Dear Dr G,

I am a 57-year-old man who has been married for thirty years.

Although my wife is nine years younger than I am, she was rarely sexually inclined, even in the early days of our marriage.

In recent years, my wife has been experiencing perimenopausal symptoms, and our intimacy has also been diminishing rapidly.

It’s nearly the halfway point of 2026, and I really cannot recall when we last had sex.

Although this has affected me deeply, my wife and I do not like to talk about the subject, as we both find the conversation embarrassing and awkward.

Truthfully, I am not keen on masturbation.

Therefore, I often find the lack of sex both depressing and frustrating.

After reading about the protective effects of sexual activity against prostate cancer, I began to wonder whether a lack of ejaculation could harm my health.

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

What exactly constitutes a sexless relationship, and how common is it?

Knowing how sex can enhance bonding in couples, what are the reasons people have sexless relationships?

What sort of physical or psychological impact can sexlessness have on health?

Finally, how do I get out of this sexless relationship?

Yours truly,

Sexless Sean

Sexual intimacy is widely recognised as an important component of many romantic relationships, contributing not only to physical pleasure but also to emotional connection, relationship satisfaction, and overall well-being. It is important to recognise that not all sexless relationships are problematic. Some couples mutually agree that sexual activity is not a priority and maintain strong emotional bonds through companionship, affection, shared interests, and mutual support. The critical factor is whether both partners feel comfortable and fulfilled with the arrangement.

A lack of sexual contact is commonly referred to as a sexless relationship. While there is no universally accepted definition, researchers generally describe a sexless relationship as one in which sexual activity occurs fewer than ten times per year. Research suggests that sexless relationships are more common than many people realise. Population studies from North America and Europe estimate that approximately 10% to 20% of married couples are living in sexless marriages. Surveys have also demonstrated a gradual decline in sexual frequency across many developed and developing countries over recent decades, particularly among younger adults. While sexual activity naturally fluctuates throughout the lifespan, prolonged periods of sexual inactivity are becoming increasingly recognised as a significant relationship and public health issue.

The causes of sexless relationships are often multifactorial and involve a complex interaction of biological, psychological, relational, and social influences. One of the most common contributors is relationship conflict. Persistent disagreements, unresolved resentment, emotional disconnection, and breakdowns in communication can erode intimacy over time. Physical health conditions are another important factor. Chronic illnesses such as diabetes, cardiovascular disease, obesity, arthritis, and cancer can directly impair sexual functioning or reduce energy levels and interest in sexual activity. Hormonal disorders, including thyroid disease and low testosterone levels, may significantly diminish libido. Women undergoing menopause often experience vaginal dryness, discomfort during intercourse, and hormonal fluctuations that can affect sexual desire.

Sexual dysfunction itself can become both a cause and a consequence of a sexless relationship. Erectile dysfunction, premature ejaculation, difficulties achieving orgasm, and pain during intercourse often lead individuals to avoid sexual encounters due to embarrassment, anxiety, or fear of disappointing their partner. Over time, this avoidance can become entrenched, creating a self-perpetuating cycle in which sexual activity becomes increasingly infrequent.

The psychological impact of a sexless relationship can be profound, particularly when the absence of sexual activity is unwanted. Individuals who desire greater intimacy often report feelings of loneliness, rejection, frustration, sadness, and diminished self-worth. Repeated experiences of sexual rejection may lead some individuals to question their attractiveness, desirability, or value within the relationship. Over time, these feelings can contribute to anxiety, depressive symptoms, and a general decline in psychological well-being. The emotional distress associated with unmet intimacy needs may be especially significant when a lack of affection, emotional support, or open communication accompanies sexual inactivity.

When sexual activity declines significantly, couples may experience reduced relationship satisfaction, increased conflict, and greater emotional distance. Although many factors influence relationship stability, studies consistently demonstrate an association between sexual satisfaction and overall relationship quality. The physical health implications of sexless relationships are more complex. The absence of sex itself is not inherently harmful, and many individuals lead healthy and fulfilling lives without sexual activity. However, sexual activity has been associated with several health benefits, including improved sleep quality, reduced stress, temporary reductions in blood pressure, enhanced mood, and increased release of hormones such as oxytocin and endorphins.

Sexless relationships are relatively common and arise from a wide range of biological, psychological, relational, and social factors. While some couples thrive without sexual activity, an unwanted absence of intimacy can significantly affect emotional well-being, relationship satisfaction, and overall quality of life. Understanding the underlying causes and addressing them with empathy, communication, and appropriate support can help couples navigate these challenges and foster healthier, more fulfilling relationships. As relationship expert Esther Perel has said, “Sex is not something you do; sex is a place you go.” Couples facing sexless relationships often look to Dr G for a solution. His view is: “When sex is going nowhere, it’s definitely time to do something to reignite the sparks of love!”

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Dear Dr G,

I am a 57-year-old man with a younger partner who is nearly 50.

I often assume having a younger partner can fulfil my healthy sexual appetite.

Since passing my milestone birthday seven years ago, my partner assumes we are approaching the sunset years and that sexual frequency would dwindle.

On the contrary, I continue to enjoy an active sex life, as often as during my youth.

My partner sadly finds such frequency unacceptable, and reckons frequent sexual intercourse should be a distant memory, with the focus shifting to non-sexual forms of intimacy in our later years.

I often find the disparity in our sexual desire a real frustration.

This is clearly having a significant adverse impact on our relationship.

I take this opportunity to put you on the spot for evidence and real-life data on sexual activity among older Malaysians.

I understand Malaysia is a conservative country. However, is there any study highlighting the normal frequency of sexual activity in Malaysia?

Is there a significant drop in the frequency of sexual intercourse in ageing populations?

Incidentally, what influences the frequency of sexual intimacy?

I look forward to your response.

Yours truly,

Frequent Frederick

Malaysia-specific data on sexual activity among married and partnered adults are relatively limited, because large-scale national surveys tend to focus on reproductive health, adolescent behaviour, or sexual health issues rather than the frequency of sexual intercourse among couples.

Nevertheless, available Malaysian studies provide some insights into sexual activity, satisfaction and wellbeing. The Asia Pacific Sexual Health and Overall Wellness (APSHOW) survey, published in 2011 in the Journal of Impotence Research, involved 4,000 participants across 13 countries, including both male and female participants from Malaysia.

It offers a glimpse of sexual health in Malaysia a decade ago and outlines how older Malaysians view sexual health. Research on older Malaysian adults aged 60 and above found that 57.3% had engaged in sexual intercourse within the previous 12 months. The prevalence was higher among men (61.6%) than women (50.6%).

Significant ethnic differences were also observed, with sexual activity reported by 68.8% of older Indians, 62.4% of Malays, and 51.7% of Chinese respondents. The study concluded that sexual activity remained an important aspect of quality of life in later years, and was associated with better physical health, marital relationships and overall wellbeing.

Among older Malaysians, another study examining sexual desire and satisfaction found many participants continued to value intimacy and regarded sexual relations as an important component of marriage. Although the frequency of sexual activity declined with age, emotional closeness, companionship and mutual support became increasingly important determinants.

There may be a decline in average frequency of sexual intercourse among couples from eight times a month to six times a month between under- and over-40 age groups. The frequency of intercourse remained relatively high in both age groups. Studies examining sexual health among Malaysians indicate sexual concerns are common but often underreported.

Research involving older adults found women reported more sexual difficulties than men. About 72.5% of women reported a lack of interest in sex, 55.1% reported difficulty achieving orgasm, and 34.8% described sex as unpleasant.

These findings suggest sexual satisfaction is influenced not only by frequency of intercourse, but also by physiological, psychological and relationship factors. Malaysia’s multicultural and religiously diverse society shapes sexual attitudes and behaviours. Marriage remains the socially accepted context for sexual activity.

Consequently, discussions about sexual health often occur less openly than in many Western countries. This conservatism can discourage couples from seeking professional help for sexual problems, despite evidence that sexual wellbeing contributes substantially to overall health and relationship satisfaction. Studies consistently show Malaysians place a high value on marital harmony, emotional intimacy and family stability, all of which are closely linked to sexual satisfaction.

Economic and lifestyle factors also influence sexual activity among Malaysian couples. Rapid urbanisation, long working hours, traffic congestion, financial pressures and the increasing prevalence of dual-income households can reduce opportunities for intimacy. In urban centres such as Kuala Lumpur, Petaling Jaya, Johor Baru and Penang, couples frequently report work-related stress as a major challenge affecting relationship quality and sexual desire.

While comprehensive national statistics on sexual frequency are unavailable, health researchers generally recognise stress, fatigue, chronic illness and mental health concerns as important determinants of sexual wellbeing among Malaysian adults.

Overall, the evidence suggests sexual wellbeing among Malaysians is strongly associated with physical health, emotional connection, communication between partners and relationship satisfaction.

Malaysian experience indicates the quality of intimacy and emotional closeness often has a greater impact on sexual satisfaction than the frequency of sexual intercourse alone. Couples who maintain strong communication, mutual respect and good health generally report higher levels of overall wellbeing and relationship fulfilment.

In conclusion, while comprehensive national data on the frequency of sexual activity among Malaysian couples remain limited, existing research suggests frequency of intercourse can be a barometer of relationship wellbeing. Sexual wellbeing is also a key component of overall quality of life.

Factors such as physical health, emotional intimacy, cultural values, communication and lifestyle pressures all play significant roles in shaping sexual satisfaction. The evidence suggests that for many Malaysians, sexual frequency remains important in maintaining healthy and fulfilling partnerships. The American sex researcher Emily Nagoski once said: “Sex strengthens the bonds between partners.”

When Dr G is questioned by people who feel deprived by less frequent sex, his view is: “The more frequent, the stronger the bond!”

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Dear Dr G,

I read with interest the articles highlighting the various adversities of sexual and reproductive health.

I think it is time for me to be open about my status as an individual living with HIV.

I am a 33-year-old man who contracted HIV in my late 20s through ignorance and carelessness.

Although guilt and shame initially drove me to despair, I am living proof there is a fulfilling life after being infected with HIV.

My world crumbled when I learned I had tested positive during routine blood donation screening, as HIV was always three letters associated with imminent death.

Now living with the virus with the right treatment, I feel compelled to spread the word that HIV no longer has the haunting past it once did.

Although I am living healthily on an antiretroviral regimen, I still cannot help doubting how treatment, or living with HIV, might affect me sexually.

As I start a new life with my wife, I would like to put you on the spot for clarification on the sexual and reproductive impact of living with HIV.

First, how does HIV affect men’s reproductive health?

Can the virus or its treatment cause sexual dysfunction in any way?

How can I prevent HIV transmission to my loved ones, including the next generation?

Lastly, my biggest fear is stigma. How do we stop stigma from consuming us?

Yours truly,

HIV-Howard

Living with HIV can affect sexual and reproductive health in physical, emotional and social ways. Since HIV was identified in the 1980s, medical advances have transformed it from a life-threatening illness into a manageable chronic condition. Today, antiretroviral therapy (ART) allows many people living with HIV to live long, healthy lives.

However, HIV and its treatment can still influence fertility, sexual wellbeing, mental health and long-term physical health. HIV can affect sexual and reproductive health in several ways. In the early stages of infection, the virus weakens immune function and may contribute to fatigue, weight loss, hormonal imbalance and increased vulnerability to other sexually transmitted infections.

In men, HIV may be associated with reduced sperm quality, lower testosterone levels and erectile dysfunction, particularly if infection is untreated or treatment is interrupted. Women living with HIV may experience menstrual irregularities, pelvic infections and pregnancy-related complications if proper care is not available.

The emotional and social impact of HIV is also significant. Many people living with HIV experience anxiety, depression, fear of rejection and stigma that affects relationships and sexuality. Concerns about transmitting the virus to partners or future children can affect intimacy and family planning decisions.

In some societies, stigma and discrimination still create barriers to healthcare and emotional support, even though medical understanding of HIV has improved greatly. One of the greatest breakthroughs in HIV care has been antiretroviral therapy. ART works by reducing the amount of virus in the body to extremely low levels.

When taken consistently, treatment can make the virus “undetectable”, meaning it cannot be sexually transmitted to others. This is the basis of “Undetectable = Untransmittable” (U=U) and has expanded the reproductive choices of people living with HIV.

In the short term, ART can cause side effects such as nausea, headache, fatigue, diarrhoea, and sleep disturbance, particularly when treatment is first started. Some people may also notice changes in mood or appetite. These symptoms often improve as the body adjusts.

The long-term effects of ART are more complex. While modern medications are far safer than earlier HIV drugs, long-term treatment may still be associated with weight gain, higher cholesterol, liver or kidney problems and reduced bone density in some patients.

Long-term HIV infection and chronic inflammation may also increase the risk of cardiovascular disease and diabetes as people age. Despite these challenges, ART has dramatically improved reproductive outcomes.

With proper treatment and medical follow-up, women living with HIV can become pregnant and give birth with a very low risk of mother-to-child transmission. Couples affected by HIV can also pursue parenthood with medical guidance, including timed conception and assisted reproductive technologies where appropriate.

Living with HIV today is very different from what it was decades ago. Many individuals can maintain healthy relationships, active sex lives and successful pregnancies. However, HIV still carries physical, emotional and social challenges that require ongoing healthcare, education and support.

Reducing stigma remains essential. “Stigma is more harmful than the disease itself” is a widely used mental health advocacy quote. In the 21st century, with the right treatment and disease awareness, living with HIV can be much like living with other chronic conditions.

Dr G is often put on the spot about how to minimise stigma.

His view is: “Only disease awareness and open communication can sway the shame and stigma against the disease itself!”

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Dear Dr G,

I can see that you are discussing various preventable viral infections in May.

I am a bit surprised that the elephant in the room, Covid-19, is not being highlighted, as it should still be fresh in our minds.

I am in my early twenties and, unfortunately, like many other people, my wife and I contracted Covid-19 during the pandemic. My wife was very lucky, as her symptoms were relatively mild, but I unfortunately ended up in the ICU due to severe respiratory distress.

Our biggest worry at the time was that my wife was also pregnant with our first child. We were very concerned about how the virus or the vaccine could adversely affect our baby.

Thankfully, our daughter is now three years old. She has achieved all her normal developmental milestones and is flourishing.

Despite life returning to normal, I cannot help but wonder what impact the virus and the Covid vaccine may have had on my family and me.

I would like to take this opportunity to put Dr G on the spot for his wisdom!

Five years down the line, what data are there on children born during the Covid pandemic?

What are the adverse reproductive consequences of Covid and the vaccine on both men and women?

Lastly, I have also read about men suffering from Covid-induced sexual dysfunction. Should I be worried that this might come back to haunt me?

Regards,

Covid-Christopher

Five years after the Covid-19 pandemic changed the world, its impact on sexual and reproductive health is still being felt. What began as a respiratory illness quickly affected many other areas of life, including fertility, pregnancy, mental health, relationships, and access to healthcare. Both the virus and the vaccines became major topics of concern, especially when questions about infertility and pregnancy safety began spreading online. Many researchers are still analysing the physical and psychological effects associated with both the virus and the vaccine.

Research over the years has shown that Covid-19 infection itself can affect reproductive health in several ways. In men, severe infection has been linked to temporary reductions in sperm quality and hormonal changes caused by fever, inflammation, and overall stress on the body. Women have also reported menstrual irregularities after infection, including delayed or heavier periods. Most of these effects appear to be temporary, but they clearly demonstrate that the virus can influence the reproductive system. Although most men and women recover completely without long-term reproductive impairment, a small proportion of individuals may experience irreversible infertility following more severe Covid-19 infection.

Pregnancy was another major concern during the pandemic. Studies found that pregnant individuals who contracted Covid-19 faced higher risks of severe illness, hospitalisation, and complications such as preterm birth. Hospitals and healthcare systems were also overwhelmed, making access to prenatal care and reproductive services more difficult in many countries. Fertility treatments, contraception services, and sexual health clinics were often delayed or interrupted during lockdowns. Encouringly, data collected during the peak of the pandemic did not show an increase in stillbirths or major birth abnormalities. The vaccines have been shown to be safe for both mother and fetus during pregnancy and after birth.

Covid-19 vaccines soon became surrounded by controversy and misinformation. Many people feared that the vaccines could cause infertility, but years of scientific studies have found no evidence to support these claims. Research involving millions of vaccinated individuals has shown that the vaccines do not reduce fertility in men or women. Some women experienced temporary changes in their menstrual cycles after vaccination, but these effects were generally mild and short-lived. Health experts have consistently concluded that vaccination is far safer than the risks associated with Covid-19 infection, especially for pregnant individuals. There is no evidence that the vaccines reduce sperm quality, and no association has been found between Covid-19 vaccination and sexual dysfunction.

The pandemic also affected sexual health emotionally and socially. Lockdowns, stress, anxiety, loneliness, and financial difficulties placed considerable pressure on relationships and mental well-being. Many people experienced depression, isolation, or reduced intimacy during this period. At the same time, telemedicine became more common, allowing people to access reproductive and sexual healthcare online when in-person visits were difficult. Although mental health issues were highlighted during the pandemic, most individuals who experienced stress and depression have demonstrated resilience and largely returned to their usual level of mental well-being. Post-infection depression and sexual dysfunction are well-documented, but they are also highly treatable with counselling and appropriate medical care.

Five years later, the evidence suggests that Covid-19 infection posed far greater risks to sexual and reproductive health than the vaccines developed to prevent severe illness. The pandemic also revealed the importance of resilient healthcare systems, robust scientific research, and clear public communication. Although scientists continue to study the long-term effects of Covid-19, the pandemic has permanently changed how society views reproductive health, public health, and medical trust. The Lebanese-American poet Khalil Gibran once said, “Out of suffering have emerged the strongest souls.” Five years after the beginning of the Covid-19 pandemic, Dr George is still being challenged by doubtful patients about the aftermath of the virus on their sexual, reproductive, and overall health. His view is: “Despite emerging as stronger souls with minimal lasting harm, our sufferings should serve as a reminder to live more mindfully and pursue a healthier life.”

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Dear Dr G,

I understand that you are outlining various viral infections that can be prevented by vaccination during the month of May.

Personally, as a Hepatitis B carrier, I am somewhat confused about the ABC of viral hepatitis and their impact on my sexual health.

I contracted hepatitis as a child from my mother.

All my life, I have been told to be cautious about my liver function and to take precautions when engaging in sexual activity.

After I got married, I became paranoid about transmitting the virus sexually to my wife.

I often tried to read up more about other forms of hepatitis and the role I play in preventing transmission of the virus to my wife and children.

Apart from vaccination and the use of barrier protection during intercourse, I often worry about other ways I can prevent transmission of my disease.

I wish to put Dr G on the spot to outline the ABC of hepatitis and how they impact sexual health.

What exactly are hepatitis viruses, and how are they transmitted?

Are hepatitis A, B, and C all different, or are they just different strains of the same virus?

How do these viruses affect sexual and reproductive health?

Looking forward to your answers.

Yours truly,

Hepatitis Howard

Viral hepatitis is a major public health problem worldwide and is responsible for significant illness, liver failure, and death. The three most important forms are hepatitis A, hepatitis B, and hepatitis C. These viral infections primarily target the liver, causing inflammation. Although they share similar effects on the liver, they differ in their modes of transmission, disease progression, and long-term complications. Viral hepatitis is also closely linked to sexual and reproductive health because some forms are transmitted through sexual contact, can affect fertility and pregnancy, and may be passed from mother to child.

Hepatitis A is caused by an RNA virus that spreads mainly via the faecal–oral route, often through contaminated food or water or poor sanitation. After entering the body through the digestive tract, the virus travels through the bloodstream to the liver. The pathogenesis of hepatitis A is mainly immune-mediated, meaning that liver damage occurs when the immune system attacks infected liver cells. This inflammatory response leads to symptoms such as fever, fatigue, nausea, abdominal pain, loss of appetite, dark urine, and jaundice. Unlike hepatitis B and C, hepatitis A does not usually become chronic because the immune system can generally clear the infection completely. Although hepatitis A is not commonly considered a sexually transmitted infection, it can spread through sexual practices involving oral–anal contact. Poor hygiene and close physical contact during sexual activity may increase the risk of transmission.

Hepatitis B is caused by a DNA virus that is transmitted through blood and body fluids, including semen and vaginal secretions. It spreads through unprotected sexual intercourse, contaminated needles, blood transfusions, and from mother to child during childbirth. After entering the body, the virus infects liver cells and replicates within them. The virus itself causes little direct damage, but the immune system attacks infected hepatocytes, resulting in inflammation and liver injury. In some individuals, especially infants infected at birth, the immune response fails to eliminate the virus completely, leading to chronic infection. Chronic hepatitis B can progress to fibrosis, cirrhosis, liver failure, and hepatocellular carcinoma.

Hepatitis B has major implications for sexual and reproductive health because it is highly infectious through sexual contact. Individuals with multiple sexual partners or those who do not use protection are at greater risk of acquiring the infection. The virus may also coexist with other sexually transmitted infections, increasing transmission rates. One of the most serious reproductive health concerns is vertical transmission from mother to baby during delivery. Infants infected at birth are much more likely to develop chronic hepatitis B, which can later lead to severe liver disease. Chronic HBV infection may also interfere with reproductive hormones and contribute to infertility and sexual dysfunction.

Hepatitis C is caused by an RNA virus that spreads mainly through blood exposure, particularly through shared needles, unsafe injections, and contaminated blood products. Sexual transmission is less common than with hepatitis B, but it can occur, especially among individuals with multiple sexual partners, HIV coinfection, or traumatic sexual practices. After infecting hepatocytes, the virus mutates rapidly, allowing it to escape immune detection and persist in the body. The continuous immune response against infected cells causes chronic inflammation and progressive liver damage. Over time, this can result in fibrosis, cirrhosis, and liver cancer.

The reproductive and sexual health effects of hepatitis C are also important. Pregnant individuals with HCV can transmit the virus to their infants, especially if they have high viral loads or coinfection with HIV. Chronic liver disease associated with HCV may affect hormone production and lead to menstrual disturbances, infertility, reduced libido, and complications during pregnancy. In the past, some antiviral treatments for hepatitis C were unsafe during pregnancy, although newer therapies are more effective and safer when given before conception.

In conclusion, hepatitis A, B, and C are serious viral infections that affect the liver through immune-mediated inflammation and hepatocyte injury. Hepatitis A usually causes an acute, self-limiting illness, while hepatitis B and C can become chronic and lead to cirrhosis and liver cancer. These infections are strongly connected to sexual and reproductive health because they may spread through sexual contact, affect fertility and pregnancy outcomes, and be transmitted from mother to child. Effective prevention through vaccination, safe sexual practices, antenatal screening, and early treatment remains essential in reducing the burden of viral hepatitis and protecting reproductive health. WHO Director-General Tedros Ghebreyesus once said, “Viruses know no borders.” When Dr G is put on the spot to outline the sexual health implications of hepatitis A, B, and C, his response is always: “Knowledge creates borders for these viruses!”

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Dear Dr G,

I read with interest your explanation of how German measles affects women and how the disease itself has minimal effect in men.

I am somewhat surprised you did not outline the risks associated with another dangerous virus, mumps, which can have a more detrimental impact on young adult males.

As a child, I contracted mumps after missing vaccination at school.

I was horrified when I learned mumps may sometimes lead to infertility, and this information has caused me concern.

Many people tend to think of mumps as only a childhood illness, but I understand complications can occur when adults are infected.

As I am venturing into adulthood, I worry the aftermath of mumps may cause havoc to both my sexual and reproductive health.

I would like to put you on the spot so you can address how mumps may affect sexual and reproductive health in young men.

What exactly is mumps and how is the infection transmitted?

How common are complications such as inflammation of the testicles, reduced fertility, or other long-term effects?

Are these risks rare, or should young adults be more cautious?

I also hope you can explain whether vaccination still provides good protection in adulthood and what steps people can take to reduce their risk of infection.

I believe this is an important public health topic that many readers, especially young adults and parents, would benefit from understanding better.

Yours sincerely,

Mumps Matthew

For many people, mumps is remembered as a common childhood illness marked by swollen cheeks, fever and a few days away from school. However, beneath this seemingly harmless infection lies a virus that can sometimes lead to serious complications, especially among adolescents and young adults.

Although vaccination has dramatically reduced the number of cases worldwide, mumps remains an important public health concern because outbreaks still occur and complications can affect long-term health and fertility. Mumps is a contagious disease caused by the mumps virus, which belongs to the Paramyxovirus family.

The illness mainly affects the salivary glands, particularly the parotid glands near the ears, producing the characteristic swelling of the face and jaw. The disease has been recognised since ancient times. The Greek physician Hippocrates described symptoms resembling mumps as early as the fifth century BCE.

However, it was not until 1934 that scientists Claude Johnson and Ernest Goodpasture proved mumps was caused by a virus spread through saliva and respiratory droplets. Before the development of vaccines, large epidemics occurred every few years, especially among schoolchildren.

Most people contracted the infection during childhood, and outbreaks spread rapidly in crowded communities. The introduction of the measles-mumps-rubella (MMR) vaccine changed the situation dramatically. In countries with strong immunisation programmes, the incidence of mumps dropped by more than 90%.

Nevertheless, the disease has not disappeared. Thousands of cases continue to be reported globally every year, particularly in places where vaccination rates have declined, or where young adults live in close-contact environments such as universities, dormitories and military camps.

The virus spreads easily through coughing, sneezing, talking, or sharing utensils and drinks. Once it enters the body through the nose or mouth, it multiplies in the respiratory tract before spreading through the bloodstream to other organs. Children infected with mumps often develop fever, headache, tiredness, muscle aches and swelling of the salivary glands.

In many cases, the illness resolves within 1–2 weeks without lasting problems. However, complications become more common and more severe in adolescents and adults. One of the most worrying complications among post-pubertal males is orchitis, which is inflammation of the testicles.

This condition can develop several days after the onset of facial swelling and may cause severe pain, swelling, tenderness and fever. Although most men recover fully, some may experience shrinkage of the affected testicle. In rare cases, particularly when both testicles are involved, fertility may be reduced. Complete infertility is uncommon, but the possibility has caused understandable concern among many young men.

Mumps may also affect other organs, including the pancreas, brain and inner ear, sometimes leading to meningitis, encephalitis or hearing loss. Vaccination has proven to be one of the greatest achievements in modern medicine.

The MMR vaccine provides strong protection against mumps and significantly reduces the risk of serious complications. High vaccination coverage also contributes to herd immunity, protecting vulnerable members of society who cannot be vaccinated.

Unfortunately, misinformation and vaccine hesitancy in some communities have allowed outbreaks to re-emerge in recent years. Public education therefore remains essential in reminding people that diseases once considered “mild childhood illnesses” can still produce serious consequences. Scientists believe mumps can potentially be controlled to very low levels through widespread vaccination, strong public health systems and rapid outbreak response.

Although complete global elimination remains difficult because immunity may decrease over time and vaccination coverage differs between countries, the dramatic decline in cases over recent decades demonstrates prevention works.

The story of mumps reminds us medical progress should never be taken for granted. Infectious diseases that once caused widespread suffering can return if societies become complacent. Continued scientific research, vaccination programmes and public awareness are necessary to protect future generations from preventable illnesses.

American astronomer Carl Sagan once said: “The consequence of today is determined by actions of the past”

Dr G is often put on the spot by infertile men questioning whether the aftermath of mumps results in irreversible damage to fertility.

His view is: “We will definitely prevent the consequence of today, when we are determined in the actions of vaccination tomorrow!”

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