Flushed cheeks, pulled down pants. We know what this (also) sounds like, and we’ve already covered the juicy topic on how to have better sex earlier this year! Read on for the medical side of things, and discover the answers to those anonymous questions you’ve been too embarrassed to ask your gynae before in our recent Ask The Expert session.
Dr Hoo Mei Lin, Consultant Gynaecologist and Obstetrician at Sunway Specialist Centre Damansara and Sunway Hospital, brings her 20 years of experience specialising in Reproductive Medicine and Fertility, and shares her advice on fertility, birth control, the reproductive system, and more.
Routine Check-Ups
We know a visit to the gynae isn’t something many of us look forward to – but it’s one of the most important routine check-ups you can do to safeguard your reproductive health through early detection and preventive health screening!
When’s the right time to visit a gynae and how frequently should I see one? Do I still need a yearly Pap Smear (even if I’m not sexually active), and how does it feel like?
The First Visit
Dr Hoo: In the US, it is recommended that the first visit to the gynaecologist happens when a girl turns 16. In Malaysia, there are no firm recommendations – but mothers often bring their daughters for a checkup when they start menstruating. Consider a first visit to the gynaecologist if:
- You are 16 and still have not had a period;
- Your periods are heavy, to the point it stops you from doing your normal activities (e.g. you cannot leave the house because you have to change your pads every hour);
- Your period pain is so bad that you cannot go to school, or need to take time off work;
- You think you are ready to have sex; or
- You are worried about your genitals/ periods etc.
Once you are sexually active, I would recommend an annual visit to the gynaecologist.
Preventing Cervical Cancer
Dr Hoo: Any woman who has had sex should have cervical screening. This is for prevention of cervical cancer. We can detect changes in the cervix before it becomes cancer. If we treat these changes, we prevent cancer.
We have also discovered that there is a virus that causes these changes in the cervix called HPV (Human Papilloma Virus). We can now prevent cervical cancer in multiple ways, such as getting vaccinated against HPV, screening for HPV in the vagina, and getting a pap smear. If you are doing a HPV screening, you only need to be screened every 5 years. If you are only getting a Pap smear, it is best you do it yearly. You still need cervical screening when you are vaccinated against HPV.
Pap Smear
When a Pap smear is performed, you will be asked to lie down with your knees bent. It is not the most comfortable examination, but it can be done pain free. You should try to relax as much as possible. Take deep calming breaths, and follow your doctor’s instructions. It only takes minutes.
Is it normal…?
We nonchalantly discuss the degree of our perineal tears with our mama friends, but choose carefully who we talk to when we share about our sex struggles, or about the mysteries of the female anatomy. Here are some ‘Is it normal?’ questions that you’ve asked:
Is it normal:
…for sex to sometimes hurt?
Dr Hoo: There are many reasons why sex may be painful. Pain during sex is not normal. It is useful to note:
- When the pain occurs (on penetration or deeper); or
- If the pain goes away in a different position.
Pain felt upon penetration is often caused by the lack of lubrication. This can be caused by the lack of arousal, vaginal infections, and hormonal changes (e.g. menopause or after childbirth). When a women experiences pain during sex, it can create a vicious cycle, whereby the fear of pain leads to a lack of arousal, which then leads to a painful sexual encounter, affirming to the woman that sex is painful. Understanding what is causing the pain and dealing with it will help break the cycle.
Painful sex can also be caused by a condition called vaginusmus. This is where the vaginal tightens involuntarily when penetration is attempted. If you feel pain deeper during sex, the cause can range from constipation, to fibroids, to endometriosis.
…to have vaginal discharge?
The vaginal discharge is a means for the body to keep the vagina clean and moist. How it looks and feels is different from woman to woman. It also changes with the time of the month. It can be clear or whitish, it can be thin and watery during ovulation, and thicker and mucousy at other times. There should be no obvious odour.
You should see a doctor if:
- It smells, especially after sex;
- It looks weird (cheesy, different colours);
- It itches;
- There is pain or fever;
- You see blisters, sores or ulcers; or
- There is abnormal bleeding.
What can I do to prevent infections?
- Avoid pantyliners.
- No need for special soaps.
- No need to douche.
- Take good care of your general health.
- A diet with probiotics rich foods may be beneficial.
Birth Control
Contraception is often an effective and inexpensive way to aid in family planning – improving your health, finances, and overall quality of life. Here are some of Dr Hoo’s thoughts on your questions relating to this topic:
What’s the best, non-invasive form of birth control? Can condoms be trusted, or are other methods (such as birth control pills, or getting an IUCD) safe options?
Dr Hoo: Birth control is a personal choice. It is a decision based on your personal preferences, and there is no one size fits all solution. It is important to discuss your options with your doctor.
Birth control can be divided into hormonal and non-hormonal methods. All birth control methods are reliable if used correctly.
Non-hormonal reversible contraception includes:
Condoms:
Barrier contraception, or condoms, are 99% effective with perfect use – but it is 80% effective with normal use. This is because people often don’t put in on correctly or at the right time, or they leave it on too long. Many people I have talked to will only put it on prior to ejaculation.
The Coil:
The coil, or the intrauterine device, is a long-acting reversible contraceptive method. A coil is placed into your womb, or uterus. It is 99% effective. The copper coil is non-hormonal. The pros are that it can be fitted and forgotten about for up to 5 years. After the age of 40, you may not even have to change your coil, until you attain menopause.
Some women, when fitted with the coil, can experience heavy and painful bleeding. There are rare cases where the coil migrates out of the uterus. If you fall pregnant on the coil, the chances of an ectopic pregnancy is higher, so do see your gynaecologist immediately, if you suspect this has happened.
The coil is best fitted at the end of your period, and while it is uncomfortable, it should not be painful. You may experience cramps immediately and in the day after it is fitted. The coil should only be fitted for women in a monogamous relationship, as its presence may increase the risk of a pelvic infection.
Fertility and Getting Pregnant
With the abundance of fertility myths and facts available online (not to mention tons of advice from well-meaning elders), read on for professional guidance on fertility and pregnancy.
We’re not pregnant yet, but we want to be sure that when we are, our baby is healthy and well. Is there a way to prepare preconception for this? Also, what can I do to improve my chances of fertility?
Dr Hoo: The best way to ensure the best possible outcome for a pregnancy is knowledge and preparation. Getting a medical checkup is a good idea. If you are on any regular medications, or have a health condition (e.g. asthma or high blood pressure), it is best to optimise your health and check that any medications or supplements that you are on are suitable for pregnancy.
You and your partner can do a simple blood tests to ensure you are free of infectious diseases, such as HIV, and that your vaccinations (e.g. Hepatitis B and Rubella which can cause blindness, deafness and developmental delay) are up-to-date.
Get vaccinated against the flu and of course, Covid-19. Cut down on caffeinated drinks and alcohol, stop smoking and start taking a folic acid supplement.
Improving Your Fertility Chances
Dr Hoo: Enjoy the pregnancy journey. It does not happen overnight. Give yourselves time. Have regular sex, two to three times a week. If you are not pregnant after six months, see your doctor.
My daughter’s left ovary was removed when she was just 1 month old, due to a cyst. Will this affect her fertility?
No. Having one ovary is adequate. However, it may be prudent to advise her to seek fertility advise, if she still has not managed to get pregnant after six months of trying.
Covid-19 and Pregnancy
What are your thoughts and recommendations when it comes to getting a Covid booster jab during pregnancy?
Dr Hoo: Pregnant women who contract Covid are more likely to have severe Covid. They are more likely to require help with breathing, more likely to need ICU admissions, and more likely to die than non-pregnant women of the same age. I would like to urge all women who are pregnant (or planning to get pregnant) to get vaccinated and boostered.
We hope this answers some of your questions on women’s health that you’ve been wanting to ask, #makchicmumtribe!
Do remember though – don’t let your feelings of embarrassment deter you from seeking medical help or advice from your own gynaecologist. Your gynae has seen and heard it all before, and are there as medical professionals to help you (and not pass judgement) 🙂 When in doubt, always check with your physician.
Wishing all our female readers the best of health!
