Men's Articles

Visiting Gynaecologist For The First Time


While most women will consult a gynaecologist in their lifetime, many do not know when their first visit should be. A girl under 18 can see a gynaecologist if she has menstrual problems such as abnormal vaginal bleeding or discharge, or other unusual pain in her pelvis or abdomen. The first visit is also a good opportunity to learn more about the changing body.

PAP Smear

A test that sexually active women should go for regularly is the pap smear, which checks for changes in the cells of the cervix, the lower part of the womb that opens into the birth canal. The purpose of a pap smear is to detect pre-cancerous changes in the cervix. This often happens at an older age, or after sexual exposure, as these changes take time. Doctors advises that pap smears should be scheduled about a week after menstruation as menstrual blood can alter the results of the test.

Also pap smears should be done one year apart if it is a woman's first two. The subsequent test is three years later. If the consecutive first two results are normal and the woman is in a stable monogamous relationship, then a three-yearly pap smear is sufficient until age 65. However if a woman has multiple partners or there are abnormalities in the smear, then they require more frequent paps.

A negative pap smear means the cells are normal while a positive result may be a sign of several things. They include: 

  • Inflammation or irritation that is caused by an infection of the cervix, such as yeast, human papilloma virus (HPV), herpes, or many others;
  • Very early signs of cancer; 
  • More serious signs of cancer, where the changes affect the top layers of the cervix, though do not go beyond the cervix; and 
  • More advanced cancer.

Human Papilloma Virus (HPV)

Medical experts say that often the culprit in abnormal pap smear results is the human papilloma virus. HPV is a common infection in women and is also the leading cause of cancer of the cervix. Up to 60 per cent of sexually active women may carry this virus on their cervix, genital area, or skin and be completely unaware of it, as it rarely causes symptoms. Only 1 per cent of sexually active adults have visible genital warts, while other types of HPV are subclinical infections.

The virus can be detected only during the annual pap smear and it is especially important for women diagnosed with the virus to have regular smears. While the pap smear is not designed to detect HPV, abnormal changes to the cervix may indicate HPV infection, said doctors. Follow-up tests can then be ordered to determine the cause of the changes. There is no cure for the virus and it may lie dormant in the skin after treatment before becoming visible again. Sometimes, visible warts never return. Treatments for HPV range from acid medicines to creams to laser therapy.

Pelvic Inflammatory Disease (PID)

PID refers to the infection of the womb, fallopian tubes and other reproductive organs. If not treated, the fallopian tubes and tissues in and near the uterus and ovaries can be damaged, leading to infertility, ectopic pregnancy (a pregnancy outside the womb), abscess formation, and chronic pelvic pain. 

In many cases, PID is associated with two very common bacterial sexually transmitted disease (STD) gonorrhoea and chlamydia. The most common way that the reproductive organs are infected is through sexual intercourse. It is not surprising then that sexually active women in their child-bearing years are most at risk.

The only way to protect oneself from PID is to use barrier methods of contraception. And although birth control pills offer no protection against STDs, doctors say they may give some protection against P1D by causing the body to create thicker cervical mucus, making it more difficult for bacteria to reach the upper genital tract.

Research has also shown that women who douche - the process of rinsing or cleaning the vagina by forcing water or another solution into the vaginal cavity to flush away vaginal discharge - often may have a higher risk of developing PID as douching changes the organisms that live in the vagina in harmful ways, and can force bacteria into the upper reproductive organ from the vagina.

The Symptoms of PID vary from none to severe. A woman may experience mild symptoms or no symptoms while serious damage is being done to her reproductive organs. Those who have symptoms most commonly suffer from lower abdominal pain. They may also have fever, smelly vaginal discharge, find intercourse painful, or have irregular menstrual bleeding. Because these could be signs of many things, PID often goes undetected.

But when diagnosed, infections can be treated with several types of antibiotics. The problem is that damage to organs cannot always be reversed. So the best way is to take precautions against sexually transmitted diseases for example, by using a condom and abstaining from casual sex.

Endometriosis And Fibroids

Endometriosis, a condition in which tissue which is similar to the lining of the uterus is found outside the uterus. These tissues react to hormonal changes during menstruation, causing cramps and pelvic pain. About 7 per cent of women of reproductive age are affected, but most will not know they have endometriosis.

Though there is no known cause for the condition, treatment ranges from birth control pills, which are taken continuously to relieve symptoms in many patients, to surgery to destroy the cells that are outside the uterus. Dull pain in the abdomen and heavy and pal periods can also be a sign of uterine fibroids. Fibroids are common, non-cancerous growths on the womb muscles.

If the fibroids do not cause any symptoms, doctors will let them be. Women who are close to menopause usually do not need surgery as to fibroids shrink once the level of the hormone oestrogen declines If the woman is of child bearing age, then the fibroids are removed individually. Expel say the good thing about surgery is that it preserves the woman's fertility and is most useful where there are one or two large fibroids.

Your Fertility Issues Answered

Infertility -typically defined as an inability to get pregnant after a year of unprotected intercourse. Dr Sheila, consultant obstetrician and gynaecologist, answer some frequently asked questions.

What Are The Causes Of Infertility?

The most common causes in women are: Problems with ovulation-the release of a mature egg from an ovary ~ > Polycystic ovary syndrome, a disorder with symptoms that include multiple cysts on the ovaries Endometriosis, which occurs when the same kind of tissue that lines the inside walls of the uterus grows outside the uterus Fibroids, which are non-cancerous growths of muscle and connective tissue in or around the uterus ),> Blocked or damaged fallopian tubes. In men, low sperm count and poor quality sperm are some of the more common causes.

Can A Previous Abortion Affect Fertility?

It may, if there had been complications like infection and scarring of the uterus lining. Infections could lead to blocked fallopian tubes while scar tissue in the uterus can affect the ability of the embryo to implant.

Will Taking Cold Drinks Affect Fertility?

No.

When Is A Woman's Most Fertile Time?

The most fertile time is when she ovulates. According to Dr Sheila, it varies from woman to woman but it generally occurs between day 10 and day 20 of a 28 to 30 day cycle. Dr Tan suggests using a urine Luteinising Hormone (LH) kit to pinpoint the time more accurately. These kits, available over the counter at pharmacies, measure the amount of LH in the urine. The levels of this hormone increase dramatically just before ovulation.

Can I Predict When I Am Ovulating By Looking At My Vaginal Discharge?

Yes. Cervical mucus changes in texture over the cycle, becoming more fluid and egg-white like as ovulation approaches. The presence of clear stringy cervical mucus occurs when the spike of estrogen occurs along with ovulation, says Dr Sheila.

Can Certain Positions During Intercourse Increase The Chances Of Conception?

They have no effect.

Are There Any Supplements That Can Help?

Many people have tried vitamin C and E but there is no proof that these will help, says Dr Loh.

Can Taking Cold Showers Improve Sperm Quality?

There is no proof of this either.

What Forms Of Assisted Reproductive Technologies (ART) Are There?

These are some of the methods:

  • Ovulation monitoring to determine the best time for intercourse.
  • Ovulation stimulation with drugs to increase the number of eggs produced.
  • Intra-uterine insemination, in which sperm are collected and artificially inseminated in the uterus.
  • In-vitro fertilisation (IVF), in which egg and sperm are collected and put together in a laboratory to allow fertilisation to occur. The resulting embryo is then implanted in the uterus.
  • Intra-cytoplasmic sperm injection (I CSI), which is similar to IVF but involves injecting a single sperm into each egg to fertilise it.
 

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