Gynaecology

Lower Urinary Tract Infection (Lower UTI, cystitis)

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Infection of the lower urinary tract occurs when the inner lining of the bladder becomes infected and the urine is full of bacteria. In pregnancy, 5 – 10% of women have bacteria in their bladder and some will have no symptoms at all.

How common?

Up to 40 – 50% of women will have at least one attack in their lifetime and 25% will have recurrences.

Causes

  • Bacteria can reach the bladder from the genital and anal area, or through the bloodstream.
  • Injury to the urethra or the bladder.
  • Prolonged use of a urinary catheter to empty the bladder, such as during childbirth or surgery.

Risk factors

  • Sexual activity.
  • Infection in other parts of the genitourinary system.
  • Pregnancy.
  • Poor hygiene.
  • Menopause.
  • Diabetes mellitus.
  • Underlying abnormalities of the urinary tract, such as tumours, calculi (stones), and strictures.
  • Incomplete bladder emptying.
  • During or after major surgery

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Contraception – Male condom

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The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects, so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb / uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

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Colposcopy

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This is a microscopic examination of the cervix, vagina, or vulva. It is used to diagnose potential abnormalities of these areas, which sometimes cannot be seen with the naked eyes. The colposcope can magnify the tissue by up to 30 times, thus making it clearer and much more accurate in terms of surface evaluation. Therefore, the biopsy of the abnormal areas performed with a colposcopic examination is more accurate than those done without the use of a colposcope.

Why do I need a colposcopy evaluation?

  • It is usually recommended if you have an abnormal Pap smear (Thin Prep) test or when pre-cancerous lesion is suspected in the vagina or labia area.

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First visit to the gynaecologist – what you should know

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Health screening as a person ages is especially important. It should be your top priority even if you are healthy. In women, this will include a visit to the gynaecologist’s clinic and will help in identifying if the woman has increased risks for developing a disease or already has the disease or condition that was not previously known about. Early identification of risks factors can help in counselling and instituting remedial or preventive measures to reduce that risk. This may in fact help to prevent the disease from occurring. Likewise, early detection of disease and starting treatment as soon as possible will results in a better outcome and lower the risks of complications. For example, many women with ovarian cancer do not have symptoms until it is too late. However, prompt diagnosis at an early stage of ovarian cancer will give excellent outcome with surgery alone and may not even need chemotherapy at all.
Many women feel nervous or even afraid to see the gynaecologist, especially if it is their first visit. Seeing a gynaecologist is just like seeing any other doctor in other specialities such as your dentist or general practitioner. They are there to help you and you should take this as an opportunity to seek their help in taking care of your health.

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Contraception – Hormonal implant (Implanon)

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The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb/uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

Hormone implant currently available is Implanon NXT®. It consists of a single plastic rod measuring 4 cm and contain a progestogen hormone called etonogestrel. Implanon is inserted surgically, just under the skin of the upper arm. The implant will release a minute amount of this hormone every day for 3 years. It works by preventing the monthly ovulation (the release of an egg from the ovary) during your menstrual cycle. It also thickens the vaginal mucus to prevent sperm from reaching the egg (fertilization). Continuous effect of the hormone will thin out the lining of the uterus (womb) to prevent attachment of a fertilized egg. Implanon does not contain any oestrogen.

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Trichomoniasis

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Trichomoniasis (or Trichomonas vaginalis, TV) is an infection of the vagina and is caused by a parasite (a flagellate protozoan) that lives in the lower genitourinary tract. The disorder can involve the vagina, urethra and bladder in women. In men, it can affect the prostate gland and urethra.

 

Symptoms and signs

The symptoms varies from women to women. Some may not have any symptoms at all and may not be aware of this infection. Infected men may have no symptoms as well. Typical symptoms are:

  • Vaginal discharge which is foul-smelling, frothy and it is most noticeable after sexual intercourse or after menses.  The discharge color may be greenish or yellowish.
  • Vaginal itching and discomfort.
  • Redness of the vaginal lips (the labia) and vagina.
  • Painful urination especially if the labia is inflamed and the urine touches the surrounding area.

Causes

This is due to a parasite called Trichomonas vaginalis. The transmission from person to person is almost exclusively via sexual intercourse. It may live in its host without producing symptoms. Since it is usually transmitted sexually, both the sexual partners must receive treatment to eliminate it completely.

Complications

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Endometrial Hyperplasia

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Endometrial hyperplasia is an overgrowth of endometrial tissue (which is the inner lining of the uterus which shed every month as menstrual blood flow). It is not cancerous. However, there is a form of severe hyperplasia which can be precancerous (especially when there is presence of abnormal cells called atypia). Classification of the hyperplasia includes:

  1. simple or complex (adenomatous) hyperplasia without atypia, or
  2. simple or complex (adenomatous) hyperplasia with atypia.

Patients who have endometrial hyperplasia without atypia usually respond well to progestogen therapy and are not at increased risk for uterine cancer. The progression of hyperplasia to endometrial cancer increases as the abnormal cells (atypia) of the hyperplasia develops.

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Bone mineral density testing (BMD)

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This test is done to measure the density of bones and this is able to predict the risk of fractures. Bone density decreases in both men and women with age, but in women, the decrease is more rapid and more severe following menopause when the ovaries stop producing the oestrogen hormone. BMD testing can show whether there is significant bone loss, resulting in low bone mass. This is a major cause of osteoporosis and of bone fractures (partic­ularly the hip, spine or forearm) in men and women over the age of 40.

Osteoporosis is a reduction in the amount of bone mass resulting in the loss of bone strength. This will predispose it to fracture. Osteopenia refers to a decrease in bone mineral density and is less severe form compared to osteoporosis. Eventually, it is likely to lead to osteoporosis if no treatment is given.

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