4.

Vaginal Health Care

Vaginal health is an important part of women's overall health. Vaginal problems can affect fertility, desire for sex and ability to reach orgasm. Ongoing vaginal health issues can also cause stress or relationship problems and affect self-confidence.

Know the signs and symptoms of vaginal problems and what you can do to protect your vaginal health.

Sexual Problems

Infections

Other Services

Sexual Issues You Can Talk to Your Gynaecologist

Pain during intercourse
Vaginal dryness
Vaginal tightening options
Vaginismus

We encourage an open discussion about sexual health & intimacy. We help women understand how things like aging, menopause, depression, medication and physical changes can affect your sexual function. Treatment is focused on restoring healthy sexual relationships and intimacy with your partner. We will also take the time to educate you on ways to ease sexual difficulties, helping you return to a state that will help you enjoy intimacy.

At Dr Siva Urogynaecology & Women's Health Clinic, we specialize in :

1

Anatomical Correction

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Pelvic Floor Disorders

2

Hormonal Management for Vaginal Lubrication

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Estrogen & Testosterone Replacement

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Vaginal Muscle Spasms (Vaginismus)

Conditions We Treat

Pain During Intercourse

Symptoms:
• Discomfort: Pain or discomfort during penetration
• Burning Sensation: Burning feeling in the vaginal or pelvic area
• Sharp Pain: Sharp or stabbing pain during or after intercourse
• Achy Pain: Dull, aching pain in the pelvic region
• Difficulty with Penetration: Resistance or pain when attempting penetration
• Associated Symptoms: May include vaginal dryness, itching, or abnormal discharge
Treatments:
• For Infections: Antibiotics or antifungal medications if an infection (e.g., yeast infection, bacterial vaginosis) is identified
• For Vaginal Dryness: Lubricants or estrogen therapy if vaginal dryness is a contributing factor
• For Pelvic Floor Dysfunction: Pelvic floor physical therapy to address muscle tension or dysfunction
• For Endometriosis or Fibroids: Specific treatments based on underlying conditions (e.g., hormonal therapy, surgical options)
• For Vaginismus: Treatment may include pelvic floor exercises, dilators, and counseling

Vaginal Dryness

Symptoms:
• Discomfort: Dry, uncomfortable sensation during penetration
• Burning Sensation: Burning or stinging feeling in the vaginal area
• Itching: Itching or irritation in the vaginal region
• Difficulty with Penetration: Resistance or pain due to lack of lubrication
• Increased Friction: Feeling of increased friction or roughness during intercourse
• Dryness: Noticeable lack of natural vaginal lubrication
Treatments:
• Lubricants: Use of water-based or silicone-based lubricants to reduce friction and enhance comfort
• Estrogen Therapy: Local estrogen treatments (e.g., vaginal creams, rings, or tablets) if dryness is due to hormonal changes, such as menopause
• Hydration: Advising adequate fluid intake and avoiding dehydrating substances like caffeine or alcohol
• Lifestyle Adjustments: Recommending changes in sexual practices or frequency to accommodate comfort

Vaginal Tightening Options

Symptoms of Loose Vaginal Tissues:
• Feeling of Looseness: Sensation of reduced vaginal tightness or support
• Decreased Sensation: Reduced pleasure or sensation during intercourse
• Incontinence: Urinary leakage or urgency, particularly during physical activities or sneezing
• Pelvic Pressure: Feelings of pelvic heaviness or pressure
• Prolapse: In severe cases, visible bulging or protrusion of vaginal walls (vaginal or pelvic organ prolapse)
• Changes in Vaginal Tone: Noticeable changes in muscle tone or vaginal firmness
Treatments:
• Pelvic Floor Exercises: Kegel exercises to strengthen the pelvic floor muscles and improve vaginal tone
• Physical Therapy: Specialized pelvic floor physical therapy to address muscle weakness and support
• Pessary Use: In cases of prolapse, a pessary can provide support and relief
• Hormone Therapy: Local estrogen therapy to improve vaginal tissue health and elasticity in postmenopausal women
• Surgical Options: For significant prolapse or persistent issues, surgical interventions such as vaginal rejuvenation or repair may be considered

Vaginismus

Symptoms:
• Involuntary Muscle Spasms: Involuntary contractions or tightening of the vaginal muscles during attempted penetration
• Pain: Pain or discomfort during intercourse, tampon insertion, or gynecological exams
• Difficulty with Penetration: Resistance or inability to insert tampons, menstrual cups, or during sexual activity
• Psychological Symptoms: Anxiety, fear, or distress related to sexual activity or penetration
• Avoidance: Avoidance of sexual activity or pelvic exams due to anticipated pain
Treatments:
• Pelvic Floor Physical Therapy: Exercises and techniques to relax and retrain the pelvic floor muscles, including biofeedback
• Vaginal Dilators: Gradual use of dilators to desensitize and stretch the vaginal muscles, improving tolerance to penetration
• Counseling or Therapy: Psychological counseling to address underlying anxiety, fear, or trauma related to vaginismus
• Relaxation Techniques: Methods such as deep breathing, mindfulness, or progressive muscle relaxation to reduce overall tension
• Education: Provide information on sexual health, anatomy, and relaxation techniques

A Vaginal Infection isn’t the same as a Urinary Tract Infection (UTI)

UTI impacts your bladder or the tubes that transport urine out of your body.
Your vagina, however, is part of your reproductive system and operates separately from your bladder and urinary tract.

Vaginal infections can be caused by bacteria, fungi, parasites or viruses. Some of these things normally live in your vagina without causing any problems. But sometimes they can grow out of control, causing an infection in your vagina and vulva (the area surrounding your vagina).

Things that can trigger this or increase your risk include:

1

being sexually active, especially if you’ve had a recent change in partner

2

taking antibiotics

3

using vaginal hygiene products like douches, soaps, bubble baths, deodorants, vaginal washes and wipes

4

some types of contraception, including the copper intrauterine device (IUD)

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taking long-term steroid medicines

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having a health condition that affects your immune system, like diabetes or HIV

Conditions We Treat

Bacterial Vaginosis

Symptoms:
• Thin, grayish-white vaginal discharge
• Fishy odor, particularly after sexual intercourse
• Mild itching or irritation in the vaginal area
• Sometimes asymptomatic
Treatment:
• Antibiotics: Prescribed either orally (e.g., metronidazole or clindamycin) or topically (e.g., metronidazole gel or clindamycin cream)
• Avoid douching: Can disrupt the natural vaginal flora
• Reduce use of irritating products: Such as scented tampons or pads
• Follow-up: To ensure the infection is resolved and to address any recurrence

Vaginal Yeast Infection

Symptoms:
• Itching and irritation in the vaginal area
• Thick, white, cottage cheese-like vaginal discharge
• Redness and swelling of the vaginal vulva
• Pain or discomfort during intercourse
• Burning sensation during urination
Treatment:
• Antifungal Medications:
- Topical treatments: Over-the-counter or prescription creams, ointments, or suppositories (e.g., clotrimazole, miconazole)
- Oral medications: Prescription antifungal pills (e.g., fluconazole) for more severe cases or recurrent infections
• Avoid irritants: Such as scented tampons, pads, or douches
• Maintain good vaginal hygiene: Wear breathable, cotton underwear and avoid tight-fitting clothing
• Manage underlying conditions: Address factors like diabetes or antibiotic use that can predispose to yeast infections
• Follow-up: To ensure the infection is resolved and to evaluate any recurrence or underlying causes

Trichomoniasis

Symptoms:
• Discharge: Frothy, yellow-green, or gray vaginal discharge with a strong, unpleasant odor
• Itching: Itching or irritation in the vaginal area
• Redness: Redness and swelling of the vulva
• Pain: Discomfort during intercourse
• Burning: Burning sensation during urination
• Asymptomatic Cases: Some women may have no noticeable symptoms
Treatment:
• Antiprotozoal Medications: Single-dose prescription medications such as metronidazole or tinidazole
• Partner Treatment: Both partners should be treated simultaneously to prevent reinfection
• Avoid Alcohol: Patients should avoid alcohol during treatment with metronidazole due to potential adverse reactions
• Follow-up: To ensure the infection is completely cleared and to address any persistent symptoms
Preventive Measures: Encourage the use of condoms and discuss safer sex practices to reduce the risk of transmission

Vaginal Discharge

Symptoms:
• Consistency: May vary from thin and watery to thick and sticky
• Color: Can be clear, white, yellow, green, or gray
• Odor: May have no odor or a fishy, sour, or unusual smell
• Volume: Varies from minimal to excessive
• Associated Symptoms: May include itching, burning, redness, or discomfort
• Change: Any new, unusual, or persistent change in discharge
Diagnosis:
• Pelvic Exam: To evaluate the discharge and other symptoms
• Laboratory Tests: Microscopic examination, culture, or pH testing to identify the cause
Specific Treatments:
• Bacterial Vaginosis: Antibiotics (e.g., metronidazole or clindamycin)
• Yeast Infection: Antifungal medications (e.g., clotrimazole, miconazole, or fluconazole)
• Trichomoniasis: Antiprotozoal medications (e.g., metronidazole or tinidazole)
Partner Treatment: If an infectious cause is identified, both partners should be treated if applicable

Vulva Dermatitis

Symptoms:
• Redness: Persistent redness or rash on the vulva
• Itching: Intense itching or irritation
• Swelling: Swelling or inflammation of the vulvar area
• Dryness: Dry, flaky, or scaly skin
• Pain or Discomfort: Pain or sensitivity, especially when touched or during activities like intercourse
• Discharge: Possible discharge if secondary infection occurs
Treatment:
• Topical Steroids: Low-potency corticosteroid creams (e.g., hydrocortisone) to reduce inflammation and itching
• Emollients: Moisturizers to alleviate dryness and restore skin barrier

Cervicitis

Symptoms:
• Vaginal Discharge: Abnormal discharge, which may be thin, watery, or pus-like, often with an unpleasant odor
• Bleeding: Spotting or bleeding between periods or after intercourse
• Pain: Pelvic pain or discomfort
• Itching or Irritation: Itching or irritation in the vaginal area
• Pain During Intercourse: Discomfort or pain during sexual activity
• Urinary Symptoms: Burning sensation during urination in some cases
Treatments:
• Antibiotics: For bacterial infections (e.g., azithromycin, doxycycline) or sexually transmitted infections (e.g., chlamydia or gonorrhea)
• Antifungals: If a yeast infection is identified as the cause
• Antiviral Medication: For viral infections like herpes

Sexually Transmitted Disease

Symptoms:
• Chlamydia: Often asymptomatic, but may include discharge, pain, or bleeding
• Gonorrhea: Similar symptoms to chlamydia, with potential discharge and pain
• Herpes: Painful blisters or sores on the genital or oral areas
• Syphilis: Painless sores (chancres), skin rashes, and systemic symptoms in later stages
• Human Papillomavirus (HPV): Genital warts, often asymptomatic
• Trichomoniasis: Frothy, foul-smelling discharge, itching, and discomfort
Antibiotics:
• Chlamydia and Gonorrhea: Typically treated with azithromycin or doxycycline
• Syphilis: Treated with penicillin
• Trichomoniasis: Treated with metronidazole or tinidazole
Antiviral Medications:
• Herpes: Managed with medications like acyclovir, valacyclovir, or famciclovir
• HPV: No cure, but warts can be treated with topical medications or procedures; vaccines are available for prevention
Follow-up: Essential to confirm resolution of the infection and manage any complications
General Care:
• Partner Notification: Inform and treat sexual partners to prevent reinfection
• Avoid Sexual Activity: Until the infection is treated and cleared

Don't Be Afraid To Speak To Your Gynaecologist

Oftentimes, women only see a gynecologist because something...isn’t right... down there. Regardless of how uncomfortable it may be, it is imperative to ask, and get answers to all of your questions regarding your reproductive health.

Other Conditions We Treat

Contraception

Oral Contraceptive Pill: Prevent pregnancy through hormonal regulation, inhibition of ovulation, cervical mucus changes and endometrial alteration. When taken correctly, it is over 99% effective at preventing pregnancy. Missed pills or inconsistent use can lower effectiveness.
Injectable Hormone: Provides long-term contraception through hormone delivery via injection. Typically contains progestin (e.g., Depo-Provera), which is injected every three months. It is highly effective but requires regular injections every three months. Return to fertility can be delayed after stopping the injections.
Implanon (Hormonal Implant): A small, flexible rod implanted under the skin that releases hormones to prevent pregnancy. Over 99% effective. The implant is highly reliable and provides long-term contraception without the need for daily or monthly maintenance.
IUCD (Intrauterine Contraceptive Device) Insertion: A small device inserted into the uterus to prevent pregnancy, available in copper or hormonal forms. Creates an environment toxic to sperm, impairing their motility and viability. Over 99% effective. Provides long-term contraception (3-10 years depending on type) and is easily reversible upon removal.
Sterilization (Tubal Ligation): Blocking or sealing fallopian tubes by clipping, tying, or cauterizing the fallopian tubes to prevents eggs from traveling from the ovaries to the uterus and sperm from reaching the eggs. Over 99% effective. Considered permanent, although reversals are possible but not always successful.

Ovarian Cysts

Symptoms:
• Pelvic Pain: Discomfort or pain in the lower abdomen or pelvis.
• Abdominal Bloating: A feeling of fullness or swelling in the abdomen.
• Menstrual Irregularities: Changes in menstrual cycles, such as delayed or irregular periods.
• Pain During Intercourse: Discomfort during or after sexual activity.
• Frequent Urination: Increased need to urinate due to pressure on the bladder.
• Nausea or Vomiting: May occur if the cyst causes significant discomfort or pressure.
Treatment:
• Observation: Many cysts resolve on their own without treatment; regular monitoring through follow-up ultrasounds may be recommended.
• Medications:
- Hormonal Contraceptives: Birth control pills can help regulate menstrual cycles and prevent new cysts from forming.
- Pain Management: Over-the-counter pain relievers or prescription medications to manage discomfort.
• Surgical Intervention: If a cyst is large, persistent, or causing significant symptoms, or if there is concern about cancer:
- Cystectomy: Removal of the cyst while preserving the ovary.
- Oophorectomy: Removal of the affected ovary, may be considered if multiple cysts or a large cyst is present.

Retained Tampons or Other Objects

Retained Objects: Objects like tampons, menstrual cups, or foreign bodies left inside the vagina for extended periods.
A) Manual Removal:
• Object Retrieval: Gently grasp the object (e.g., tampon) with sterile forceps or fingers, if accessible.
• Careful Extraction: Remove the object slowly and carefully to avoid causing additional trauma or discomfort.
Special Instruments: If the object is not easily reachable or is lodged deep, use specialized instruments such as:
• Forceps: For grasping and pulling out the object.
• Suction Devices: In some cases, a suction device may be used to help remove the object if it’s lodged firmly.
Anesthesia: Rarely required, but local anesthesia may be used if removal is particularly difficult or painful.

Cervical Cancer Screening

Pap Smear (Papanicolaou Test): A test to detect abnormal cells in the cervix that could indicate pre-cancerous changes or cervical cancer.
HPV Test (Human Papillomavirus Test): A test that detects the presence of high-risk HPV types that are associated with cervical cancer.
Colposcopy: A diagnostic procedure used to closely examine the cervix, vagina, and vulva for signs of disease. It is often performed after an abnormal Pap smear or HPV test result.
LLETZ: A procedure used to remove abnormal cells from the cervix, particularly those found in the transformation zone where the cervix’s outer and inner cells meet. It is often performed following an abnormal Pap smear or colposcopy results.
Cone Biopsy: A surgical procedure that involves removing a cone-shaped section of abnormal tissue from the cervix. It is used to diagnose and treat pre-cancerous changes or early-stage cervical cancer identified through screening tests.

Ovarian Tumour

Symptoms:
• Abdominal Pain or Discomfort: Persistent or severe pain in the lower abdomen.
• Abdominal Swelling or Bloating: Noticeable increase in abdominal size.
• Changes in Menstrual Cycle: Irregular periods or abnormal bleeding.
• Early Satiety: Feeling full quickly after eating, which can be due to pressure on the stomach.
• Unexplained Weight Loss: Sudden weight loss without a clear cause.
• Difficulty Breathing: If the tumor grows large enough to exert pressure on the diaphragm.
Treatment:
• Benign Tumors:
- Observation: Regular monitoring if the tumor is not causing symptoms.
- Surgical Removal: If the tumor is symptomatic or growing.
• Malignant Tumors:
- Surgery: Often involves removal of the ovaries, uterus, and surrounding tissue, depending on the stage and type of cancer.

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