Dr Lisa Wong, obstetrician and gynaecologist at Mount Elizabeth Hospital, answers 5 questions you may be too embarrassed to ask.
1. What is causing my unusual gynaecological symptoms?
Several conditions can lead to unusual gynaecological symptoms. If you’re concerned about a symptom, always speak to a doctor.
Here’s what your symptoms could mean:
Unusual vaginal discharge: Vaginal discharge is your body’s way of cleaning the vagina. Common conditions like thrush (a yeast infection) can alter its volume, consistency, colour or smell, and make the entire area feel itchy or uncomfortable. More serious conditions like cervical cancer can also cause unusual discharge. Bloodstained vaginal discharge is worrisome for cancers and you need to see your doctor if it occurs.
Frequent urge to urinate: One of the most common causes of frequent urination is a urinary tract infection (UTI), and this commonly occurs after sexual activity (which is why it’s also known as honeymoon cystitis). However, it could also be a sign of other gynaecological problems like uterine fibroids (benign tumours in the uterus that can compress on the bladder).
Bleeding between periods, or unusually heavy bleeding: Stress, hormone imbalance, an infection – there are many possible causes for changes to your menstrual cycle and irregularity in your periods. More serious conditions, such as endometrial polyps, uterine fibroids, cervical cancer or uterine cancer, could also be responsible.
Pain during sex: Just a lack of lubrication can be enough to cause pain during sex. Other causes could be an infection like thrush, vaginismus (vaginal muscle spasms), or endometriosis (a condition where endometrial tissue grows outside of the uterus).
Bleeding after sex: Many women experience bleeding after sex at some point as a result from vaginal dryness or vigorous sex. However, it is also a common symptom of cervical polyps or cervical cancer.
Unexplained pelvic/back pain: This is another symptom that could have several gynaecological explanations, such as endometriosis, pelvic inflammatory disease (uterus infection), ovarian cysts, uterine fibroids, cervical cancer or ovarian cancer.
Bleeding after menopause: If you’ve gone through menopause, you shouldn’t bleed at all. Your gynaecologist will check for polyps (non-cancerous growths), endometrial atrophy (thinning of the uterine lining), endometrial hyperplasia (thickening of the uterine lining) and cancer from the cervix or endometrium.
With so many possible causes for most gynae problems, you should always visit your gynaecologist for a proper assessment. In some cases, you may be recommended for a Pap smear (to screen for cervical cancer) or an ultrasound (to check for problems arising from the uterus or ovaries).
2. I don’t have any symptoms, so how often should I see a gynaecologist?
Pap smear screening is very important. Human papillomavirus (HPV) causes the majority of cervical cancers. This viral infection has over 100 strains and is passed through skin-to-skin contact, so you don’t actually need to have sexual intercourse to contract it. It is found present in 70 per cent of normal couples and most people will get some variety of it at some point.
Many HPV infections go away on their own without causing problems. However, some high-risk HPV strains can lead to abnormal pre-cancer cell changes in your cervix, which don’t cause symptoms. Left untreated, these abnormal cells can develop into cervical cancer. That’s why regular Pap smears are so important.
“The Pap smear and HPV test is a good screening test to check for pre-cancerous cells on the cervix,” says Dr Wong. “If abnormal cells are treated early, this can prevent the progression to cervical cancer.”
You should go for a Pap smear every three years from the age of 25 (or more regularly, if you have symptoms or have previously been diagnosed with HPV) or every five years if your high risk HPV test is negative.
If your gynaecologist discovers pre-cancerous cells, they may remove them using cryosurgery (destroys the cells using liquid nitrogen), laser surgery (burns the cells away) or a loop electrosurgical excision procedure (removes the cells using a heated wire loop).
Your gynaecologist may also perform an ultrasound, blood tests and a vaginal examination to check for ovarian cancer, as it is another condition that doesn’t always cause symptoms.
3. How are cervical and ovarian cancers treated?
“Treatment of cervical cancer depends on the stage of the disease,” says Dr Wong. “If cancer is caught in the early stages, you may only need a radical hysterectomy (surgery to remove uterus and cervix). With more advanced stages of cervical cancer, you may need a combination of chemotherapy and radiotherapy to destroy the cancerous cells. In selected cases of very early cervical cancer, treatment may involve cone biopsy or radical trachelectomy (to remove the cervix and parametrium) for women who intend to preserve their fertility.
“As ovarian cancer is often not caught until the later stages, treatment usually involves a combination of chemotherapy and surgery to remove the uterus, cervix, tubes and ovaries and omentum.”
Many gynaecological surgeries can now be performed using minimally invasive surgery, so you can recover faster with less post-operative pain and shorter hospital stay than with traditional open surgery.
4. What are uterine fibroids and how are they treated?
Uterine fibroids are non-cancerous tumours that grow in the muscle of the uterus. While many women who have fibroids experience no symptoms at all, they can sometimes cause heavy and painful periods, pelvic/lower back pain and increased urination.
If you have fibroids, your gynaecologist may prescribe you medication to help control your periods. If you have several or they are excessively large, your doctor may recommend surgery to remove them.
“The number and location of the fibroids, and whether you intend to get pregnant, may affect the type of surgery you can get,” says Dr Wong. “If you have had a previous pelvic surgery or infection, minimally invasive fibroid surgery may be more difficult and could increase your risk of injury to the bowels and bladder. In these cases, your doctor may recommend a robotic-assisted keyhole surgery, which offers more flexibility and range of movement. Bear in mind, though, that this could prove more expensive.”
If your fibroids are small and don’t cause symptoms, you probably won’t need any treatment at all as most fibroids shrink when menopause sets in.
5. Can I ask for a female gynaecologist?
It’s understandable if you want a female doctor to perform your gynaecological examination, or if you feel more comfortable voicing your symptoms to a female rather than male. “If you would prefer to speak to a female doctor, don’t be afraid to ask,” says Dr Wong. “Regardless of gender, a good doctor will want you to feel at ease and explain what the examination involves to help you relax.”
If you’ve more questions about women’s health, speak to a gynaecologist.