DEAR DR. ROACH: This question is just too embarrassing for me to even sign my name. I get many infected pubic hairs that are painful. Is this normal? Do other people get them? I have had them off and on my whole life, but the past two years have been just awful. Some are like boils, and it takes them many weeks to go away. What can I do?

I have never mentioned this to my doctor. I won’t even go for my Pap test if I have one, because I don’t want the doctor to see it. — Anon.

ANSWER: Infected hair follicles are common, and when they are in the pubic area or in the armpits, they can be quite painful and last a long time. They often are caused by Staphylococcus, which nowadays can be resistant to multiple antibiotics (MRSA).

Please don’t be embarrassed by these. I guarantee you that your doctor has seen them many times before. The sooner you are seen, the faster you can get relief. And you certainly don’t want to delay important tests like your Pap for these common infections.

DEAR DR. ROACH: I am a 56-year-old female. I recently have been having terrible pain in my joints. It is so bad at night that I can’t sleep. Mainly the pain is in my neck, ribs, elbows, knees and wrists. My finger joints have hurt for years. I recently went to a rheumatologist because I had an elevated rheumatoid factor (it wasn’t extremely high). I was told I have arthritis and a high risk for rheumatoid arthritis. I was then diagnosed with fibromyalgia. I was shocked and embarrassed! I had always thought that fibro was not a real disease. I feel bad and tired almost every day, and I am so sick of it! — S.S.

ANSWER: Some of my colleagues still doubt it, but I think that fibromyalgia certainly is a real disease. There is no doubt that there are a large number of people with chronic pain in the muscles and soft tissues who meet the diagnostic tests for fibromyalgia, which are all based on history and exam — there’s no blood test or X-ray for fibromyalgia, but that doesn’t mean it isn’t real. The current thinking is that fibromyalgia is due to alterations in the perception of pain by the central nervous system.

The most common symptom is aching in the body, usually in the muscles and joints. Although there are specific commonly tender spots that clinicians look for on exam, the diagnosis of fibromyalgia can be made without them. Fatigue and poor-quality sleep also are nearly universal in fibromyalgia.

Depression is highly prevalent in people with fibromyalgia, and in my opinion, the depression is more likely caused by the chronic pain and fatigue than the other way around.

Before making the diagnosis of fibromyalgia, your rheumatologist had to exclude other possible causes, such as rheumatoid arthritis, restless leg syndrome and thyroid disease. This isn’t always easy or straightforward, and requires experience.

My opinion is that it is better to have a diagnosis of fibromyalgia because, even though fibromyalgia isn’t completely understood, it is a starting point for understanding and treating chronic pain.

Tricyclic antidepressants are the most common initial treatment of fibromyalgia, because they affect the way pain is processed. They are usually started at far, far below the effective dose for depression.

Feeling a sense of control over the pain, continuing to work and exercising more are all associated with a better outcome in fibromyalgia.

READERS: The booklet on vertigo explains this disruptive condition in detail and outlines its treatment. Readers can order a copy by writing: Dr. Roach — No. 801, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from

(c) 2014 North America Syndicate Inc.

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