What are some gynaecological conditions and preventive measures that women should be aware of?

Pap Smears

All sexually active women should have pap smears performed routinely every 1-3 years depending on their results as this is the recommended method for cervical cancer screening. It accurately detects 90% of cervical cancers, even before symptoms develop. The early stages of cervical cancer often cause no symptoms. This is why it is so important to have regular cervical pap smear tests. If cervical cancer does cause any symptoms, the most common one is abnormal bleeding from the vagina, either between periods (mistaken as a result of hormonal imbalance) or after sex (mistaken as a result of dryness or infection). Other symptoms include unpleasant-smelling vaginal discharge (mistaken as a result of vaginal infections) and pain during sex (mistaken as a result of dryness).

HPV Vaccine

Getting the HPV vaccine can reduce the risk of developing cervical cancer so women who are not pregnant or have not developed cervical cancer should get themselves vaccinated with the available HPV vaccines in Singapore. Cervical cancer is not a hereditary condition. In fact, the majority of cases are caused by a virus called Human Papillomavirus or HPV. HPV is a very common virus and it was found that in USA, up to 50% of couples who have ever been sexually active are likely to be infected with an HPV virus at some time in their lives. As these vaccines prevent the initial HPV infection at the point of exposure, girls from the age of 12 are routinely vaccinated at school in some countries.

Vaginal Infection

Vaginal infections or vaginitis is an inflammation of the vagina that creates discharge, odour, irritation or itching. The 3 commonest vaginal infections are bacterial vaginosis, yeast infection and trichomoniasis vaginalis.

• Bacterial vaginosis causes an abnormal vaginal discharge with an unpleasant odour. Some women report a strong fish-like smell, especially after intercourse. The discharge is usually white or grey. They may also experience a burning sensation during urination or itching around the outside of the vagina, or both. Some women with bacterial vaginosis have no symptoms at all.
• Yeast infections or candidiasis cause a thick, whitish-grey “cottage cheese” type of vaginal discharge and may be itchy. You may have intense itching in your genitals. You may not always have a vaginal discharge. Men with genital candidiasis may have an itchy rash on the penis. Most male partners of women with yeast infection do not experience any symptoms of the infection.
• Trichomoniasis causes a frothy vaginal discharge that may be yellow-green or grey in colour. It may be associated with itching and irritation of the genitals, burning during urination (sometimes confused with a urinary tract infection), discomfort during intercourse, and a foul smell. Because trichomoniasis is a sexually transmitted disease, symptoms may appear within 4-20 days after exposure. Men sometimes have symptoms and can present as a thin, whitish discharge from the penis along with pain or difficulty when urinating.

There are many other types of vaginal infections besides these 3 but regardless of the cause, women should seek treatment (antibiotics, antifungals or a combination of both) from their gynaecologist sooner rather than later as some infections may damage fallopian tubes and therefore cause infertility or ectopic pregnancies in the future.

PMS (Premenstrual Syndrome)

Premenstrual syndrome is a disorder characterized by a set of hormonal changes that trigger disruptive symptoms in a significant number of women for 7 to 10 days before menstruation and disappear a few days after menses. PMS is a natural part of the menstrual cycle, affecting 1 in every 5 women in Asia Pacific at some time during their lives.

PMS symptoms vary greatly from woman to woman and cycle to cycle, and can range from mild to severe. Some women note that their symptoms are worse during times of increased emotional or physical stress. Of the more than 150 symptoms that have been linked to PMS, the most common are listed below.

Physical symptoms include:

• Breast swelling and tenderness.
• Bloating, water retention, weight gain.
• Changes in bowel habits.
• Acne.
• Food cravings, especially for sweet or salty foods.
• Sleep pattern changes.
• Fatigue, lack of energy.
• Decreased sexual desire.
• Pain. Common complaints include headaches or migraines, breast tenderness, aching muscles and joints, or cramps and low back pain prior to menstrual bleeding.

Behavioral symptoms include:

• Aggression.
• Withdrawal from family and friends.

Emotional and cognitive symptoms include:

• Depression, sadness, hopelessness.
• Anger, irritability.
• Anxiety.
• Mood swings.
• Decreased alertness, inability to concentrate.

Premenstrual dysphoric disorder, or PMDD, is a severe form of premenstrual syndrome (PMS). The symptoms of PMDD are similar to those of PMS, but are severe enough to interfere with work, social activities, and relationships. PMDD occurs in 2-10% of menstruating women. Women with a personal or family history of depression or postpartum depression are at greater risk for developing PMDD. Most researchers believe that PMDD is brought about by the hormonal changes related to the menstrual cycle. Some modern oral contraceptive pills are actually used to treat PMS and PMDD.