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Gynaecology

Women's body is constantly changing from childhood to puberty, through pregnancy and delivery to postmenopausal life. There will be many questions that you want to ask about gynaecological, reproductive and sexual health. Thus, it is important that a woman establishes a partnership with her gynaecologist early. It is recommended that women who have started sexual life or experience gynaecological symptoms, have an annual gynaecological check-up. Most of the gynaecological problems that detected are early will be easier to treat, cheaper and have a better result.           

The main purpose of gynaecological screening is to pick up women's disease early before it is too late for complete cure. The annual gynaecological screening includes:

1. blood pressure
2. breast examination
3. ultrasound scan of ovaries, uterus and pelvis
4. Papanikolaou test (pap smear)
5. urine test for infection and diabetes
6. general body blood test including tumor marker CA 125 (a 'tumor-maker' which is found in greater concentration in body with tumor cells).

Common gynaecological problems/ encounters:

1. Endometriosis
 
This is a non-cancerous condition where the uterine endometrial cells grow outside the uterus, such as on the ovaries, Fallopian tubes, bladder and bowel. It may cause pain and discomfort during menses. Endometriosis is one of the leading cause of infertility.
   
2. Fibroid
 
Fibroids are common benign (non-cancerous) tumor in the uterus which consist mainly of muscle fiber. The cause of fibroids are usually related to a combination of factors including genetics, hormones, and the environment. It affect 20% woman under age of 50 years (woman of childbearing age) and are the main reason for hysterectomies (removal of the womb). Fibroids are categorized according to their locations as follows;
  1. Submucous fibroid- grow from below the uterine lining, into the cavity of the uterus.

  2. Intramural fibroids-grow in between the muscles of the uterus, within its walls.

  3. Subserous fibroids- grow on the outer wall of the uterus.

  4. Pedunculated fibroids- grow on stalks from the outer surface of the uterus, sometimes protruding out through the cervix.

Symptoms of fibroids include the following:

  1. Heavy menses due to larger menstrual surface area, increase blood vessel and poor coagulation.
  2. Pelvic discomfort due to distension of uterus by growing fibroid.
  3. Feeling full in the lower abdomen sometimes called pelvic pressure.
  4. Lower back pain due to back pressure by the fibroid.
  5. Infertility due to poor implantation over the fibroid area.
  6. Multiple miscarriages due to poor implantation or increase uterine contraction.
  7. Early onset of labour during pregnancy because fibroid precipitate preterm baby.
  8. Increase frequency of urination due to fibroid pressing on the bladder.
  9. Pain during sex.

Treatments for fibroid will depend on your symptoms, age, family size, number and size of fibroids you have, and willingness to conceive in the future. The choices of treatments are:

  1. If your fibroid size is small and you don't have symptoms persist, regular basis observation using ultrasound scan will be suffice.

  2. If your fibroid is larger than 5 cm, then surgery to remove the fibroid (myomectomy) is needed. If you have completed your family the removal of uterus and fibroid (hysterectomy) is preferred.

  3. Fibroid can also be shrunk without surgery by decreasing the blood flow to them using embolisation technique. Recurrence may occur.

   
3. Breast Cancer
 
This is the most common cancer in women in most parts of the world. In Malaysia, breast cancer is the commonest cancer in women amongst all races from the age of 20 years (National Registry Report 2003).
   
4. Gynaecological cancers
 
(a) Cervical cancer; does not appears abruptly; the normal cervical cells gradually develop pre-cancerous changes and later turn into cancer.  The precancerous changes and early stage of cervical cancer can be detected by Pap smear. This is the second commonest cancer in Malaysian women (National Registry Report 2003).
 
(b) Uterine cancer; also known as womb cancer, usually occurs after menopause. This usually presents with abnormal vaginal bleeding or bleeding after menopause. A minor dilation and curettage (D&C) procedure will confirm the diagnosis.
 
(c) Ovarian cancer; usually happens in women over 50 years of age. Ultrasound scan of the pelvis will help to detect it at early stage.
   
5. Ovarian Cyst
 
It is a fluid-filled sac located within the ovary. The cyst usually goes away on its own after a few weeks or months. However, if it grows to more than 4 cm, it may rupture and bleed or twist the ovary and cause severe pain. Surgery is needed if the cyst is twisted or ruptured, larger than 5 cm and appears suspicious on ultrasound scan.
   
6. Polyp
 
Polyp is the tissue mass formed due to overgrowth of uterine lining or cervical lining. Polyp can be benign or malignant (cancerous). D&C (dilation and curettage) is necessary to remove it and the tissue will be analyzed for cancerous changes.
   
7. Sexually transmitted diseases (STDs)
 
STDs are diseases that can be transmitted through body contact during intercourse. They can be easily passed to the sexual partners, and some STDs can also be passed from a mother to her unborn child. STDs are caused by viruses, bacteria or parasites. There are at least 25 different sexually transmitted diseases. The common ones are chlamydia, herpes, HIV, gonorrhea and syphilis. Many STDs are infectious and can cause long-term or permanent damage, including infertility if left untreated.

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