Gynaecology

Dysmenorrhea (period pain / menstrual cramps / menstrual pain)

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Dysmenorrhea refers to lower abdominal pain felt during menstruation. It is divided into two broad categories, which are primary and secondary dysmenorrhoea.

  1. Primary dysmenorrhea refers to the presence of pain during menses without any obvious gynaecological disease that could account for these symptoms. The pain is typically recurrent, crampy pain that starts just before or with the onset of menses and then gradually reduces over the next 24 to 72 hours. It is more often seen in adolescents and young females. Physical examination and an ultrasound scan of the pelvis is usually normal.
  2. Secondary dysmenorrhea refers to the pain before and/or during menstruation in females with a gynaecological disease that could explain the symptoms. These could be endometriosis, adenomyosis, or uterine fibroids. The cramping pain can be in the lower abdomen, lower back or radiates to the inner thighs. The pain may even persist after menstruation has stopped.

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Infertility investigations

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The woman and her partner should be present at the initial evaluation for infertility. The doctor will obtain a full clinical history from the couple and then proceed on to a physical examination. The initial investigations that need to be performed will be based on these assessments. Sometimes, the cause of the infertility may be found at this visit. Further evaluation and clinic visits may be necessary for other couples. It may take several weeks. This is because some of the tests may have to be repeated for verification at different specific times in her menstrual cycle. The initial workup of a man usually can be done faster, because men have no monthly cycles and because there are fewer tests for men.

COMMON INVESTIGATIONS IN FEMALE

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Bacterial vaginosis (BV)

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Bacterial vaginosis (BV) is caused by an overgrowth of certain types of bacteria, which results in vaginal inflammation.  With BV, there is a shift in the bacterial ecosystem, favouring the “not so good or healthy” type such as Gardnerella vaginalis, Mycoplasma hominis and Mobiluncus species and a corresponding reduction in the healthy types such as lactobacillus. There is also a disturbance of the vaginal pH. Bacterial vaginosis most often occurs during reproductive years. It is not regarded as a sexually transmitted infection, but sexual activity has been linked to the development of this infection.

Symptoms and signs

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Myths and facts of combined oral contraceptive (COC) pills

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Currently, there is a wide selection of contraceptive methods available to suit the various reproductive needs of couples. Despite these, there is still a huge unmet need with regards to contraception. There are 123 million women around the world who are not receptive to contraception. In the 2015 United Nations Population Fund (UNFPA) report, 15 million adolescent girls in developing countries gave birth and 13 million lacked access to contraceptives. WHO estimated that approximately 214 million women of reproductive age, in developing regions, who want to avoid pregnancy are not using a modern contraceptive method and between 2015 and 2019, almost half of all pregnancies were unintended.

The combined oral contraceptive (COC) pills are readily available in the markets and yet women avoid them due to their belief in the myths surrounding them. Following are some common myths regarding the combined oral contraception pills and the facts to dispel them.

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Vulval Care

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The female external genitalia area (also called the vulval area) is particularly susceptible to skin disorders since this area is warm, sweaty, and moist. The wearing of undergarments in this type of condition can predispose the area to constant irritations and possible infections. Many types of irritants can aggravate the skin such as vaginal and menstrual discharge, use of sanitary pads or panty liner, synthetic undergarments, and vaginal lubricants. Chemicals used in the manufacturing of the undergarments, sanitary pads, and panty liners may act as irritants and sensitizing allergens. In postmenopausal women, lack of oestrogen can cause atrophy of the skin, with gradual loss of subcutaneous fat and skin elasticity. The labia fold (external skin fold at the side) will also shrink in size. This thinning of the skin will predispose to irritation and may lead to various skin disorders.

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Heavy Menstrual Bleeding (HMB)

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menstrual bleedingHeavy menstrual bleeding or HMB (previously called menorrhagia) is a significant cause of morbidity in women of reproductive age. It often involves soaking through ten or more sanitary napkins in a day, a menstrual flow that lasts for seven to 14 days or even longer. The presence of “flooding” or clots is indicative of heavy bleeding. Normal menstrual blood flows freely without clotting. This is because of the presence of an anti-clotting agent produced by the uterus. However, if the bleeding is excessive and far exceeds the amount of anti-clotting agent available, then the remaining blood that flows out will form clots. Bleeding between menstrual cycles is also abnormal. The presence of other clinical signs such as anaemia will further support the diagnosis and indicate the severity of the bleeding

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Endometrial polyps

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Endometrial polyps are growths that arise from the inner walls that lined the uterine cavity. It is sometimes called uterine polyps. It is believed to arise from the overgrowth of endometrial tissue. It may range in size from a few millimetres only to a few centimetres. Sometimes, there can be several polyps present at the same time. It may have a long stalk and can extends through the cervix into the vagina.
An endometrial polyp is usually a non-cancerous growth. However, in a small proportion of women, some of these polyps can lead to cancer (called pre-cancerous type). The risk of cancer in a polyp is increased in post-menopausal women. It can arise at any age but rarely occur in women under 20 years old.

Cause and risk factors

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Saline infusion sonohysterography (SIS)

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Saline infusion sonohysterography (SIS) is also sometimes called saline infusion hysterogram (SHG). It is an investigative procedure to assess the uterus cavity to ascertain the shape and look for any abnormalities within it. It incorporates an ultrasound scan and instillation of sterile fluid into the uterus to show the uterine cavity and endometrial layers. With the use of an ultrasound scan, the uterine wall and the ovaries can be visualized as well.

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