Here's all you need to know to fix that appointment you've been putting off. By Lee Xin Hui
When should I see one?
1) When you've got really bad menstrual cramps.
Red flags: Pain, accompanied by giddiness and breathlessness. You should also take note if you have to change your pad or tampon almost every hour for more than a week, or if you bleed between periods, says Dr Ann Tan, obstetrician and gynaecologist at Women & Fetal Centre.
You could have: A polyp, which can cause irregular menses, or a uterine fibroid, which can cause heavy bleeding. One in five women will have fibroids in her lifetime, says Dr Ting Hua Sieng, specialist in obstetrics and gynaecology at The Obstetrics & Gynaecology Centre. Although both polyps and fibroids are benign growths, it's best to have them checked. You may need surgery to remove them.
2) When your lower back aches terribly during your menses.
Red flags: Pain, possibly accompanied by an urge to clear your bowels, and a deep pelvic pain during sex.
You could have: Endometriosis. This affects about 10 per cent of Singaporean women during their reproductive years, says Dr Ting. It occurs when tissue from the lining of the uterus grows outside it, and breaks down and bleeds during your period, forming a chocolate-coloured cyst. Left alone, the condition can lead to infertility. Treatments include medication and surgery.
3) When your discharge smells off or changes colour.
Red flags: Clumpy or foamy vaginal discharge that smells fishy, or is green or yellowish-grey (normal discharge is usually translucent or white, with a mucus-like appearance).
You could have: A vaginal infection such as candida and bacterial vaginosis, or a urinary tract infection. Your gynae will examine you to determine the cause, before prescribing a topical gel or oral medicine.
4) When you leak urine when you laugh or jog.
Red flags: Difficulty holding in your pee; leaking urine when you laugh, sneeze, run or jump; and a frequent downward tugging sensation in the groin area.
You could have: Postpartum urinary incontinence, which is caused by weakened pelvic floor muscles. This sometimes happens after a natural delivery, especially if it was a difficult one. Your gynae may suggest Kegel exercises to strengthen your pelvic floor muscles or recommend physiotherapy. For moderate to severe cases, laser treatments or surgery may be required.
5) When sex is really painful, sometimes impossible.
Red flags: Pain before, during or after sex; painkillers, longer foreplay and lube all don't help.
You could have: Physical-health problems, such as vaginal infections and endometriosis, or psychological conditions such as vaginismus, where a fear of pain causes the vaginal muscles to go into spasms, thereby making penetration difficult. Your gynae will determine the cause before recommending solutions.
What can I expect on my first visit?
Expect questions about your last menses (such as the date it started and the problems you faced), your sexual history and the use of birth control, so make sure you have ready answers for your gynae. Other tips: Prep for your visit by identifying your concerns and writing a list of questions for the gynae, bring along past medical reports, and highlight existing medical conditions and any family history of genetic diseases during consultation.
The physical check-up
Your gynae will record your height, weight and blood pressure, and examine your heart, lungs and abdomen.
The pelvic exam
Before your visit, ensure that you aren't having your period. Your gynae will examine your lady bits with a gloved hand before using a speculum to widen your vagina for a better view of the cervix and vagina walls. If it feels uncomfortable, tell her - she'll apply more lubricant on the speculum. A Pap smear, which involves using a small brush to swipe the inside of your cervix for a sample, will also be done; this takes a few seconds and all you'll feel is a slight probing sensation.
The ultrasound scan
A probe narrower than the width of two adult fingers in diameter will be inserted into your vagina to examine your uterus and ovaries for growths such as fibroids and cysts. To ensure that the inside of the pelvic area is seen clearly on the screen, a full bladder is required, so drink about 500ml of water (roughly two glasses) at least an hour before your visit - and don't pee until you've done the scan.
Two Tests You Really Need
1) Pap smear: Go for this once you turn 21 or when you become sexually active. Get one done once every three years, until you're 65.
2) Mammogram: Start going for this once a year when you turn 40. After menopause, you can do it once every two years.
This article first appeared in the Jan 2015 issue of Her World.
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