Vaginal Douching – To Douche or Not to Douche?

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What is Vaginal Douching?

Vaginal douching is the practice of washing the vaginal canal with fluid – this may come in the form of a bottle or bag of water or various over-the-counter or self-concocted mixtures of fluid- which is squirted up into the vaginal canal. The fluid then comes back out of the vaginal entrance.
Most women who practice vaginal douching do so because of hygiene or health concerns. Common reasons for douching include wanting to keep the vaginal canal clean or trying to get rid of bad vaginal odour or abnormal vaginal discharge.

“Why Do I Have Abnormal Vaginal Discharge?“

Is Vaginal Douching Recommended?

To put an end to the confusion regarding the practice of douching: douching is not medically recommended.
The vaginal canal is a self-cleaning organ. There are various glands in the walls of the vagina which produce fluids responsible for maintaining the natural balance in the vaginal environment. The vagina also has naturally occurred “good” bacterial flora which is important for your vaginal health. You do not need additional external chemicals or water to “wash” or cleanse the vagina.

What are the Consequences of Douching?

In fact, the practice of douching can give rise to more health problems and do more harm than good. Douching may disrupt the delicate, natural balance of the vaginal flora, leading to an increased risk of common vaginal infections like yeast or bacterial vaginosis. These may manifest as abnormal vaginal discharge, vaginal itching, or a bad odour. In the setting of a pre-existing sexually transmitted infection (STI), douching may potentially increase the risk of pelvic inflammatory disease, where the infection spreads to the uterus (womb), or the fallopian tubes and ovaries. Furthermore, douching can also result in irritation of the skin both in and around the vaginal canal, particularly if one is sensitive to the chemicals or components of the douche. Also Read, Anal Douching

“What Are The Common STD Symptoms in Women” 
“An Overview of STDs – By An STD Doctor”

How Can One Get Rid of Vaginal Odour or Abnormal Discharge?

Vaginal odour or discharge is usually due to an underlying vaginal infection and it is best that you see a doctor for appropriate testing and treatment. With treatment of the underlying offending organism, you can also expect that the abnormal discharge and odour will resolve.
In terms of hygiene, washing externally with warm water or a gentle, non-scented cleanser will suffice. There is absolutely no need to worry about washing or cleaning the vaginal canal itself.

Misconceptions About Vaginal Douching

Some women may persist with douching because of certain misconceptions they have. Vaginal douching does NOT – prevent pregnancy after unprotected sexual intercourse. Vaginal douching also does NOT prevent or reduce the spread of STIs from intercourse.
Instead, you should ensure you have safe sexual practices, such as the use of barrier protection, regular STI checks, and having a regular partner whose infection status you are aware of. If you are not planning to conceive, other reliable and safe forms of contraception are available and you can have a discussion with your doctor about these.

If you wish to speak to female doctors if you have experienced the above Treatment & Testing, please visit us at our clinics. Alternately,  call us or email us for an appointment at hello@dtapclinic.com.sg.

Take Care!

Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. Mycoplasma Genitalium Infection (Uncommon STD)
  3. How Late Can a Period Be (Delayed Menstrual Cycle)
  4. 10 Causes of Abnormal Vaginal Lumps and Bumps
  5. 11 Causes of Dyspareunia (Pain During Intercourse)
  6. Sex During Period (Sex & Menstruation) What To Know
  7. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  8. Why Do I Have Abnormal Vaginal Discharge
  9. What is HPV Vaccination – Gardasil 9

 

HGH (Human Growth Hormone) and the Ageing Woman

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What is HGH (Human Growth Hormone)?

Human growth hormone, also known as HGH, is a hormone that is produced in the pituitary gland located at the base of the brain. HGH stimulates metabolic processes in your cells and plays an important role in cell regeneration, cell reproduction and growth.

HGH prompts the body to produce another hormone called insulin-like growth factor 1 (IGF-1). It helps to maintain tissues and organs and helps with healing and wound/tissue repair. It is responsible for bone, cartilage and organ growth in childhood and adolescence. In people of all ages, HGH increases protein production and fat utilisation.

Ageing and Associated Hormonal Changes

From childhood to adulthood and as we age, our hormones fluctuate and change throughout our lifetime. Estrogen and progesterone are two important female hormones. In women, the most significant hormonal changes associated with ageing occur during menopause.

Menopause usually occurs sometime between age 45-55. During menopause, the ovaries stop releasing eggs and menstrual periods become less frequent and eventually stop. Estrogen and progesterone levels fall during and after menopause. Also see: Does Male Menopause (Andropause) Exist?

Does HGH Truly Have Anti-ageing Benefits?

Synthetic HGH is also available as a prescription injectable drug. It is typically used in children with growth hormone deficiency or to help with height e.g. in medical conditions leading to short stature. In adults, it may be used to treat growth hormone deficiency caused by damage to the pituitary or to counter muscle wasting in certain medical conditions like AIDS or short bowel syndrome.

Beyond its formal medical uses, HGH has been used/abused by athletes in hopes of improving their sporting performance and has also been touted as a possible anti-ageing solution, with

The use of HGH in ageing individuals has also been studied but to date there is no convincing evidence that its benefits outweigh potential risks. Individuals who received HGH did indeed see an improvement in lean muscle mass and reduction in body fat. However, side effects including water retention, joint pain, carpal tunnel syndrome were reported. Other HGH related studies (not specifically conducted in older individuals) also suggest there may be a potential increased risk of cancer with HGH use.

All in All

All in all, at this point in time, we lack robust data to firmly support the use of HGH in ageing women. There may not be a magic pill or injection to reverse the effects of ageing, but nonetheless, if you have concerns about ageing or related symptoms, you should speak to your doctor about possible individualised treatment options available to address your unique needs.

Find a doctor | Make an appointment

Bumps on Vaginal Area – Vaginal Lumps & Vaginal Bumps

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Lumps and bumps over the external genitalia (the vulva) or vagina are a fairly common concern that ladies may have. These can be normal or benign, or due to infections, sexually transmitted diseases, and less commonly, due to cancers (malignancy).

Here are some of the Causes of Vaginal Lumps & Bumps:

1) Benign bumps

Causes of benign bumps in the genital region include vestibular papillomatosis, Fordyce spots, ingrown hairs and folliculitis, various cysts (sebaceous cysts, Bartholin cysts).

Vestibular papillomatosis

This is a variation of normal anatomy. Vestibular papillomatosis appears as multiple, symmetrical, tiny bumps or finger-like projections over the labia minora and vestibule (vaginal opening). This can often be mistaken for warts and may thus be an undue cause for worry but there are features which help differentiate it from warts. No treatment is required for vestibular papillomatosis. It is harmless and it is NOT due to infection and cannot be spread to your sexual partners.

Fordyce spots

These are due to enlarged oil glands, which appear as tiny (1-3mm) whitish or yellowish bumps over the labia minora. These can also occur in other parts of the body, for instance around the edges of the lips or on the penis in men. They are completely harmless and painless and are part of normal anatomy. There is no need for any treatment or worry.

Folliculitis and ingrown hairs

Ingrown hairs may manifest as bumps, particularly in someone who shaves. Both ingrown hairs, as well as hair follicles, can get infected (known as folliculitis), resulting in small, red, tender bumps. Usually, topical creams will suffice for treatment.  Good hygiene, particularly relating to hair removal, is helpful in reducing the risk of folliculitis.

Cysts

Cysts are small round bumps that can be felt underneath the skin. These may arise from structures in the skin layer itself e.g. sebaceous cysts, or from glands which are found in the genital region near the labia minora (Bartholin’s glands).

Sebaceous Cysts

Sebaceous cysts are the result of oil glands which get blocked. They are painless unless they become infected. Most of the time, they can be left alone—but in the event of infection or if they become too large, incision and drainage or removal may be necessary.

Bartholin Cysts

Bartholin cysts are the result of Bartholin’s glands which are blocked. These cysts can enlarge, become infected and tender. They also have a tendency to recur and a minor surgery to remove them may be required.

2) Infections and Sexually Transmitted Diseases (STDs)

Warts

These are caused by certain strains (type 6, 11) of the Human Papilloma Virus (HPV). They appear as small skin-coloured bumps or irregular, cauliflower-like skin growths. They and can occur in isolation but are usually multiple. Genital warts usually appear anytime between weeks to 8 months (average 3 months) from the time of HPV infection and are highly infectious. The clinical course of warts can vary – in some individuals, genital warts may spontaneously resolve, while in others they may stay the same or increase in size and number.
The treatment of genital warts does not remove the underlying HPV infection and the only medication available against this is the HPV vaccine. The HPV vaccine protects against future infection but does not get rid of existing strains, so it is best to get vaccinated as soon as possible before one is exposed to more strains of HPV.
Read: Cervical Cancer, PAP SMEAR & HPV Vaccination – What you need to know

Molluscum contagiosum

This is skin infection caused by the Molluscum contagiosum virus which causes multiple small, pearly white or skin coloured bumps, sometimes with a central dimple (“central umbilication”). These are painless, non-itchy and can occur not just in the genital region but elsewhere on the body as well. The virus is spread through direct skin contact, or through contaminated clothing and towels. These lesions are harmless and will generally resolve within 6 months to a year (occasionally longer). Treatments available to address these bumps include topical medications like imiquimoid cream, freezing, and electrosurgery (laser).

Herpes

One of the stages of genital herpes is painful genital blisters – red bumps which eventually become fluid filled and later burst to form ulcers. Genital herpes is caused by the Herpes Simplex Virus which can be transmitted through secretions such as saliva or genital fluids. There is no cure for herpes, but antiviral medications are prescribed when an individual has a painful flare of blisters and ulcers.

Read: Genital Warts, Genital Blister & Genital Ulcer – Causes and Treatments
Read: Syphilis Symptoms – Painless Sores & Rashes

3) Malignancy

Vaginal cancer

Vulval or vaginal cancer are rare but serious causes of a vaginal lump or bump. These may be accompanied by other features such as persistent itching, pain, a persistent ulcer, and abnormal vaginal bleeding or discharge.

Melanoma

Vaginal melanoma (a type of cancer of the skin) can appear as a pigmented lump which may be associated with itching, bleeding and pain.

Malignancies tend to occur in older women but as their symptoms can be rather nonspecific, it is best to get any abnormal lump/bump checked.

If you wish to speak to female doctors if you have experienced the above signs and symptoms, call us or email us for an appointment at hello@dtapclinic.com.sg.

Take Care!

Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. How Late Can a Period Be (Delayed Menstrual Cycle)
  3. 10 Causes of Abnormal Vaginal Lumps and Bumps
  4. 11 Causes of Dyspareunia (Pain During Intercourse)
  5. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  6. Why Do I Have Abnormal Vaginal Discharge
  7. What is HPV Vaccination – Gardasil 9
  8. Sex During Period (Sex & Menstruation) What To Know

 

Urinary Tract Infections (UTI) in Women

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What is a Urinary Tract Infections (UTI)?

First, let’s talk about the urinary tract. The urinary tract begins with the kidneys, which are responsible for producing urine. Each kidney is connected to a tube called a ureter, which carries the urine from the kidney to the bladder. Urine is stored in the bladder before it is released through another tube (called the urethra) when we pee.
A urinary tract infection (UTI) is when there is a bacterial infection affecting any of the above components mentioned, most commonly the bladder. This is called “cystitis”. In rarer but more serious cases, important structures like the kidneys may be affected as well.
Urinary tract infections tend to affect women much more than men, simply because women have a shorter urethra than men. UTIs in healthy men are uncommon because the length of their urethra protects against bacteria spreading upwards.

What are the Causes of a UTI in Women?

Certain risk factors for UTIs are specific to women:

  • Sexual intercourse
  • Contraception (diaphragms and spermicide use)
  • Menopause

In women of all ages, common triggers include sexual intercourse (through the introduction of bacteria due to the mechanical nature of intercourse). Certain forms of contraception such as the use of diaphragms and spermicides may increase the risk of UTIs as well. In ladies who are post-menopausal, decreased levels of estrogen result in vaginal atrophy (thinning and dryness of the vaginal lining and walls) and stress incontinence, leading to an increased risk of UTIs as well.

Other risk factors are common to both males and females alike and include:

  • A weakened immune state – as may be seen in diabetes or with cancer, chemotherapy or people who are on long term immunosuppressive medications
  • Structural abnormalities in the urine tract (some people may be born with abnormalities in their urinary tract which place them at increased risk of frequent UTIs from early childhood onwards and throughout their life)
  • Kidney stones
  • Any factors which increase the risk of urine retention – this includes constipation in the elderly, certain medications, and in older men, an enlarged prostate gland
  • Foreign bodies like a urinary catheter

What are Symptoms of an UTI in Women?

Urinary tract infections can affect the urethra (urethritis), the bladder (cystitis), and the ureter and kidneys (pyelonephritis).
Common symptoms include:

  • Dysuria (a stinging or burning pain when passing urine)
  • Frequency and urgency (always feeling the urge to pee and going more often)
  • Hematuria (blood in the urine)
  • Foul smelling or cloudy urine
  • Suprapubic pain (pain over the lower part of your abdomen where your bladder is located)

Symptoms of a more serious infection affecting the kidneys and upper urine tract:

  • Flank pain (pain over the lower back region either on the left or right side corresponding to the kidney affected)
  • Fever and chills
  • Nausea, vomiting

It is best to see a doctor early, as soon as the symptoms of a UTI begin because if left untreated, there is a risk that what was initially simple cystitis or bladder infection may spread upwards to the kidney and turn into a serious and even potentially life-threatening infection that might leave permanent kidney damage.

How Will My Doctor Diagnose a UTI?

Diagnosis of a UTI begins with the history (symptoms and risk factors) you tell your doctor as well as a physical examination to see if there are any alarming red flags that suggest you have a more serious infection like pyelonephritis.
Your doctor may also ask you to provide a urine sample for a urine dipstick test in clinic – this is a simple and immediate test which can detect the presence of blood, white blood cells (infection-fighting cells which suggest ongoing inflammation), and nitrites (which are present when there is a bacterial infection) in your urine.
Another useful test that your doctor may order is a urine culture. This is when your urine sample is sent off to the lab to check for bacterial growth over the course of a few days. This is useful as it can tell your doctor which specific bacteria is responsible for your UTI, as well as what antibiotics the bacterium is susceptible to.
If you have recurrent urinary tract infections, you may benefit from additional imaging investigations, such as an ultrasound scan, to look at the structure of your urinary tract as well as look for any stones that may be triggering these infections.

How Is a UTI Treated?

Antibiotics are required to treat a UTI. Most simple cases of UTIs require only oral antibiotics, but if you have a more severe infection affecting the kidneys, you may end up having to go to hospital for intravenous antibiotics.
Medications (usually in the form of a powder that you dissolve in water and drink) that help alkalinise your urine will also be helpful in reducing your urinary discomfort while the antibiotics kick in.

What Can I Do To Reduce My Risk Of Getting a UTI?

Adequate hydration and passing urine regularly may help flush bacteria out and helps reduce your risk of kidney stones. Passing motion regularly also helps reduce the risk of urinary retention from constipation.
In women, emptying your bladder after sexual intercourse, as well as avoiding the use of diaphragms and spermicides may be helpful. Wiping from front to back after defecation also helps reduce the risk of introducing faecal bacteria.
Cranberry juice does contain a compound which inhibits bacteria from sticking to the walls of your bladder but there is no conclusive research that demonstrates cranberry juice reduces the risk of UTIs. Essentially, there is no harm in drinking cranberry juice, but it may not necessarily help as much as you hope it will.
UTIs are common and treatable! The most important thing is to see a doctor early for assessment and treatment and you’ll feel better in no time at all.
If you have any concern about UTI and wish to speak to our doctor, you may walk into any of our clinics or call us for an appointment or email us at hello@dtapclinic.com.sg.
Take Care!

Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. How Late Can a Period Be (Delayed Menstrual Cycle)
  3. 10 Causes of Abnormal Vaginal Lumps and Bumps
  4. 11 Causes of Dyspareunia (Pain During Intercourse)
  5. Pelvic Inflammatory Disease Causes Symptoms & Treatment
  6. Bacterial Vaginosis Treatment
  7. Monkeypox – What You Need to Know
  8. Abnormal Vaginal Odor – What are the Remedy 
  9. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  10. Why Do I Have Abnormal Vaginal Discharge
  11. What is HPV Vaccination – Gardasil 9

Menstrual cramps? Period Cramps? What is The Causes of Dysmenorrhea

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Menstrual cramps are what a girl dreads the most during that time of the month.
That intense crampy pain in the lower abdomen that just doesn’t seem to go away. Sounds familiar?
Well, you are not alone.
Menstrual cramps can affect more than 50% of women each month during their period, and approximately 10% suffer from debilitating pain during this time, affecting their daily lifestyle.
But what exactly causes this excruciating and annoying symptom that seems to plague so many girls almost every month?

What Causes Menstrual Cramps?

Every month during our menstrual cycle, our uterus sheds its inner lining (also known as the endometrium) as a result of hormonal changes that occur when our body senses that we are not pregnant. Additionally, the womb also contracts to help in the expulsion of this inner lining.
This shedding of the endometrium results in the bleeding that girls experience during their period.
This action also releases hormones into our body also known as prostaglandins. Prostaglandins are hormones that are involved in causing pain and inflammation, which hence leads to the pain we experience in our lower abdomen known as cramps.

What Are the Common Symptoms Associated with Menstrual Cramps?

Menstrual cramps are extremely common and can occur a few days before, during or after your menstrual period.
You may experience a cramping sensation most commonly over the lower abdomen and back and can range from mild to severe intensity.
Some people may also experience additional symptoms such as bloating, nausea, vomiting or diarrhoea.

How Do I Know If My Menstrual Cramps Could Mean Something More?

The cause behind the majority of the menstrual cramps a girl experiences are part of the normal menstrual cycle. This is known as primary dysmenorrhea. Dysmenorrhea is the medical term that refers to menstrual cramps.
However, sometimes, these menstrual cramps could be due to an underlying problem in the womb or pelvic organs. So when should you worry if your cramps are more than your regular period pains? When should you seek a doctor’s opinion?
If you experience severe or excruciating pain during each period that affects your activities of daily living, if you persistently experience pain that is out of your menstrual cycle, or if you have any other symptoms that are out of the usual, then you should get it checked if in doubt!

What Could Be the Other Causes of Menstrual Cramps?

Menstrual cramps that are caused by an underlying pathology is referred to as secondary dysmenorrhea.
Common reasons why you could be having recurrent and persistent menstrual cramps could be due to underlying conditions such as endometriosis or adenomyosis.
Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus
Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium).
Your doctor will perform a physical examination and detailed investigations to look for these conditions.
 

Can Menstrual Cramps be cured? What Is the Best Way of Treating It?

Menstrual cramps, unfortunately, cannot be cured.
However, the good news is they can be well controlled with various types of medication.
A good way to control and reduce the discomfort that is caused by menstrual cramps is by taking painkillers. In particular, painkillers that belong to the NSAIDs group are particularly useful in controlling the symptoms of dysmenorrhea.
This is due to the mechanism of action of the painkillers in the NSAID group, which specifically target and block the prostaglandins that are the cause of the period pains!
Other good ways to manage period cramps can also include:

  • Using a heating pad or hot water bottle
  • Drinking a warm drink
  • Avoid smoking or alcohol
  • Regular exercise

If you are experiencing any worrying menstrual cramps, please call or visit any of our DTAP Clinics or drop us an email at hello@dtapclinic.com.sg for an appointment for a proper evaluation and treatment.

Take Care!

Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. How Late Can a Period Be (Delayed Menstrual Cycle)
  3. Sex During Period (Sex & Menstruation) What To Know
  4. 10 Causes of Abnormal Vaginal Lumps and Bumps
  5. 11 Causes of Dyspareunia (Pain During Intercourse)
  6. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  7. Why Do I Have Abnormal Vaginal Discharge
  8. What is HPV Vaccination – Gardasil 9

 

Menstrual Cycle Delay – How Late Can a Period Be

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What exactly is a delayed menstrual cycle?
You may not know this, but not everyone has a menstrual cycle that functions like clock-work.
While some girls have the privilege of being able to accurately predict when their next period is going to come due to their extremely regular cycles, many of us actually experience some variation in our menstrual cycles.
These variations are usually a difference of a few days, with the average length of a menstrual cycle ranging from 28-35 days.
A delayed menstrual cycle occurs when your menstrual period deranges from this average duration of 28-35 days. While some people do have longer menstrual cycles of up to 45 days, any cycle that is delayed or out of the norm should be checked out by your doctor.

What Causes a Delayed Menstrual Cycle?

Causes of a delayed menstrual cycle will depend on 2 main things:

  1. Your age
  2. Whether you’re sexually active or not

The most important cause of a delayed menstrual cycle that cannot be missed is PREGNANCY.

If you are of a reproductive age group (after puberty and before menopause) and sexually active, the first thing to do with a delayed menstrual period is to do a urine pregnancy test.
Girls at the ‘extremes’ of their reproductive age also may tend to experience a delayed menstrual cycle.

What Do We Mean By This?

Adolescent girls who recently underwent puberty or are within the first few years of getting their first period may also experience some delays in their monthly menstrual period.
On the other end of the spectrum, older women in their late 40s or early 50s may also experience delayed menstrual cycles as they approach menopause.
Several other factors can also contribute to a delayed menstrual cycle:

  • Weight gain or loss
  • Over-exercise
  • Stress
  • Hormonal imbalances or thyroid problems

 
 

What Does a Doctor Do for a Patient with Delayed Menstrual Cycle?

If you experience any delays, irregularity or changes in your menstrual cycle, you should see a doctor get it checked out.
The first thing your doctor will do is to take a detailed history of your condition, which may include personal questions such as your sexual history.
It is also important for the doctor to have an idea on your usual menstrual patterns as well as your general lifestyle.
Next, a physical examination on the abdomen and vaginal area is carried out to look for any clues for the cause of your delayed menstrual period. The doctor will also look for signs such as excessive hair growth, acne or obesity.
After taking the history and performing the physical examination, your doctor may then order some investigations to find out what is causing your delayed menstrual period.

What type of investigations are required?

As previously mentioned, the most important thing to rule out with a delayed menstrual cycle is pregnancy.
Once pregnancy is ruled out, other types of tests can then be conducted to further investigate the cause of the delayed menstrual period.
One of the tests that may be done is a hormonal blood test. This will ascertain if there are any hormonal abnormalities resulting in the abnormal menstrual period.
An ultrasound may also be arranged to look for any abnormalities.
It is also important for all women to have an up to a date PAP smear.

What Should I Do For My Delayed Menses?

The first thing you should do if you experience delayed menses is to seek a doctor’s opinion as early as possible!
Also, as mentioned above, doing a urine pregnancy test is one of the basic steps that you can do on your own as well.
If you are pregnant, then your doctor will refer you to a gynaecologist or a hospital for further testing.
If you are not pregnant, then further tests will be conducted to determine the causes of the delayed cycle.
After which you may be prescribed with some medications to help.

 

How to Get Emergency Contraception “Morning After Pills” in Singapore

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Failed contraception, unprotected intercourse: these are causes for concern, especially the day after. As a lady, the associated emotional distress and anxiety can be nerve-wracking and even more so if you are in Singapore for the first time. The “morning after” pill or Emergency Contraception is a safe and effective way of preventing unintended pregnancies.
In some countries, the morning after pill can be obtained over the counter at a pharmacy. However, in Singapore, a doctor’s prescription is required.

Top 5 Pressing Questions on How to Get Emergency Contraception (the “Morning After” Pill) in Singapore

We answer your top 5 pressing questions as you search for answers on how to get emergency contraception/ the “morning after” pill in Singapore.

1. How Do I See a Doctor in Singapore?

Most private clinics offer a walk-in system, but not every clinic may carry the morning after pill, or be staffed by a team familiar with women’s health. While obtaining the morning after pill on time is crucial, it is also as important to speak to a doctor who will be able to address and allay your concerns in a judgement-free safe space.
Dr Tan & Partners clinics are conveniently located around Singapore and we attend to a diverse mix of locals, travelling tourists and expatriates on a daily basis.
The process of obtaining the emergency pill is quick and convenient: simply walk into any of our clinics, register, consult our doctor who will advise you appropriately, and you will be able to collect your medication immediately. No additional trip to an external pharmacy is required.
Payment is usually made by cash in Singapore dollars, (other modes of payment like WeChat Pay etc) or credit cards (Visa/Master/AMEX).

2. What Should I Be Worried about When Taking the Morning After Pill?

Common side effects include nausea, mild abdominal cramps, spotting (bleeding when not on your period) and changes in the next menses date (either slightly earlier or later).
The morning after pill can be taken up to 3 to 5 days after sexual intercourse (depending on the type of pill) but the earlier it is taken, the more effective it is. It does not protect against future occurrences of unprotected intercourse and should not be used as a regular form of contraception.
While it is extremely effective, it is not completely foolproof and if you find that your period is significantly delayed, you should do a blood or urine test to check for pregnancy.

3. Which are the Available Morning After Pills in Singapore and How Do I Take Them?

Postinor Ella
Timing Effective up to 72 hours from time of intercourse Effective up to 5 days after the time of intercourse
Dosage 2 tablets taken 12 hours apart 1 tablet taken immediately

4. What Should I Do If I am Already on the Combined Oral Contraceptive Pill but Missed my Dose?

You should speak to your doctor if you are taking the combined oral contraceptive pill (e.g. Diane-35, Yasmin, YAZ, Microgynon etc) but have missed a dose or some doses. If there is a need for you to take emergency contraception, you may have to hold off restarting your regular pill for up to 5 days to prevent interactions between the different medications. Your doctor will advise you accordingly.
Alternative barrier contraception (condoms) should be used during this period and for 7 days after restarting your combined pill.

5. What Other Options Do I Have for Long-term Contraception? How Do I Prevent This From Happening Again?

There are many options available, from the mini pill to the combined pill, to an IUD (intra-uterine device) and even a hormonal implant (Implanon)
We provide a listening ear to better understand your individual needs and will help advise you on the most suitable form of regular contraception for you.
Lastly, let us take care of your health needs so that you can focus on enjoying yourself as you travel. Stay Safe
Emergency contraception is available in all of our clinics
Take Care!

Other Reads:

  1. What Is the Cause & Treatment For Oral Herpes (Cold Sores)
  2. How Late Can a Period Be (Delayed Menstrual Cycle)
  3. 10 Causes of Abnormal Vaginal Lumps and Bumps
  4. 11 Causes of Dyspareunia (Pain During Intercourse)
  5. What You Need to Know about HPV Vaccination, Cervical Cancer & Pap Smear
  6. Why Do I Have Abnormal Vaginal Discharge
  7. What is HPV Vaccination – Gardasil 9

Why Do I Have Abnormal Vaginal Discharge?

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Let’s talk a little about normal vaginal discharge first.

The vagina is a muscular passage which leads from the vaginal opening to the cervix, which is the entrance to the womb. There are naturally occurring “good” lactobacillus and other bacteria which are part of the normal vaginal flora. The walls of the vagina have glands which produce secretions for the cleansing of the vaginal canal. Normal vaginal discharge is a result of these secretions. It is usually clear or whitish and largely odourless and may change slightly throughout your menstrual cycle.
 

via GIPHY
 

How to identify abnormal vaginal discharge and what you should be worried about?

However, when you notice a major change from your usual vaginal discharge, this abnormal vaginal discharge may indicate that something is wrong.
Signs that your vaginal discharge may be abnormal include different coloured discharge – greenish, yellowish, greyish or even brownish discharge, the presence of a bad vaginal odour, changes in discharge consistency such as thicker, clumpy discharge or large amounts of watery discharge.
If this discharge is accompanied by abdominal pain, fever, or spotting/bleeding after sexual intercourse or bleeding when your period is not due yet, then these are all alarming features that should Fprompt you to consult a doctor.
Abnormal vaginal discharge is one of the most common female health problems and it should not be something you feel you have to suffer in silence about. Most ladies will experience this at some point in their life and while it can be an extremely distressing and uncomfortable problem, it is very treatable.
 
 

You probably have a vaginal infection.

The top cause of abnormal vaginal discharge is a vaginal infection, also known as vaginitis. Other rare causes of abnormal vaginal discharge include cervical abnormalities such as cervical cancer.
The next question, then, would be what sort of infections you have to worry about if you are experiencing abnormal vaginal discharge. These can broadly be divided into Sexually Transmitted Infections (STIs) and non-Sexually Transmitted Infections (STIs).
The most common causes of abnormal vaginal discharge are non-sexually transmitted infections- Bacterial Vaginosis and yeast infections. These all occur when there is disruption to the delicate balance of your healthy vaginal flora and can be triggered by a multitude of factors.
However, if you have had unprotected sexual intercourse, particularly if you are unsure of your partner’s infection status (whether this be a casual partner or a long-term partner), then your abnormal vaginal discharge may very well be due to a Sexually Transmitted Disease (STD) such as Chlamydia, Gonorrhoea, Trichomonas, and various types of Mycoplasma and Ureaplasma bacteria.
Regardless of the underlying cause of your abnormal vaginal discharge, proper evaluation is crucial as it allows you to receive the appropriate treatment, which is important not just in relieving your discomfort but also in preventing more serious, long-term complications (like Pelvic Inflammatory Disease) that can occur with certain infections.
 
 

Why does the abnormal vaginal discharge keep coming back?

This is a very common question and recurrent abnormal vaginal discharge can be an extremely frustrating and distressing issue.
Recurrent yeast infections and bacterial vaginosis tend to be responsible for the above phenomenon and can be triggered by a variety of factors which upset the balance of your vaginal flora.
 

1) Hormonal Fluctuations

  • For some ladies, they may find that the hormonal fluctuations during their peri-menstrual period (before or after menses), may cause them to be prone to recurrent yeast infections.
  • Pregnancy

 

2) Weakened Immune System

  • If you have diabetes or are undergoing any other sort of medical treatment that affects your immunity, you may be more prone to recurrent yeast infections.

 

3) Sexual Lifestyle

  • Sexual intercourse can trigger off bacterial vaginosis – in fact, the number of sexual partners which one has had is actually a risk factor for bacterial vaginosis, with every new partner that a lady has increased the risk of Bacterial Vaginosis infections.
  • Other habits like using spermicide may also kill off the good lactobacilli in the vagina and lead to increased susceptibility to infection

 

4) Medications

  • Being on the combined oral contraceptive pill does increase your risk of recurrent yeast infections
  • Antibiotic usage (for instance, taking something for a bacterial throat infection) can also (ironically) upset the delicate balance down there

 

5) Hygiene Habits

  • Use of vaginal douche washes or feminine washes with harsh chemicals can disrupt your natural vaginal balance and lead to increased yeast and BV infections
  • Tight underwear, pantyliners or menstrual pads which trap humidity and moisture may also place you at increased risk for a yeast infection

 
As can be seen, not all triggers may be entirely avoidable but good habits- like avoiding feminine douche washes, wearing breathable cotton underwear, minimising antibiotic use unless medically indicated, and using condoms- do play a part in helping you maintain a healthy vagina.
If you keep having abnormal vaginal discharge that comes back with a vengeance after the initial episode, do speak to your doctor about additional treatment that may be suitable for you.
 
Remember that you are not alone – abnormal vaginal discharge is common – and treatable!
Don’t let your discomfort about the topic keep you from treatment.
 
Take Care!

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. How Do I Get an Anonymous HIV Testing?
    4. What is HPV Vaccination (Gardasil 9)
    5. 10 Causes of abnormal Vaginal Lumps and Bumps
    6. An Overview of Gonorrhoea
    7. What is the Treatment for Cold Sores? What causes Cold Sores?

 
 

Cervical Cancer, Pap Smear & HPV Vaccination – What You Need To Know

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What is Pap Smear?

Pap smear is a cervical cancer screening recommended every 3 years for all sexually active females starting from age 25 years old.

This is a quick, simple and painless procedure that can be done in the clinic and it only takes a few minutes.  A brush will be used to collect some cells from the neck of the womb (cervix) and it will be sent to the lab to identify any precancerous and cancerous cells.

Cervical Cancer

In Singapore, cervical cancer is the 3rd leading cause of cancer deaths in women age 15-44 years old.
Cervical cancer risk is increased with :

  1. Multiple sexual partners
  2. Human papillomavirus (HPV) infection
  3. Smoking
  4. Unprotected sex

What is Human papillomavirus (HPV)?

Human papillomavirus (HPV) is one of the commonest sexually transmitted infection. It can affect both men and women.
There are 2 types of HPV – the low risk and high-risk types.

  1. Low-risk HPV can cause genital warts in both female and males. These are flesh coloured growths on the genitals, and they are infectious.
  2. High-risk HPV plays a significant role in the increased risk of cancer, such as cancer of the cervix, vulva, and vagina in women as well as anal cancer in men who have sex with men (MSM)..

The American College Obstetrician and Gynaecologist (ACOG) strongly recommends co-testing using Pap smear and HPV DNA testing (high-risk HPV types) especially for women ages 30-65 years old.
Patients are advised to repeat these tests in 5 years if pap smear and HPV results are negative.
This allows patients to extend their screening interval.

However, for women who test positive for high-risk HPV types, this means their risk is increased and hence, may need to have Pap smear screening at a closer interval, i.e once a year and depending on the results of the pap smear, some may need a referral to a gynaecologist for early intervention.

Remember, women can have no symptoms with an abnormal pap smear and HPV infection. Hence, early detection and screening are crucial as early intervention can be life-saving. Symptoms such as bleeding and pain during sex (postcoital bleeding), bleeding in between periods, heavy vaginal bleeding, and bleeding after menopause are usually late signs of cervical cancer.

The good news is cervical cancer can be prevented through vaccination.

GARDASIL 9 is a vaccine that helps protect against Human Papillomavirus (HPV). Most people infected with HPV show no signs or symptoms, this means they can transmit the HPV virus to others without knowing it in any kind of sexual activity or skin to skin contact.

Gardasil 9 provides protection against 9 major strains of HPV, which includes HPV types 6,11,16,18,31,33,45, 52 and 58 which are responsible up to 90% of genital warts and cervical cancers or precancer changes.

The vaccine, however, does not treat the infection.

It can be given to both females and males from the age of 9 up to 45 years old.
From the age of 9-14 years, 2 doses 6 months apart is recommended while those age 15 onwards, 3 doses will be recommended according to the schedule of 0, 2 and 6 months.
The side effects post vaccination is usually mild and temporary including pain, swelling, bruising over injections site and very rarely may cause fever and nausea.
HPV vaccine reduces your risk significantly but it does not mean your risk becomes zero.

After the completion of HPV vaccination, all women who are sexually active and above the age of 25 should still undergo routine screening via pap smear.

If you are due for your routine PAP smear or if you have questions about cervical cancer screening & HPV vaccination and wish to find out more, please call or visit any of our clinics or drop us an email at hello@dtapclinic.com.sg
We have Female doctors at our Robertson Walk, & The DUO Galleria Branches Location. Call our clinic @ +65 6976 5023 

Take Care! 

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. Herpes – What You Need to Know
    7. The Good Wrinkles, Bad Wrinkles & the Ugly Wrinkles

11 Causes of Dyspareunia in Women (Pain During Intercourse)

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Dyspareunia or Pain During Intercourse is a condition whereby people experience pain during sexual intercourse. Both men and women can experience pain during sex sometime during their lives. However, it is much more common for women. Particularly in young women who are inexperienced or women who are in the perimenopause or menopause stages.

There is not much awareness about this topic as there is still a stigma surrounding it. Consequently, women are not speaking to their sexual partner, friends, close family or doctor when faced with this issue. If the situation is not dealt with, it may lead to other problems. Besides not being able to enjoy sex, the pain will progressively worsen due to the muscles tightening up.
Dyspareunia will have a negative physical impact on you, as well as being able to emotionally affect you and your partner’s relationship.

Pain During Intercourse can be classified into either deep or superficial pain during sex.

 

Causes of superficial pain include:

1.) Vaginismus

Vaginismus is the spasms of vaginal muscles which arises from the fear of being hurt. This can cause both deep and superficial pain, making sex extremely painful and sometimes even impossible. As a result of fear of vaginal examinations, women with vaginismus may never be able to use tampons or have a pap smear test.
The causes of vaginismus can be attributed to a restrictive upbringing, a history of rape or sexual abuse as a child, or past painful vaginal infections such as genital herpes.

2.) Lack of Vaginal Lubrication

This is arguably the most common cause of dyspareunia. Lack of vaginal lubrication can be due to nervousness, failure to relax, not having enough foreplay, or having unskilled foreplay performed by the male partner. Dyspareunia because of this can be resolved through increased foreplay, using lubricants by both counterparts, or if the female can become more relaxed.
One feature of menopause is the fall in production of the female hormone oestrogen, this causes vaginal dryness in perimenopausal or menopausal women. In this case, using lubricants during sex should reduce the pain substantially. Other treatment options available for these women are hormone replacement therapy (HRT) or vaginal hormone creams with the purpose to actively boost oestrogen production.

3.) Vaginitis (Inflammation of the Vagina)

Vaginitis is essentially the inflammation of the vagina which is caused by infections from thrush (candida), trichomonas or bacterial vaginosis (BV).
Common symptoms of this condition would be abnormal vaginal discharge, as well as itchiness and a burning sensation in the vagina and vulva (opening of the vagina).

Another type of causes, especially if associated with an infection, can also cause pain.
This includes:

  • Genital herpes
  • Foreign body in the vagina
  • Forgotten tampon

Generally, treating the infection will simultaneously clear dyspareunia.

4.) Vulvitis (Inflammation of the Vulva)

Vulvitis is the inflammation of the vulva (opening of the vagina) that can progressively lead to cracks in the skin of the vulva. It can also cause pain (including dyspareunia), itching and a burning sensation in the vulva.
Contact dermatitis is a common skin disorder that can also lead to inflammation of the surrounding skin of the vulva either due to an allergic reaction or direct exposure to agents like perfumed soaps, douches or lubricants.

5. Injury

Injuries to the vulva commonly stem from labour. During labour, episiotomy cuts or tears can occur. If unattended to, it may cause pain during sex for an extended period of time. Otherwise, badly healed stitches can cause pain too.
If you are experiencing any of these problems, it is advised to see a doctor sooner.

Causes for deep pain include:

6. Problems with the Cervix

During sex, the penis is able to come into contact with the cervix (opening of the womb). This can cause pain due to deep penetration, also known as ‘collision dyspareunia’. This open contact can also cause STDs such as gonorrhoea, chlamydia, trichomoniasis, genital herpes and others.
Additionally, if an intrauterine contraceptive device (IUD) or ‘coil’ planted at the cervical canal becomes displaced during sex, this can also cause pain.

7. Problems with the Uterus (womb) or Ovaries

Womb disorders or other problems in this region can cause deep pain during sex, such as:

  • Fibroids
  • Fixed retroverted uterus
  • Ovarian cysts

8. Endometriosis

Endometriosis is a disorder in which the tissues intended to line the uterus start growing outside the uterus. The location where endometriosis occurs will determine how much pain you experience during sex. The pain is expected to be more intense if endometriosis occurs behind the vagina and lower part of the uterus.

9. Pelvic inflammatory disease (PID)

PID is caused by a sexually-transmitted infection in the upper female genital tract (pelvis). During sex, pressure on these badly inflamed tissues in the affected region can cause deep pain.

10. Pelvic Adhesions

Pelvic adhesions are when the tissues in the upper female genital tract (pelvis) become stuck together. This development is usually due to the aftermath of surgery, injury (trauma), radiation treatment or infection, like a complication of pelvic inflammatory disease (PID). These adhesions can cause pain, including dyspareunia.

11. Ectopic Pregnancy

An ectopic pregnancy is when the pregnancy is located outside the womb, like in the fallopian tubes, cervix or ovary. As this type of pregnancy develops, it will stretch out the surrounding tissue, creating discomfort. Pressure on this region during sex will cause more pain.
If you are experiencing repeated pain during or after sex, do not hesitate to see a doctor or visit our clinic as dyspareunia is not normal and often the underlying cause is curable. The longer you leave it, the more issues it may cause to yourself and also may lead to a detrimental effect on your relationship with your partner.

If you are experiencing Pain During Intercourse, it is highly recommended to visit our doctor at our DTAP Clinics as soon as possible, especially if the pain becomes persistent. Most causes of dyspareunia are not serious. However, there is a few that can be severely detrimental to your health and well-being.

Take Care!

Other Interesting Reads:

    1. What You Need To Know about HPV, Cervical Cancer, Pap Smear & HPV Vaccination
    2. 11 Causes of Dyspareunia (Pain During Intercourse)
    3. What is HPV Vaccination (Gardasil 9)
    4. 10 Causes of abnormal Vaginal Lumps and Bumps
    5. An Overview of Gonorrhoea
    6. What is the Treatment for Cold Sores? What causes Cold Sores?
    7. Sex During Period (Sex & Menstruation) What To Know