An Itch of a Problem

An Itch of a Problem

April 28, 2022   Return

Our vagina is not empty – it is, in fact, home to millions of bacteria. Don’t feel grossed out, these bacteria – such as the Lactobacilli – actually play a role in maintaining our vaginal health.

By merely being present in our vagina, they prevent invading, potentially harmful germs from coming in and settling down.

Some produces helpful substances that either kill those harmful germs or maintain an acidic environment that prevents those germs from thriving.

Furthermore, a healthy vagina will regularly secrete a discharge that will help clean itself. Therefore, the vagina can be quite the low-maintenance wonder, as long as you do not interfere with the normal acidic level or pH (which allows the helpful bacteria to thrive).

What happens when the pH goes out of whack?

A Yeast Problem

Yeast, a kind of fungus, is not always a troublemaker. Under normal circumstances, we may harbour a small number of Candida yeast in our vagina, the population and its problematic antics kept in check by its good bacteria neighbours. However, when something happens to disrupt the balance between helpful and troublemaking organisms in our vagina, the yeast population can grow in number. That is when the itches, soreness and even pain start.

Yeast infection is a common condition, so let’s take a look at this and what to do when it hits you.

When things go wrong.

The signs of a vaginal yeast infection are itchiness and soreness, sometimes accompanied by a burning or painful sensation when you urinate or have sex. You may also experience thick white vaginal discharge – called “cottage cheese” due to its appearance.

How did all this happen?

There are many possible reasons. Antibiotics, changes in hormone levels due to pregnancy or taking of certain medications, improper vaginal hygiene are just some common possible causes. Health conditions such as diabetes and HIV infection, which weaken the immune system, may also be a possible cause.

Should you see a doctor?

Yeast infection is rarely life-threatening. If you have had yeast infection before and you believe you recognise the symptoms, you can visit the pharmacy for medications. However, pregnant women and those who experience frequent infections should see a doctor.

How is yeast infection treated?

Common treatment methods are antifungal creams, tablets or suppositories.

Other things to take note of.

  • During a yeast infection, keep your vaginal area dry as much as possible.
  • Should you use a feminine wash, choose one that mimics the normal vaginal pH level and falls within the acidic pH range of pH 3.8 to 4.5.
  • Foods with probiotics such as yoghurt can help boost the growth of good bacteria in your vagina, and hence may be of help when it comes to beating the itch.
  • While yeast infection is not considered a sexually transmitted disease, you may still transmit your infection to your partner. Thus, you may wish to avoid sexual activities during the meantime.

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Between a Rock & a Hard Place

Between a Rock & a Hard Place

April 28, 2022   Return

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Things were going well for young mother Alana. With a doting husband, an adorable two-year-old son and a baby on the way, she couldn’t be any happier. But unbeknownst to her, a storm was brewing on the horizon.

Recalling the day when her life took a 180° turn, she says, “I was in midst of reading a story to my son when I noticed a lump in my breast. I hoped that it was one of those things which normally occur during pregnancy but I had a bad feeling about it.” Acting on her gut instinct, she decided to get herself checked.

“Initially, the doctor didn’t think it could be serious but he suggested that I undergo an ultrasound scan, followed by a biopsy just to be sure.” Nothing could prepare her for the results that came back: she was diagnosed with stage 3 breast cancer. “I was stunned. It seemed so impossible. I was too young to have cancer,” she says. After the initial shock, came panic. What was going to happen to her unborn child? “I was terrified. I kept wondering if I would be able to keep my baby.”

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Pregnant with cancer

Someone once said, “Pregnancy and motherhood are the most beautiful and significantly life-altering events that I’ve ever experienced.” And it really should be for mothers everywhere. But while pregnancy is a joyous occasion for many, it can be a difficult journey for those who have been diagnosed with cancer. To find out about this predicament and what it entails for both mother and child, we speak to an expert on the matter: Consultant oncologist Dr Mastura Md Yusof.

When asked how common this predicament is in Malaysia, Dr Mastura says, “We don’t have specific statistics but I would say that cancer during pregnancy is something that may be on the rise. An increasing number of women are postponing childbearing to a later age; more women have picked up smoking; obesity is a growing problem among women – all these factors can play a role.”

In Alana’s case, it was a lump in her breast that set off alarm bells. What other symptoms should pregnant women look out for? “The symptoms depend on the type of cancer and its stage of presentation,” she replies. Will these tell-tale signs differ between someone who is expecting and someone who isn’t? “No, the symptoms are often similar. In the case of breast cancer, women will typically have a breast lump or nipple discharge whereas for those with cervical cancer, they are likely to experience abnormal per vaginal bleeding. Always remember, if in doubt, see your doctor. Don’t wait,” she emphasizes.

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‘Will my baby be safe?’

As with other chronic diseases, diagnostic tests are necessary to confirm if patients do indeed have cancer – pregnant women included. “It’s popular belief that diagnostic tests will harm the pregnancy but it’s actually not true. Biopsy is a simple procedure which entails taking an extremely tiny amount of tissue from the tumour area. This is so we can examine the tissue under the microscope for any presence of cancer. It doesn’t involve radiation of any kind so it won’t harm the foetus. It’s also safe for expecting mothers to undergo biopsies under anaesthesia,” Dr Mastura assures.

Listing down other forms of diagnostic methods, she says, “Other tests that are considered safe include ultrasound, magnetic resonance imaging (MRI), blood tests and lumbar puncture.” What about things like chest x-rays and mammograms? “They can be safe as long as an abdominal shield is utilized to protect the foetus from exposure to radiation,” she clarifies.

Diagnostic tests may be safe for pregnancies but now it begets the question: can pregnancies compromise the diagnosis process? “In breast cancer, pregnancy does cause the breasts to enlarge. Therefore, it may be difficult to feel for the lump upon examination – both by the patient and the doctor. But other than that, pregnancy generally won’t affect the process.”

‘What are my options?’

Like many things in life, there is no one-size-fits-all strategy when it comes to cancer treatment. “The treatment options that are available to a patient depend on various factors,” Dr Mastura explains. These factors include:

Patient history

“Firstly, it depends on the patient herself. Does she have any pre-existing medical conditions? How is her physical fitness and organ function? Is this pregnancy her first? Does she have any other kids? How far along is she?”

Type of cancer

“Another factor we take into consideration is the type and stage of cancer she has. Once those details have been confirmed, we can look into the treatment (eg, surgery, chemotherapy, etc) that is indicated for her exact condition. Surgery can be performed at any time during the pregnancy while most chemotherapy drugs can be administered during the 2nd and 3rd trimesters. Patients who undergo chemotherapy aren’t allowed to breastfeed. Instead, they will be given medications to halt breast milk production. Radiotherapy, on the other hand is not given during pregnancy.”

‘Can I keep my baby?’

The few first questions to cross every patient’s mind are likely to be ‘Can I keep my child? Can I undergo treatment while pregnant? Will treatment jeopardize my pregnancy? Must I abort my baby?’ However, Dr Mastura has encouraging words to offer.

“Abortion is only considered if the patient’s cancer is advanced, treatment has to be given acutely or she is still in her 1st trimester whereby treatment like chemotherapy will put the baby at risk,” she says.

“Battling cancer whilst pregnant can be terrifying but it’s not a dead end. It is a treatable condition. If a patient is managed in a multidisciplinary setting by a team of specialists (eg, oncologists, surgeons, radiologists, pathologists, anaesthetists, neonatologists, etc) all the way, the outlook is usually good. Additionally, an obstetrician will regularly review her at the antenatal clinic every two weeks or so until delivery to ensure the foetal progress is good. We’ve had many women opting to continue with their pregnancies – and they have gone on to give birth to healthy babies. In fact, some actively share their experiences with the hopes of allaying the fears that new patients have. So, don’t lose hope!”

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Is it preventable?

When asked if early screening can help lower the risk of cancer during pregnancy, Dr Mastura says, “As of now, there’s no evidence that screening before conception can either reduce that risk or improve a cancer patient’s survival. What women should actually do is firstly check their family’s medical history for any types of cancer. Then of course, they must live healthily – meaning no smoking, no alcohol, be physically active, eat a well-balanced diet, have a healthy weight, etc. Having kids before turning 30 plays a significant role too.”

Reference:

Health at Iowa. Available at www.medcom.uiowa.edu

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Cancer Ain’t The End

Cancer Ain’t The End

April 28, 2022   Return

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For many people, there is nothing worse than being diagnosed with a chronic illness such as cancer. They see it as the beginning of a terrible end, the moment when their lives begin to unravel along with all their hopes and dreams for the future. However, Susanna Wong strongly disagrees. The 53-year-old retiree says, “Yes, I was shocked when my doctor informed me that I had cancer. Yes, living with cancer is no easy feat. But cancer is not a death sentence.”

A sudden blow

“I was diagnosed with metastatic breast cancer when I was 45 years old. At that time, I was working as a purchaser at a private company. My life then only revolved around work, my then 15-year-old daughter and my ill husband. Aside than work and family, I didn’t have time for anything else,” Susanna remembers clearly.

Allowing us a glimpse into her family’s medical history, she says, “My father had prostate cancer. So, do two of my cousins. They have cancers of the breast and the uterus.” Despite the warning signs, she never expected she would one day share a similar fate. “Prior to my diagnosis, I would work for 10 hours every day. I slept late, had unhealthy dietary habits, led a sedentary lifestyle… Basically, I wasn’t living healthy.”

All this went on until one day when she felt pins and needles in one of her breasts. “At that point, I had often been feeling weak and tired for no particular reason but it was the pins and needles which prompted me to see my GP. He said there didn’t seem to be anything wrong with me but he did advise me to go for a mammogram as I was already above 40 years of age. So, I went.” And it was a good thing that she did.

“The mammogram showed an abnormal growth in my breast. I wanted to be sure so I sought a second opinion, which confirmed my worst fears. I had metastatic breast cancer,” she says. Recalling that fateful day, she says, “I was a mixture of emotions. I was shocked, sad and anxious. I was also very worried for my 15-year-old daughter.” But being the tough person she was, she did not wallow in worry for long. “I wanted to know how much chance I had of recovering so I fervently tried to find out as much as I could about breast cancer and my available treatment options.”

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Determined to live

Not too long after her diagnosis, Susanna was started on treatment. “I underwent many treatments – surgery, radiotherapy, six cycles of chemotherapy, trastuzumab (for every three weeks for two years), tamoxifen, lapatinib, letrozole – you name it. I also took bisphosphonates to treat the high levels of calcium in my blood – an effect of the cancer.” To further compound matters, doctors found a tumour at the neck of her spine late last year. An operation soon followed the discovery. But an operation and numerous drugs later, Susanna remains undeterred.

“Cancer was a rude interruption in my life, but it made me stop and reflect on my life. It was time for me to prioritize and focus on myself. When it comes to meals, I now cook my own food, avoid deep-fried and spicy foods and moderate my meal portions. I also spend more time with my family, friends and of course, my new-found breast cancer survivor friends. I participate in various physical and therapeutic activities such as choir groups made up of my fellow survivors.” All this has no doubt done her a lot of good. “I’m more energetic. I feel alive again! I now look forward to each new day,” she enthuses.

While her cancer survivor ‘buddies’ (as she fondly calls them) have undoubtedly enriched her life, she couldn’t have endured as long as she has if it weren’t for her daughter and husband. “They are my main pillars. They motivate me, support me and give me the determination to continue with life-extending treatment. I live for them. My intrinsic motivation has always been to see my daughter succeed in academics and in life.”

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‘Cancer isn’t a death sentence’

As Susanna has been so encouraged by the support she received from family and friends (both old and new), she now strives to offer her support to others. An example is her work with Together Against Cancer Association Malaysia (TAC).

“I first heard about TAC from my exercise support group. Then, I was invited for the launch of their book Elevating the Voice of Cancer Patients. I was impressed that TAC was voicing out the rights of people with cancer. That was what motivated me to be a part of TAC so I can too help by sharing with others how I try to gain access to life-extending cancer treatment in government hospitals. I hope that our voices will be heard and that more budget will be allocated for treatment for metastatic cancer patients like myself.”

When asked if she had any messages for fellow cancer patients like herself, she concludes, “I would like to tell those with advanced cancer that cancer isn’t a death sentence. There is life-extending treatment which can help you live longer – thereby, allowing you more time with your loved ones and granting you the opportunity to do the things you wish to do. For me, I want to live life. There’s so much that I want to do, see and experience.”

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Deciphering the Code…

Intimacy & Breast Cancer

April 28, 2022   Return

Ah, lady parts. Seeing how all of us women folk are born with them, surely we would know all there is to know about our female genitalia, right? Well, not necessarily. For starters, if we did, there would not be as many misconceptions about our reproductive organs floating about as there are now. So, how well do we actually know ourselves ‘down south’?

Pregnancy cures endometriosis

You may have come across women (especially those who have kids) vouching for this. However, experts say that endometriosis does not always go away with pregnancy. During pregnancy, progesterone hormone levels increase significantly. Studies have found progesterone to effectively suppress the development and growth of endometrial tissue, resulting in a temporary decrease – or in some cases, an absence – of endometriosis symptoms e.g. pain during pregnancy. Symptoms typically recur after giving birth.

Having sex when menstruating ups my health risk

A woman’s risk of STDs (sexually transmitted diseases) is higher when she has intercourse during her period for several reasons. Firstly, the cervix dilates during menstruation to allow blood to flow through – making it easy for germs to enter deep into the pelvic cavity. Secondly, period intercourse increases the likelihood of blood-bourne diseases like hepatitis and HIV, even with the practice of safe sex. Also, the vagina’s pH reduces in acidity during menstruation so yeast infections can develop more easily.

Vaginal discharge is a sign that I’m unhealthy

Is your discharge green, yellow or grey in colour? Does it smell bad? Is it clumpy? If so, you should get it checked by your gynaecologist. But if your vaginal discharge is normally odour-free and transparent or white, there shouldn’t be anything to worry about.

Post-menopausal bleeding is normal

Although common, post-menopausal bleeding (even if it’s merely spotting) is by no means, normal. While the bleeding can result from something minor like polyps, inflammation of the womb lining or vaginal dryness, it can also be a symptom of cancer.

Douching keeps my vagina healthy

It actually does the opposite. Douching can cause an imbalance to the vagina’s normally acidic environment – something which not only increases your risk of STDs but can make it difficult for you to become pregnant. Remember, the vagina is self-cleaning so there’s no need for douching.

I’ve had the HPV vaccine so I don’t need pap smears

You may have been vaccinated against HPV but you still have to be tested for cervical cancer regularly as the vaccine does not protect you from all HPV types. Screening is recommended every three years for women aged 21 to 65, commencing at 21.

References:

1. American Cancer Society. Available at www.cancer.org

2. Cleveland Clinic. Available at www.health.clevelandclinic.org

3. Endometriosis.org. Available at www.endometriosis.org

4. Family Health Online. Available at www.familyhealthonline.ca

5. Living with Endometriosis. Available at www.livingwithendometriosis.org

6. NHS Choices. Available at www.nhs.uk

7. SheKnows. Available at www.sheknows.com

8. WebMD. Available at www.webmd.com

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Intimacy & Breast Cancer

Intimacy & Breast Cancer

April 28, 2022   Return

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Dr Azura Rozila Ahmad   Consultant Medical Oncologist

If you were to ask then 35-year-old Linda Dackman what her biggest fears were, it is likely she would have answered “intimacy.” To the uninitiated observer, her reply did not hold water. Here was this young successful Californian museum public relations director who seemed like she had it all together. Surely, she was joking. But as she recounts in her book Up Front: Sex & the Post-Mastectomy Woman, her struggles with intimacy could not be any more real.

A year before she turned 35, Linda had undergone a mastectomy with the hopes of preventing her breast cancer from spreading to other parts of her body. Her initial experience as a “single-breasted woman” (as she puts it) left her frightened and insecure about her sexuality. She had the habit of immediately blurting out her medical history when meeting with potential suitors – causing things to turn painfully awkward. Once sexually active, she found herself clueless as to how to behave in intimate situations.

Like Linda, many women (both single and married) find intimacy after breast cancer to be an almost impossible feat. But is it really? Consultant Medical Oncologist Dr Azura Rozila Ahmad is quick to reject that notion. “No doubt undergoing cancer treatments can leave women with body image issues and this subsequently may put a huge strain on their relationships but a breast cancer diagnosis doesn’t have to spell the end to intimacy and sex,” she assures.

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What maketh a woman?

Delving further into the subject of body image, Dr Azura says, “It is human nature to equate physical attributes such as long, luscious hair and breasts with femininity. So, when patients are left with hair loss, blisters, surgical scars, puffiness, a single breast or in some cases, no breasts at all, they feel as if they have lost the very characteristics which made them ‘woman’.”

Vaginal dryness and extreme fatigue are two other concerns. “Chemotherapy and radiation can do that to a person. You become so exhausted that all you want is to sleep. Also, medication can cause vaginal dryness. As a result, sexual intercourse can turn into an uncomfortable – and perhaps even, a painful – affair. All of these physical changes can deal a huge blow to a woman’s self-esteem because she now fears her partner will not find her appealing anymore.”

What thinketh a man?

Breast cancer patients may view their bodies differently than they did pre-treatment (and worry that their partners will do the same) but Dr Azura offers words of encouragement.

“You and your spouse have gone through a lot at this point. You have had to battle cancer and experience the harsh side effects of treatment while he has had to deal with the possibility of losing you. Post-treatment, you both may feel uncertain about getting intimate. The woman may be insecure and choose to wait for her partner to initiate sex. Meanwhile, the man may decide to wait for her sign of approval because he doesn’t want to pressure her into doing something he feels she might not be ready for,” she explains. “In other words, they are both waiting for the other to take the first step.”

And when they do get intimate, things can be awkward too. “Upon seeing his partner’s body for the first time post-treatment, the man might be surprised or even, puzzled because he doesn’t know what to expect or how to react. His facial expressions however can be misconstrued by the woman. She might think her worst fears have been confirmed – that he finds her repulsive and ugly. But this might not be the case.”

Dr Azura continues, “Women may also have trouble adjusting to differences in their body’s sensitivity post-treatment. Besides experiencing discomfort during penetration as a result of vaginal dryness, women – especially, those whose nipples or breasts were erogenous zones pre-treatment – may not be capable of achieving the same arousal in her breasts as she once did. This can lead to sexual frustration both for the woman and her partner – further straining their relationship.”

Intimacy is possible

Despite all the aforementioned difficulties, Dr Azura assures, “Cancer is undoubtedly challenging to any relationship but I have seen relationships emerge from cancer stronger and more intimate than ever. What matters is how couples handle it.” Here, she offers some suggestions.

“We’re in this together”

Dr Azura cannot emphasize more on the importance of patients involving their partners in their journey with breast cancer. “I always encourage a woman’s partner to be there for her from the beginning of treatment. Some choose not to accompany their wives or girlfriends to medical appointments; they may be having trouble accepting the diagnosis. But treatment will take months and months so it’s crucial for partners to offer their full support and be there for their loved ones all the way.”

Communicate!

Communication is something every couple must practice, even more so for those facing something as serious as cancer. She advises patients to be honest with their partners. “He might be waiting for you to broach the subject of cancer because he doesn’t want to hurt your feelings. So, talk to him. Tell him how you feel. It’s alright to be vulnerable.” Women should also not be hesitant to talk about sex with their partners. “Tell him how you want to be touched; what you like, what you don’t.”

For those who are single, she says, “Don’t be afraid to look for love. When you’re ready, tell him about your history with breast cancer. If he accepts you for who you are, you know you’ve found the one.”

Be creative

In the bedroom, that is. “A woman’s body is bound to change post-treatment so why stick to the same sex routine? Whether it’s trying a new sexual position, sexy lingerie or vaginal lubricants, couples should be willing to try new things.” She has this tip for breast cancer patients, “Instead of focusing on the chest area where you still may have body image issues, you and your partner can explore other areas like the neck, ears or shoulders.”

Of wigs & reconstructive surgery

Post-treatment, some women might struggle with the drastic physical changes their bodies have gone through. In cases like these, she suggests, “Wigs, scarves and breast prosthesis might help restore their self-esteem. Although breast sensation cannot be restored via reconstructive surgery, your breast shape can be rebuilt. If you are interested in breast reconstruction, there are plastic surgeons who are more than capable of helping you.”

Intimacy is more than just sex

Lastly, both breast cancer patients and their partners need to realise that intimacy is much more than intercourse. Dr Azura concludes, “Intimacy doesn’t have to always end up in sex. Spending quality time together such as giving each other massages or taking long walks can also promote intimacy. So, don’t let breast cancer treatment stop you from rediscovering intimacy with your partner.”

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Pregnancy, Motherhood & The Iron Truth

Pregnancy, Motherhood & The Iron Truth

April 28, 2022   Return

You are wrong if you think you cannot be lacking in iron. Iron deficiency – the medical term for lack of iron in your body – is common, especially in premature babies, school children and pregnant women in Malaysia. So, preventing or correcting iron deficiency early on is important in improving your health.

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Myth: You can get enough iron from your diet.

Fact: Yes, you can if you eat iron-rich foods. But, a lot of our foods are lacking in iron.

There are two forms of iron in foods: heme iron and non-heme iron. Heme iron can be found in meat, poultry and fish. Non-heme iron is from plant sources like lentils, beans and spinach.

Our body can absorb heme iron better than non-heme iron. Iron in food is usually not enough especially for premature babies, children experiencing growth spurts ie, 4 to 8 year-olds, and pregnant women.

Myth: Multivitamins is an effective way to treat iron deficiency.

Fact: Take a close look at the label on the multivitamins bottle. There may be hardly any iron in each capsule.

“Even if there is 1-3 mg of iron per capsule that you take everyday, only 10% of it is absorbed into your system,” says Dr See.

Myth: Iron deficiency is only a concern for pregnant women if they are anaemic.

Fact:  Anaemia occurs when iron deficiency is already at a late stage. If you have anaemia, it means that your problem started a long time ago!

“If you are anaemic, you have already lost some IQ points and you might already have mood disorders and thought issues. So, make sure you are iron sufficient from pre-pregnancy stage,” says Dr See.

Myth: Iron supplements taste bad and cause stomach upsets.

Fact: This belief stemmed from an older form of iron supplements, which were infamous for tasting bad and causing black stools. Most people stopped taking them after 1-2 months!

These days, newer versions taste much better and they also do not cause stomach upsets. They are worth considering if your diet is often low in iron, or you need some extra iron for health reasons.

Myth: Breastfeeding provides adequate amounts of iron for the baby.

Fact: Breast milk contains useful substances such as antibodies, isozymes and long-chain polyunsaturated fatty acids (LCPUFAs), which are good for the brain and eyes. But after 6 months, iron supply in breast milk wanes. In addition to breast milk, babies must be fed iron-rich supplementary foods such as whole grain cereals or porridges and fish.

Dr See points out that iron deficiency is an epidemic issue worldwide.

“It is the single most prevalent micronutrient deficiency in the world and it is always underestimated,” he said.

Prevention and early correction – even from the pre-pregnancy stage – will definitely improve your health and also lower iron deficiency in newborns.

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What’s That Itch Down There?

What’s That Itch Down There?

April 28, 2022   Return

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Dr. Kim Wong  Consultant Obstetrician & Gynaecologist

An Infection Down South

HT: What is vaginitis?

KW: Vaginitis generally means discomfort and the soreness that an infection can bring to the vagina. It is a condition where the vaginal lining wall becomes inflamed which then, results in discharge, itchiness, and pain. The types of infection that can cause vaginitis are:

  • Bacterial
  • Fungal
  • Parasitic
  • Viral

And, these infections can arise from:

  • Constant exposure to contaminated water
  • Wearing unhygienic undergarments
  • Sexual intercourse

Vaginitis can happen to women of any age.

HT: What happens when one has vaginitis?

KW: For starters, the bacterial flora that lives in the vagina plays an important role in maintaining and protecting your vaginal health. Once the flora is disrupted as a result of an infection, the damaged vaginal wall is no longer a feasible home for the good bacteria. The bad bacteria then have the opportunity to invade and secrete toxins that can kill some of the good bacteria residing in the vicinity. And, this is when the inflammation worsens.

The prescription of certain antibiotics to counter vaginitis will not make the situation any better either. They cannot tell the difference between good and bacteria, so they end up killing off more of the already depleted good bacteria population – contributing to the vicious cycle of vaginal infection.

HT: What are the complications that can occur?

KW: In severe cases, the infection can spread to the cervix, uterus, endometrium, the fallopian tubes and even, the pelvis (abdominal cavity) and become an abscess.  It can cause

  • Infertility
  • Ectopic pregnancy
  • Lifelong chronic pain in the abdomen
  • Pelvic inflammatory disease
  • Pelvic abscess
  • Increased risk of HPV infection and cervical cancer

Doing Away with Vaginitis

HT: How can a woman tell that she has vaginitis?

KW: The vagina should be clean and dry under normal circumstances. The following may be signs that something is not right:

  • Itchiness.
  • Pain during sexual intercourse.
  • Lower abdominal pain.
  • Pain when passing urine.
  • Vaginal discharges that are of greenish, dark yellow or brown-red in colour with a cheesy- or tofu-like texture occurring for more than a week.
  • Unpleasant odour that is comparable to that of a dead fish or stale food.
  • Abnormal bleeding from the vagina.

HT: How is vaginitis treated?

KW: The majority of infectious vaginitis cases are treatable by taking oral antibiotics. In severe cases, however, an injection may be required.

Most acute vaginitis cases (80%) are easily treatable with the appropriate anti fungal or antibiotics. However, some will develop into chronic vaginitis or recurrent vaginitis.

About 20% of these recurrent cases may need further medical treament.  But then again, there are about 3-5% of vaginitis cases which are hard to treat as the infection will recur regardless. This can be due to weak immunity. These women are just prone to infections or have a sensitive vagina, where it is easily irritated.

HT: Can vaginitis go away on its own?

KW: If you have a strong immune system and the bacteria causing the infection are non-aggressive, then yes, it will clear off on its own. Furthermore, the good bacteria living in the vagina wall can produce a form of “antiseptic” (a combination of hydrogen peroxide and lactic acid) that can help get rid of the bad bacteria.

HT: Will it be back for a “return visit”?

KW: Unfortunately, vaginitis can recur in some people. Their body does not develop immunity against the bacteria that cause vaginitis.

HT: Any advice for women who are too shy to see a doctor about their condition “down below”?

KW: Speaking up about your condition, especially if its related to your private parts, can be hard and it does take a lot of confidence to voice out. But, vaginitis is a condition that can become chronic and may even affect your pregnancy chances. The only way to reduce this risk is to seek early treatment.  Visit a doctor with whom you feel comfortable to share your condition.

HT: Any prevention tips?

KW: You can prevent vaginitis with the following:

  1. Have protected sex. Use a condom or diaphragm to avoid transmission of any bacterial, fungal, parasitic or viral infections.
  2. Ensure your undergarments are clean and dried preferably under the sun as UV light is able to kill the germs.
  3. Pantyliners, when not menstruating should be changed regularly, preferably once every 4 hours. Remember not to wear one to sleep; you should go for about 10-12 hours without a pantyliner.
  4. Use a feminine wash. Choose a product that mimics the normal vaginal pH level and falls within the acidic pH range of pH 3.8 to 4.5.
  5. Take one capsule of probiotics per day; choose one that contains Lactobacillus Acidophilus as this bacterial species is commonly found in female genitalia.
  6. Regularly insert a vaginal pessary that contains Lactobacillus Acidophilus
  7. Undergo a Pap smear test at least once every 1- 3 years.

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How Much Do You Know About PCOS?

How Much Do You Know About PCOS?

April 28, 2022   Return

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Dr Kim Wong   Consultant Obstetrician & Gynaecologist

They say to understand a woman, you have to go to the root of the problem to know what is really troubling her. And, this is very true of PCOS.

The number of women diagnosed with PCOS is on the rise globally. According to Dr. Kim, the prevalence of polycystic ovarian syndrome or PCOS is about 1 in 10- 20 women, which makes up about 5-10% of women of the reproductive age group. It seems that urbanization and stress may play a role in this.

So, what exactly is polycystic ovarian syndrome (PCOS)?

PCOS is a hormonal disorder which can affect women of the reproductive age.

And, there are 2 plausible reasoning for its occurrence:

  • Your genes. It could potentially be hereditary that this occurs, where the genes are passed down directly. On the other hand, it could be your genetic makeup that is the culprit. For instance, if someone in your family has PCOS, the chances of you having it are increased.
  • Lifestyle. The way you live your life could also trigger PCOS. For example, a poor diet, a sedentary lifestyle and stress may affect your chances in having PCOS. 

How do I know if I have it?

According to Dr. Kim, the 4 signs to look out for are:

  1. Irregular menses. Although factors such as pregnancy should not be excluded, visit a doctor if your menses are not as regular as they should be or if you experience heavy bleeding for days – especially if you have passed adolescence.  
  2. Abnormal hair growth. If you notice that you are having a moustache, pubic hairs that grow up to your navel, hairy legs and arms, bushy eyebrows, or receding hair lines similar to those of a male’s baldness, then visit a doctor.
  3. Obesity. Most women with PCOS are obese with weight gain observed around the waistline. They also tend to have a BMI of above 30.
  4. Have oily skin and acne

“PCOS can, in fact, happen to any woman of the reproductive age and when they are meant to menstruate on a regular basis,” says Dr. Kim.

The kind of tests required…

  • A transvaginal ultrasound. The ovaries usually appear enlarged with small cysts in it when a scan is done. Each cyst is measured to be around 8mm in size.
  • Diagnosis based on clinical history.  Your doctor will look out for common symptoms such as abnormal hair growth, irregular menses and acne or hair problems. A transvaginal ultrasound usually follows once the symptoms are identified. A blood test may also be necessary to support diagnosis.

Can it be treated..?

“Treatment varies according to symptoms,” says Dr Kim.

For weight and acne problems: Exercise and eat a well-balanced diet that contains the right proportion of carbohydrates, proteins, fibres and vitamins. Speak to a nutritionist if you are having trouble following the diet.

For abnormal health growths: Permanent removal of excess hair is possible through laser therapy or you can opt to for medications to control hair growth.

For acne problems:  Birth control pills are usually prescribed to resolve acne problems as they can reduce testosterone levels, which in turn reduce both acne and excessive hair growth.

For menstruation problems: A progesterone therapy is usually prescribed to those with irregular menses or experiencing prolonged heavy bleeding. Birth control pills can also be used for those with irregular menses.

For infertility problems:  Fertility drugs such as clomiphene or FSH injections may be given to treat infertility.

And the complications are…?

  • Infertility
  • Difficulty to conceive
  • Womb cancer
  • High risk of developing type 2 diabetes at a later age, stroke and heart attack
  • Prolonged periods of no menses (known as amenorrhoea) if left untreated or not treated properly.

And if you do get pregnant, you may experience one or more of the following complications:

  • Gestational diabetes
  • Hypertension
  • Premature delivery
  • Miscarriage

Is there a way to minimise risks..?

You can minimise your risk simply by living a healthy lifestyle:

  • Eat a balanced diet. A diet that follows the food pyramid and contains the right balance of carbohydrates, proteins, fibres and vitamins will do the trick. Best to avoid fine sugar, processed food, canned or sugary drinks.
  • Exercise at least once a day for 30 minutes.
  • Have enough rest and sleep daily. 8 hours of sleep should be enough for women of reproductive age while 6-7hours of sleep for those in menopause and older.

Don’t be shy, just come forward

 “It is okay to come forward and have a chat with a doctor should you face any of these difficulties. Don’t just sit on the problem and wait. Get it treated before it becomes worse,” Dr. Kim advices.

The most obvious symptom that could indicate PCOS is when you are not menstruating on time. Visit a gynaecologist if this happens.

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Screening for Hope

Screening for Hope

April 28, 2022   Return

In Fertility Specialist Dr Wong Pak Seng’s line of work, he is always up to date on the constantly evolving genetic screening technology. These days, there are machines that can help detect any number of mutated or abnormal genes present in one’s DNA, even the very rare ones.

Dr Wong believes that pre-conception genetic screening should be recommended for people with a family history of inheritable. “These are the high-risk groups, so they should go for screening,” he says. For other couples hoping to conceive and have no family history of such conditions, he recommends going for pre-implantation genetic screening and prenatal screening instead.

The following are couples who may benefit from pre-conception genetic screening:

  • With a family history of an inheritable conditions, birth defect, mental handicap as well as cancer.
  • Has a previous child with genetic condition, birth defect or mental handicap.
  • Have a history of two or more pregnancy losses, stillbirth or babies who died unexpectedly.

Accurate? While the list of conditions that can be screened for grows longer as technology evolves rapidly with time, not every condition can be tested, and the results of testing may not always be clear either. This is because there are still limitations to what current genetic testing methods can do. Therefore, a result indicating that everything is normal may not guarantee that the child will be healthy.

Why should you get screened? According to Dr Wong, many couples who have a family history of a condition that may be passed on to a child will find the results useful to help them decide whether they want to proceed with fertility treatments. And if they decide to go ahead, they can also look up options and plan in advance as to what they should do if their child is found to have an inheritable disorder.

What is the process like? Before fertility treatment such as in-vitro fertilization (IVF) can begin, the fertility specialist will review the couple’s family history thoroughly. Dr Wong explains that, should the specialist believe that there is a need for pre-conception genetic screening, the specialist will discuss this with the couple. The couple can also be referred to a genetic counsellor for advice as well as emotional support.

Once the couple agree to the screening, a blood sample will be extracted and sent to the laboratory for further analysis. How soon the results will be available depends on the specific gene mutation being analysed – rarer ones may require the sample to be sent to specialized labs out of Malaysia, for example, as their analysis may require special chemicals and/or equipment.

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The ‘Holy Grail’ of IVF

The ‘Holy Grail’ of IVF

April 28, 2022   Return

Aaron and Lisa Christy was a happily married couple with a young son and another on the way. But unlike their firstborn who was born healthy, their second son, Ben was diagnosed with Wilms’ tumour (a rare inherited form of kidney cancer) when he was merely 18 months old. “When Aaron was a child, the doctors had diagnosed him with the very same kind of tumour. Thankfully, chemotherapy and surgery saved his life. But we never expected our child to have this cancer as we were told that it couldn’t be passed on to the next generation,” Lisa explains in an interview with Perth Now. While Aaron survived, the same couldn’t be said for Ben. After two years of anti-cancer therapy, he finally succumbed to the aggressive cancer.

Despite their loss, Aaron and Lisa were still adamant to have more kids, as they had always wanted a large family. But they now knew that it would come with risks. “If we decided to get pregnant naturally, there was a significant risk that our baby would have Wilms’ tumour. We didn’t want to put ourselves through that painful experience ever again,” Lisa says.

With this in mind, they turned to genetic experts at a Sydney hospital who referred them for a procedure known as pre-implantation genetic testing whereby Lisa’s embryos were screened for genes carrying the Wilms’ tumour to determine which ones were healthy and which weren’t. Five of the embryos were found to carry the cancer gene, only three were unaffected. “The results just drove home the fact that if we had gotten pregnant naturally, we would have been playing Russian roulette.” One of the three unaffected embryos was then implanted in her womb – to great success. “Now, we have a totally healthy baby girl and couldn’t be happier. I wasn’t prepared to gamble with my child’s life so I underwent the procedure – and I’m glad I did.”

Maximising your chances

The Christy couple is not the only one who has to deal with the fear of passing on flawed genes to their offspring. Many couples share the same predicament. Fortunately, thanks to advances in fertility treatments such as pre-implantation genetic testing (PGT), their dreams of having a healthy baby can now become a reality.

But it isn’t just couples with a history of inherited disorders who are seeking out PGT, healthy couples are also opting for this screening method according to Pre-implantation Genetic Testing Scientist Mr Aaron Chen. “These couples have no history of inherited illnesses. They just want to increase their chances of having a baby via IVF. By choosing only healthy embryos for implantation, the higher the success rate of the pregnancy,” he explains. “Therefore, PGT can be for everyone.”

Lifting the curtain on…

Pre-implantation genetic testing

“Basically, PGT refers to the technique used for identifying genetic defects in embryos via IVF. It acts as an alternative to post-conception diagnostic procedures like chorionic villus sampling and amniocentesis (amniotic fluid test). For some couples, these tests yield unfavourable results which can put them in the difficult predicament of deciding whether to keep their baby or not.”

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Elaborating further, he explains, “We can break PGT down into a number of steps.”

  • Step 1: The woman undergoes IVF so we can collect and fertilise her eggs.
  • Step 2: The embryos (fertilised eggs) are grown in the lab for 2-3 days. By now, the cells would have divided and each embryo should consist of eight cells.
  • Step 3: One of the cells (a blastomere) is removed from the embryo.
  • Step 4: This cell is tested to see if the embryo from which it originated has a genetic or chromosomal anomaly.
  • Step 5: An embryo, which is found to be healthy, is implanted in the womb while unhealthy embryos are discarded.
  • Step 6: The remaining healthy embryos can be stored for future use. 

Pre-implantation genetic diagnosis

“PGT is actually divided into two types,” Mr Chen continues. “Firstly, we have pre-implantation genetic diagnosis (PGD) which is used to determine practically any inheritable disorder where a particular gene is known to cause that disorder. When one or both parents have a genetic abnormality, the embryos are subjected to PGD to see if they carry that same abnormality. Only genetically normal embryos are chosen.”

As of now, PGD is capable of testing for more than 250 inheritable disorders including:

  • Sex-linked diseases like haemophilia, which are usually inherited by the son from the mother who is a carrier.
  • Single-gene defects like thalassaemia, which results from a single gene abnormality.

Chromosomal disorders like Fragile X syndrome.

Mr Chen strongly recommends PGD to couples who are at risk of passing on inheritable disorders to their future children. Aside from couples with the aforementioned genetic conditions, potential PGD candidates are:

  • Couples with affected children.
  • Women who have had more than one failed fertility treatment.
  • Women aged 35 and above.
  • Women with a history of recurrent miscarriages.

Pre-genetic implantation genetic screening

“On the other hand, pre-implantation genetic screening (PGS) is where embryos from parents who are presumed to have chromosomally normal genes are tested for aneuploidy (chromosomal abnormalities). Aneuploidy occurs when a cell has an abnormal number of chromosomes such as 45 or 47 chromosomes, instead of the normal 46. Aneuploidy can result in disorders such as Down syndrome,” Mr Chen says.

Delving into the benefits which PGS offers, Mr Chen says, “Aneuploidy is the most common factor in IVF failure. By choosing chromosomally normal embryos, PGS helps to:

  • reduce the risk of spontaneous miscarriage
  • enhance implantation, pregnancy and live birth rates
  • allow single- or double-embryo transfers (subsequently, reducing the number of high-risk multiple pregnancies).

He recommends PGS to couples with:

  • A female partner who is advanced in age
  • A male partner who has severe male factor infertility
  • recurrent pregnancy losses (both naturally and via IVF).

“A decreasing live birth rate is a growing issue for couples who decide to wait till later in life to have kids. This is because late maternal age embryos are more likely to be chromosomally abnormal. This is why we suggest older couples to undergo PGS,” he stresses. “To sum it up, PGS is an effective tool in fertility treatment as it significantly lowers the risk of transferring chromosomally abnormal embryos into the mother.”

“Couples can rest assured, PGS has evolved over the years. In 2007, PGS used the Fluorescence In-situ Hybridization (FISH) technology which could only test 5-12 chromosomes and had a 9.1% error rate. Now, we have Next Generation Sequencing (NGS) which enables us to comprehensively screen all 24 chromosomes and has only a 1.9% error rate. It’s a great breakthrough.”

There’s always hope

Mr Chen concludes, “While genetic testing doesn’t guarantee that all clinical failures are eliminated, it delivers what it promises to do: significantly increases your chances of having a smooth pregnancy, a healthy baby and finally, a happy family. We like to call it the ‘Holy Grail’ of IVF.”

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References:

1. American Pregnancy Association. Available at http://americanpregnancy.org/infertility/preimplantation-genetic-diagnosis/

2. Fertility Centers of New England. Available at www.fertilitycenter.com/fertility_cares_blog/the-difference-between-pgd-and-pgs/

3. Genesis Genetics. Available at http://genesisgenetics.org/pgs/ngs/

4. Human Fertilisation & Embryology Authority. Available at www.hfea.gov.uk/preimplantation-genetic-diagnosis.html

5. Medscape. Available at http://emedicine.medscape.com/article/273415-overview#a4

6. Penn Medicine. Available at www.pennmedicine.org/fertility/patient/clinical-services/pgd-preimplantation-genetic-diagnosis/

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