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

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 Women’s 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)

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 Women 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


10 Causes of Abnormal Vaginal Lumps and Bumps

Some women may develop lumps or bumps in the vaginal area sometime during their lives.

The severity of the condition, indicated by these lumps and bumps, can be classified into three categories:

  • Harmless
  • Infection or sexually-transmitted disease
  • Malignancy

For the most part, these lumps or bumps are harmless. The following conditions fall under this group.

1.) Cysts

Cysts can occur anywhere in the body. They are sacs, that range in size, filled with liquid or other substances. In the vaginal area, these cysts are usually benign and painless unless infected. It would feel like a small pebble just underneath the skin of the vulva.

There are two kinds of cysts:

Sebaceous Cysts

Sebaceous cysts result from the blocked hair follicles and ingrown hair when shaving or waxing. Most of these cysts do not require treatment and can be ignored if it does not cause any problems. However, some may need a small incision if they enlarge or become infected.

Bartholin Cysts

When the Bartholin gland (a gland in the vaginal and vulva region) becomes blocked and swells, this will cause a Bartholin cyst to form. The cyst is also harmless unless it becomes infected and turns into an abscess (a swollen area containing pus). In such cases, a trial of antibiotics usually is effective. In some cases, minor surgery may be necessary.

2.) Molluscum Contagiosum

A virus called pox virus causes molluscum contagiosum. It is a skin infection which causes multiple tiny bumps to spread across the area of infected skin. These harmless bumps or raised lesions are pearly white to skin-coloured and will eventually vanish after 1-2 years.
Molluscum contagiosum commonly appears in children and other parts of their bodies. However, it may pose as a sign of an STD when it occurs in adults. It is then advised for these people to get tested for other STDs.
Effective treatment options available to cure this particular type of molluscum contagiosum include:

  • Electrosurgery
  • Freezing (liquid nitrogen)
  • Topical cream


3.) Vestibular Papillomatosis

VP is a skin condition whereby multiple shiny small papules appear over the skin of the inner labia and vaginal opening. Similar to pearly penile papules (PPP) in men, VP is a normal variant of female genitalia; therefore treatment is not necessary.
It should be noted that Vestibular Papillomatosis is commonly mistaken for genital warts because of their similar appearance. Genital wart is a type of Sexually Transmitted Disease (STD). Therefore it is essential to have a correct diagnosis of the condition as a measure to prevent undue stress or prolonged deterioration. Our doctors are able to distinguish between both conditions.

4.) Fordyce Spots

Fordyce spots are enlarged oil glands materialising as small white to yellow lumps over the inner labia. These spots can also appear on the lining of the mouth and occasionally on the penis in men. They are completely painless and harmless.
The condition where lumps and bumps associated with an infection is folliculitis. Other conditions that are STD-related include genital warts, syphilis and herpes.

What are some of the causes of Bleeding after Sex (Post Coital Bleeding)?

5. Folliculitis

Folliculitis is the skin condition where the hair follicles in the labia region become inflamed and infected, causing tender red spots containing pus to surface. The hair follicles become inflamed from bacterial, fungal or even viral infection (e.g. herpes), due to situations that irritate ingrown hair, like shaving or waxing. The treatment is dependent on the type of infection.

6. Genital Warts

Genital wart is a Sexually Transmitted Disease (STD) caused by the Human Papilloma Virus (HPV), usually, type 6 and 11. Genital warts present as small, skin-coloured cauliflower-like bumps that can either develop into one single lump or more commonly into multiple lumps. Genital warts are highly contagious through skin-to-skin contact.
Depending on the individual, the HPV warts may go away, remain present or spread and increase in amount. Even without developing these warts, the individual can still be a carrier of the HPV virus.
There are HPV vaccinations now available to protect you from certain strains of HPV including type 6 and 11.
(The new Gardasil 9 HPV Vaccination is available in all our clinics in Singapore and Malaysia)

7. Syphilis

Syphilis is a sexually-transmitted disease that is caused by a bacterial infection. From this, a chancre, a painless sore, will appear in the genital or mouth area. The sore can eventually go away untreated in a few weeks. However, this will lead to the development of severe complications because the infection remains.
Please click here to find out more about syphilis, including treatment options.

8. Genital Herpes

Genital herpes is a contagious sexually-transmitted disease appearing as multiple painful blisters or ulcers clustered in the genital area. The infection can spread quickly to sexual partners, even with the use of condoms.
Although there is currently no cure for the infection, there are different treatments, like antiviral medications, to prevent and control recurring outbreaks of blisters.

Lumps and bumps can also be a malignant growth, and potentially a sign of cancer.


9. Vaginal Cancer

Vaginal or vulvar cancer can be presented as a lump or bump in the vaginal region. Besides the lumps, this type of cancer is also accompanied by other symptoms, including:

  • Abnormal vaginal bleeding
  • Unusual vaginal discharge
  • Pain during intercourse

In such cases, a pelvic examination and pap smear are done to look for any red flags. A pelvic examination and a pap smear test is done to check for signs of early changes and cancer.
If the results are positive, the doctor will then discuss the next steps for treatment.

10. Vaginal Melanoma

Melanoma is a type of skin cancer arising from pigmented cells. 2% of melanoma are diagnosed in the vagina or vulva. This cancer is more prevalent in women older than 50.
Vaginal melanoma appears as a pigmented lump in the vaginal area. Other non-specific symptoms include itching, bleeding and pain.
If you are experiencing Abnormal Vaginal Lumps & Bumps, it is highly recommended to visit our female doctors at our Women Clinics as soon as possible.
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?