Gynaecology is the field of women’s health medicine that looks at the clinical care of the female reproductive system. This not only includes the management of clinical problems but also preventive management such as vaccinations and screenings to keep your reproductive health at an optimal state.
Gynaecological problems that we manage:
- Gynaecological cancers (endometrial, cervical and ovarian cancer)
- Vaginal laxity and dryness
- Ovarian Cysts
Ovarian cyst is a fluid or semi fluid filled sac in the ovary. There are many types of ovarian cysts and they are categorized below:
Follicular Cyst is the most common cyst. This is a normal development in an ovulatory cycle. After ovulation, the cyst will become a corpus luteal cyst. If pregnancy does not occur, the corpus luteal cyst will resolve and disappear. These cysts are usually asymptomatic. However, some women do experience some ‘mid-cycle’ pain around ovulation. Occasionally the corpus luteal rupture can rupture and cause bleeding in the abdomen.
Benign Ovarian Cysts (Non-Cancerous Cysts)
a) ENDOMETRIOTIC CYST
These cysts are filled with brownish stale blood and are also called ‘chocolate cysts’. They are usually associated with endometriotic spots in the pelvis and sometime, pelvic adhesions. Endometriosis can cause infertility, pain during menses, pain on defecation and painful sexual intercourse.
b) DERMOID CYST
Dermoid cysts are filled with thick yellow fluid, sebum. Structures such as skin tissues, hair, teeth, brain tissues can also be present.
c) MUCINOUS AND SEROUS CYSTS
These cysts are filled with mucoid and watery clear serous fluid respectively
d) MALIGNANT CYST (CANCEROUS CYST)
Usually these cysts do not present with symptoms until at a late stage. These cysts may be multi-septated with some solid areas. Ascites (fluid in the abdomen) may be present. CT Scan assessment is needed
Preventive Management Services for Women:
1. Female Cancer Screening
- PAP Smear for Cervical Cancer
Who should do it?
Once a woman becomes sexually active. After age 69, Pap smears are less essential, especially if previous smears have been negative.
Women are at increased risk of cervical cancer if they had sexual intercourse at an early age, have multiple sexual partners, had sexually transmitted infections, smoke, are immuno-compromised or are HIV-positive.
When to do it?
Optimally to be done once a year if not at least once every 3 years. Annual screening would have a higher detection rate as compared to every 3 years.
How is it done?
There are 2 forms of PAP smears presently available. The conventional dry smear and the liquid based cytology. The latter has higher detection for cervical cancer. HPV DNA is used in conjunction with Thin prep Pap smear to diagnose the presence of high risk HPV.
- Endometrial Cancer (Inner lining of the womb)
At present there is no effective means of screening. Women who have abnormal bleeding should see their doctors early and consider hysteroscopy / endometrial biopsy for evaluation.
Risk factors for endometrial cancer:
- Never been pregnant
- Hypertension (high blood pressure)
- Late onset of menopause
- Taken drugs such as Tamoxifen or unopposed estrogens.
- Ovarian Cancer
Women with a family history of ovarian or breast cancer would be at increased risk. There is at present no effective screening for women at average risk. They would be advised to see their doctors if they feel bloated or have pain in the abdomen, indigestion, frequent urination, back pain, loss of weight and appetite. Those with increased risk may consider a transvaginal ultrasound scan and CA 125 serum testing.