The experts answer your gynaecological questions

The experts answer your gynaecological questions
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If you find talking about your gynaecological health embarrassing you’re certainly not alone. Following a feature about womb cancer in Yours, gynaecological charity The Eve Appeal was inundated with calls from our readers. Many of you were too embarrassed to see your GP about symptoms that could possibly be life threatening. So we’ve asked Adam Rosenthal a Consultant Gynaecologist at Barts Cancer Institute to answer some of the questions that you might be too embarrassed to ask.

I’m 65 should I still be having a smear test?

Smear tests (which check for pre-cancerous changes on the cervix) are rarely necessary if you’re over 65 years old. This is because it’s very unusual to get cervical cancer after 65 if you’ve had regular smears throughout your life that have been normal. If you’ve had certain pre-cancers or cancers of the female organs, or if you’ve had less than three smears before the age of 65 you may still need to have smear tests.

 I feel like something is falling down ‘down there’ – what could it be?

It could be ‘prolapse’ of your womb or vaginal walls. This means that your womb and/or vagina are no longer being held in the correct position in the middle of your pelvis and are now low down closer to opening of your vagina. You should see your GP who can examine you and refer you on to a gynaecologist if necessary. To make a proper diagnosis your GP will need to examine you. Try not to be embarrassed, you GP has trained to do these examinations and will have done many before. It may sound odd, but being examined internally whilst you are standing up is often the best way to diagnose prolapse, as gravity tends to make prolapse more obvious 

Which gynaecological symptoms should I never ignore?

You should never ignore vaginal bleeding after the menopause, itching or abnormal looking skin on your vulva, or unpleasant discharge. If you suddenly start to experience persistent bloating (not bloating that comes and goes), constant pelvic or abdominal pain, difficulty eating and feeling full quickly, nausea, or your abdomen increases in size, you should see your GP. Occasionally, bladder or bowel symptoms, indigestion, extreme tiredness and back pain could be due to a gynaecological problem.  

What level of discharge is normal?

It depends on your age, if you are menopausal or not and whether you are taking hormone replacement therapy (HRT). The key thing to ask yourself is ‘has my discharge changed recently with no obvious explanation (such as starting, stopping or changing HRT)?’ If the discharge contains blood, has an unusual colour or has an unpleasant smell, then you should see your GP. If no obvious cause is found, such as an infection, then it may be worth having a scan to rule out a problem with your ovaries or fallopian tubes.  

Should I be bleeding post menopause?

Only if you are taking a type of HRT that is meant to cause regular bleeding once a month like a period. If you are on a ‘no-bleed’ type of HRT or if you are not taking any HRT and you are experiencing bleeding, then you should see your GP. You may then be referred to a gynaecologist. Abnormal bleeding from your vagina, or blood in your urine or in your stools should never be ignored and should always be mentioned to your GP. 

How can I deal with my vaginal dryness?

There are a number of vaginal moisturising gels available from larger pharmacies or on-line. These are not just simply to reduce friction during sexual activity. They also provide longer lasting moisture within your vagina. These gels don’t contain hormones, so you don’t need to see a doctor or get a prescription for them. If these don’t seem to work (and try more than one type before giving up on them), then talk to your GP about hormonal creams and pessaries (tablets for the vagina), which can be very helpful at improving vaginal dryness. Dryness can make sex painful for some post-menopausal women, but there are rarer causes of painful sex such as infections in your pelvis, skin diseases affecting your vulva or vagina or abnormalities inside your pelvis. Speak to your GP for advice. 

Adam says

A huge 77 per cent of women over 55 find it embarrassing to talk about gynaecological health issues. So we asked Adam Rosenthal why we shouldn’t feel uncomfortable.

“It’s important to remember that whilst you might be embarrassed about your gynaecological symptoms, it’s your doctor’s job to ask about them. If you don’t mention your problems then no one is going to make a diagnosis and you won’t get the right treatment. I often see women who wish they had gone to their GP sooner because a nagging problem turned out to be nothing serious, or because once they had the right treatment they felt much better. Occasionally I see women who have delayed going to their doctor with tragic consequences. A potentially curable cancer could become incurable if you are too embarrassed to have symptoms properly checked and diagnosed.
 
You may feel especially embarrassed if you have to see a male GP, but all doctors have been trained to ask about gynaecological symptoms and to perform gynaecological examinations. Their training emphasises the need to be sensitive to issues which patients may find embarrassing. A female staff member should always be present if a male doctor is doing a gynaecological exam. Your doctor will look at and feel your tummy, and gently examine your pelvic organs via your vagina using their fingers in a clean plastic glove. If the doctor needs to look at your cervix and vagina, he or she will use an instrument called a speculum, which is used during a smear test. This is a curved tube that fits your vaginal walls so it doesn’t cause undue discomfort. It is inserted with lubricating gel and gently widened inside the vagina so its sides move apart. This examination will allow your doctor to establish what is wrong and see if you need further treatment. And in some cases it could even save your life.

“Don’t ignore that niggling doubt”

Gabrielle Neal, 64 from Woodbridge was diagnosed with womb cancer in January 2008.

“In 2007 we’d had a busy year, so I put my tiredness down to being menopausal and moving house. People kept saying I was losing weight, but I was struggling to do up my trousers and couldn’t hold my tummy in. I had a pain in my left hip and groin, which I put down to arthritis. At the back of my mind I thought maybe something else was going on.

On Christmas day I had a bleed. I was worried but thought I might just have missed an HRT tablet. In the New Year I saw my GP. She gave me an internal exam and referred me immediately to the hospital.

I had scans and a hysterescopy – a narrow camera inserted into my womb. I had womb cancer. There’s no way to prepare yourself for hearing the news, but I knew I had to go on autopilot to get through it. My husband James is a marvel and so level headed and positive. He helped me tell our four daughters who stayed so strong – at least in front of me.

In March 2008, I had a radical hysterectomy. My womb, the tissues holding my womb in place, my ovaries, cervix, top of my vagina, fallopian tubes and the lymph nodes around my womb were removed. I also had the lymph nodes taken from the top of both thighs.

I was lucky, my cancer was caught early and I didn’t need radiotherapy or chemo. If I had waited longer to see my GP my story might have been different. Many women my age won’t talk about problems ‘down there’. And I understand that it can be embarrassing to go to a GP. But it’s your health you’re risking. I’ve had four children and it’s no less dignified than that. Leave your modesty at the door and pick it up on the way out.”

Contact The Eve Appeal on 0207 605 0100 or visit www.eveappeal.org.uk