Embarrassing questions that you’re too shy to ask your GP answered by our experts
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. Surveys suggest that up to two-thirds of Britons avoid visiting their GP for conditions they consider embarrassing. Many instead ignore their problems, hoping they’ll go away, but often they are unwittingly delaying diagnosis and treatment until things have worsened considerably.
Bowel and cervical cancer, for example, are frequently detected too late because many people don’t attend screening or see a doctor when they get worrying symptoms.
Thankfully, 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, over the next two weeks we will guide readers through some of the most common intimate problems, explaining the symptoms, causes and treatments. This week, I focus on conditions affecting women, while my GP colleague and Mail on Sunday columnist Dr Ellie Cannon tackles those that men most commonly suffer from.
Alongside our own in- depth knowledge, we’ve spoken to leading specialists for the very best advice. We hope it will help dispel the myths, arm you with the facts and give you the courage to pick up the phone and make that appointment with your GP.
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.
About one woman in ten in the UK suffers long-term genital itching and, 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. I find it hugely frustrating when patients say they have put up with it for years, too embarrassed to seek help, or didn’t realise there was anything that could be done.
WHAT CAUSES IT?
Usually an itch is linked to dryness, says Paula Briggs, consultant in sexual and reproductive health at Southport and Ormskirk Hospital NHS Trust.
This is common around the time of the menopause, due to t he lack of the hormone oestrogen which keeps the delicate membranes of t he 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. Indeed, a 2013 survey of British women found one in ten sought no treatment out of embarrassment, and 42 per cent ‘didn’t think it was important’. Dryness can also be due to a common skin condition called lichen sclerosus, where white, itchy patches form on the vulva. But left untreated, this can cause scarring. The cause is not known but scientists believe it may be due to a fault in the immune system leading to attacks on the skin. 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 l i chen 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 SHOULDN’T IGNORE EXTREME PMS
IT’S A familiar feeling for millions of women – sudden, inexplicable despair that strikes around the same time every month. 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 utterly 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 a minority of 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 such as fluoxetine or sertraline, but only for the last two weeks of each menstrual cycle rather than every day.
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.
A survey of British women rated intimate bleeding the most ‘embarrassing’ condition.