissue oxygenation. Although this effect is best known for improving erectile function, it also affects blood flow to the prostate, bladder, lungs, and other organs.

Daily dosing has demonstrated notable effectiveness in the treatment of erectile dysfunction, particularly for individuals with persistent symptoms or those who prefer spontaneity in sexual activity. Rather than planning medication use around specific occasions, patients taking daily therapy maintain a consistent level of medication in their system. This approach may improve baseline erectile function and reduce anxiety related to performance. Continuous treatment may also support long-term vascular health in penile tissue by improving oxygenation and reducing episodes of hypoperfusion. Hence, it is known to be effective for “penile rehabilitation” following the trauma of surgical intervention, such as radical prostatectomy for the treatment of prostate cancer.

Beyond sexual health, daily PDE5 inhibitor therapy has shown effectiveness in managing urinary symptoms caused by benign prostatic hyperplasia, a condition involving enlargement of the prostate gland. The medications relax smooth muscle in the bladder and prostate, thereby reducing urinary urgency, improving urine flow, and decreasing nocturnal urination. For patients experiencing both erectile dysfunction and urinary symptoms, daily dosing offers the advantage of treating multiple conditions with a single medication. Another important medical application is pulmonary arterial hypertension, a serious disorder characterised by narrowed blood vessels in the lungs. PDE5 inhibitors improve exercise tolerance and help reduce pulmonary blood pressure, illustrating the broader significance of their effects on the circulatory system.

The advantages of daily therapy include stable drug levels in the bloodstream and reduced fluctuations associated with higher, intermittent doses. Continuous dosing may produce more consistent therapeutic effects and may improve treatment adherence for individuals managing chronic conditions. However, these benefits must be weighed against potential side effects and the need for ongoing medical supervision.

The most common side effects of PDE5 inhibitors are generally mild and are associated with their vasodilatory effects. Headaches, facial flushing, nasal congestion, indigestion, and mild dizziness are among the most frequently reported symptoms. Some individuals experience muscle or back pain, particularly with longer-acting medications. These effects often diminish as the body adjusts to treatment. More serious risks are rare but important to consider. Because these drugs lower blood pressure, they must never be combined with nitrate medications used for heart disease, as this combination can cause a dangerous drop in blood pressure. In rare cases, individuals may experience changes in vision or hearing, and prolonged erections lasting several hours require immediate medical attention. Drug interactions with certain antibiotics, antifungals, and heart medications also require careful management by healthcare professionals.

Research into PDE5 inhibitors continues to expand, with scientists exploring their potential role in cardiovascular disease, circulation disorders such as Raynaud’s phenomenon, and other conditions related to vascular function. These ongoing investigations highlight the possibility that the medications may offer broader health benefits than initially recognised, potentially including the treatment of altitude sickness in both men and women.

In conclusion, daily-dose PDE5 inhibitors represent a significant evolution in pharmacology. What began as an accidental discovery during research on heart disease has evolved into a versatile therapeutic approach for several chronic conditions. Daily therapy offers consistent effectiveness and improved convenience, though it requires awareness of possible side effects and careful medical oversight. As scientific understanding of vascular health continues to develop, PDE5 inhibitors may play an increasingly important role in future medical treatments. American actress Mae West once said, “Sex is emotion in motion.” Men contemplating switching from “Valentine” pills to a daily dose for sexual benefits and beyond often put Dr G on the spot for his opinion. His view is: “Sexual health treatment is also evolution in motion!”

So, take advantage of this evolution and enjoy Happy Daily Valentines!

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