Health: Your most embarrassing problems solved
WE doctors are a fairly unshockable bunch. We’ve seen it all — multiple times, usually, and probably that same day. People talk of embarrassing ailments — often, but not exclusively, ones that involve our ‘private’ body parts or bodily functions. But it really is all in a day’s work for us.
Of course, I understand why some patients find these topics hard to talk about. But the big concern is when it stops them seeking any kind of medical help. Many instead ignore their problems, hoping they’ll go away, but often they are unwittingly delaying diagnosis and treatment until things have worsened considerably.
Most of the time it’s nothing that can’t be easily treated and, really, the worst part is knowing people have suffered in silence for so long. I often hear the phrase ‘I thought I was the only one…’ when it couldn’t be further from the truth. Most of these problems affect millions every year.
So in an effort to finally banish any awkwardness, we will guide readers through some of the most common intimate problems, explaining the symptoms, causes and treatments. Here I focus on conditions affecting women and in the following pages Dr Ellie Cannon tackles those that men most commonly suffer from.
THE ITCH THAT MANY WOMEN JUST PUT UP WITH… FOR YEARS
PERSISTENT itching — medically termed pruritus — anywhere on the body is uncomfortable. But when it affects an already sensitive area such as the vagina or vulva (the vaginal opening, labia and clitoris), it is particularly distressing. Aside from the burning and irritation, it may also cause the skin to break, leading to bleeding and skin infections. Sex can be so painful that some women avoid it altogether.
While it can affect any woman at any age, the dryness that causes the itching is more common in later life.
WHAT CAUSES IT?
Usually an itch is linked to dryness, says Paula Briggs, consultant in sexual and reproductive health at Southport and Ormskirk Hospital.
This is common around the time of the menopause, due to the lack of the hormone oestrogen which keeps the delicate membranes of the vagina and vulva supple. But breastfeeding, use of the contraceptive pill, breast cancer drugs and other medications can trigger it too.
‘No one talks about dryness — it’s a massive taboo subject,’ says Dr Briggs. Dryness can also be due to a common skin condition called lichen sclerosus, where white, itchy patches form on the vulva. On very rare occasions, an itch can be a sign of vulval cancer.
WHAT CAN I DO?
Dr Briggs says: ‘Dryness will go on for ever if it’s not treated. It’s a chronic, progressive condition, not like most menopausal symptoms, which will resolve.’
Thankfully, creams or pessaries containing oestrogen can improve the quality of the skin and reduce the itch, as can prescription drugs such as ospemifene. ‘The longer the gap without oestrogen, the longer it takes to reverse symptoms,’ warns Dr Briggs.
Vaginal moisturisers are useful too, but stick to brands such as Sylk and Yes as they do not contain perfumes or additives found in soaps, bubble bath or talcum powders that irritate sensitive skin.
For lichen sclerosus, steroid creams can reduce the inflammation causing the discomfort in about 95 per cent of cases.
But your GP should also refer you to a gynaecologist or dermatologist to rule out skin cancer, as the symptoms are similar.
WHY YOU SHOULD NOT IGNORE EXTREME PMS
About 90 per cent of women suffer premenstrual syndrome mood changes or anxiety, and most manage symptoms with painkillers or lifestyle tweaks.
But for the estimated five to eight per cent with the most extreme form of the condition — called premenstrual dysphoric disorder (PMDD) — the symptoms can be debilitating, with many experiencing suicidal thoughts and self-managing with alcohol.
WHAT CAUSES IT?
Again, a drop in the sex hormone oestrogen, coupled with the rise in levels of the hormone progesterone before a period. This triggers a decline in levels of serotonin — a chemical neurotransmitter which helps to regulate mood.
Research shows some women are extremely sensitive to these hormonal fluctuations, probably due to genetic susceptibility.
WHAT CAN I DO?
Getting the right diagnosis is key, yet PMDD is poorly understood by many doctors.
If you believe you suffer with it, visit a helpful website — such as the one run by charity Mind — and print off some of its PMDD information pages. Show them to your GP to help them understand your symptoms.
One effective treatment, according to Dr Briggs, is suppressing ovulation, using the combined contraceptive pill. This controls fluctuating hormones. Other women may need antidepressants but only for the last two weeks of each menstrual cycle.
A trial of a drug called sepranolone, which inhibits chemicals in the brain involved with PMDD, found it reduced symptoms by 80 per cent in a group of 120 women. Now a larger trial, involving 250 women, has started.
WHEN PAINFUL SEX CAN BE A SIGN OF CANCER
MANY women suffer occasional discomfort during sex, but persistent pain or bleeding afterwards should always be checked out.
Vaginal pain, or dyspareunia, is divided into two categories. Either it is ‘superficial’ and felt in the vagina and vulva, or it is ‘deep dyspareunia’, which is felt in the pelvis or abdomen.
WHAT CAUSES IT?
Common causes of bleeding after sex include a benign growth in the cervix, called a polyp, as well as side effects of the contraceptive pill. Sexually transmitted infections such as chlamydia or gonorrhoea — which are increasingly common in women over 50 — can also cause bleeding.
In worst-case scenarios, bleeding after sex could be an indication of cell changes in the cervix, which may signal cervical cancer.
GP surgeries may stock leaflets about your problem – so you’ll know you’re not alone
Sometimes painful sex is due to vaginismus — involuntarily tightening of the vaginal muscles when penetration is attempted.
If the deep pain exists without bleeding, it could be endometriosis — a common condition in which womb tissue grows outside the womb, or non-cancerous growths called fibroids. Most worryingly, it could signal ovarian cancer.
WHAT CAN I DO?
Your GP can take swabs from inside the vagina, or a urine test, to rule out sexually transmitted infections. A smear would also be used to check for changes which could lead to cervical cancer.
A blood test may be carried out to check for signs of ovarian cancer. It measures levels of a protein called CA125, which may be present if there is a tumour.
If the pain is superficial, the GP can prescribe hormone creams, emollients and lubricants.
And if the problem is vaginismus, the tight muscles can be retrained with vaginal dilators or you may be referred to a psychosexual counsellor to ease physical tension.
FEMININE WASHES CAN DO MORE HARM THAN GOOD
A WIDE range of bacteria live all over our skin, including inside the vagina, forming a balanced ecosystem. This bacterial cocktail can cause a slight, subtle smell, which changes throughout the menstrual cycle. Lots of women think this is a sign of poor hygiene, a myth perpetuated by marketing companies to sell dubious and potentially harmful washes and deodorants.
The vagina is, in fact, one of the cleanest organs in the body — as its healthy bacteria kill nasty ones.
If a smell becomes especially pungent (often described as fishy, with a watery discharge), it could be a common problem called bacterial vaginosis.
WHAT CAUSES IT?
Bacterial vaginosis, which affects one in three women, develops when the natural balance of bacteria in the vagina becomes disturbed, causing a growth in an organism called gardnerella.
Bacterial vaginosis usually comes from over-cleaning or using scented products. Such products alter the delicate pH balance of the vagina.
WHAT CAN I DO?
Treatment usually involves prescribed antibiotic tablets, gels or creams which restore the bacterial balance within a week. Further problems are rare but gynaecologists warn that there’s a risk of early delivery if you’re pregnant and leave it untreated.
THERE IS HOPE AFTER HAIR LOSS
ABOUT half of women over 65 have inherited pattern baldness, otherwise known as androgenetic alopecia. But it can also be triggered by a drop in oestrogen levels after the menopause, which damages the hair follicles.
WHAT CAUSES IT?
Aside from the menopause, it could be deficiencies in nutrients, such as zinc and iron, or even thyroid problems.
WHAT CAN I DO?
Firstly, blood tests by a GP can spot any underlying hormonal, thyroid or vitamin deficiencies.
If it’s an iron deficiency it can be treated with supplements, while thyroid problems respond well to the hormone thyroxine.
Other treatments include steroid creams, steroid scalp injections and a lotion, or foam, called Minoxidil.
LOOK OUT FOR CHANGES TO YOUR ‘NORMAL’
MOST women have some vaginal discharge, which is typically clearer and more watery before ovulation but thicker and stickier in the second half of the menstrual cycle. But when it becomes uncharacteristically thick, frothy or is green in colour, it could be a problem.
WHAT CAUSES IT?
It could be a yeast infection, such as thrush, but other causes include trichomoniasis, a bacterial infection that makes discharge green and watery, failure to remove a tampon or gonorrhoea (a thick yellow discharge). When coupled with other symptoms, such as blood traces or pains, it could be signs of cervical or endometrial cancer.
WHAT CAN I DO?
Antibiotics or antifungal medication should take care of thrush, bacterial infections or a sexually transmitted infection. Most discharge is completely harmless. You should be concerned only if it’s a significant change in what is usual for you.
Doctors have seen it all, multiple times, and probably even that same day
NOW TURN OVER FOR THE QUESTIONS MEN ARE TOO EMBARRASSED TO ASK