The Gynae Geek: Your no-nonsense guide to ‘down there’ healthcare. Dr Mitra Anita

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СКАЧАТЬ This is usually associated with men, but believe it or not, women need it too – not just to promote sex drive, but also for bone and muscle strength, as well as brain function.

       THINGS YOU’VE ALWAYS WANTED TO KNOW, BUT WERE TOO AFRAID TO ASK

       What is a retroverted uterus and will it affect my chances of getting pregnant?

      Also known as a tipped/tilted uterus, it means the uterus points backwards (retroverted) instead of forwards (anteverted). Between 20 and 30 per cent of women have this and in many cases, it is just how they were born and bears no impact on their health. In some women, however, it may be due to conditions such as endometriosis (see here), fibroids (see here) or the presence of scar tissue that pulls the uterus backwards. The actual position of the uterus does not affect your chances of getting pregnant because sperm is able to swim in all directions; however, any one of the underlying conditions above may cause problems. It also doesn’t cause pain, but again, if it’s due to an underlying disease, that may do so.

      A retroverted uterus can make your cervix a little trickier to find when you have a smear test, which can be slightly uncomfortable. But we know plenty of tricks to make it easier and less painful. I often use the ‘make-fists-and-put-them-underneath-your-bottom’ position – if you know, you know! But the smear itself shouldn’t be any worse than normal.

      As the uterus increases in size in pregnancy, it will gradually flip forward, and by twelve weeks – when most women are having their first scan – a retroverted uterus may have corrected itself, so that many women never even find out they had one.

       Why do I bleed after sex?

      Also called post-coital bleeding, bleeding after sex can have many causes, including:

       cervical ectropion (see here)

       cervical and endometrial polyps (see here)

       infections such as chlamydia, or even something simple like thrush, which causes irritation of the vagina and cervix and the added friction of sex can be enough to make it bleed

       vaginal dryness (lack of lubrication, which can make the vaginal tissue more sensitive to friction in particular)

       skin conditions such as psoriasis or lichen schlerosus – these can make the skin more delicate and increase the chance of getting small skin tears

       cervical cancer – the one that everyone worries about, but is actually the least likely cause, which is why I’ve put it at the bottom of the list; the risk ranges from 1 in 44,000 cases of post-coital bleeding in women aged 20–24 to 1 in 2,400 in 45–54-year-olds.6

       Does removing a fallopian tube affect my fertility?

      Sometimes fallopian tubes may need to be removed in cases of severe infections (see Chapter 9 on STIs) or due to an ectopic pregnancy (a pregnancy in the tube). You can still get pregnant with one tube (see here), but if both are removed it does mean that you would need IVF to get pregnant. Removing either one or both tubes also does not affect the function of your ovaries and does not cause you to go into the menopause.

       Why do I have a cyst on my ovary?

      Ovarian cysts are very common and about 1 in 10 women will need surgery for one at some point in their lifetime. Most arise as a result of the normal workings of the ovary (see here). We get tonnes of referrals to the gynaecology clinic for ovarian cysts that have been found incidentally during a scan for something else. Ultrasound is the best way to look at your ovaries initially, preferably an internal scan using a small probe inside the vagina because it gets closer to the action. Most cysts will disappear on their own within a couple of months. You may need a follow-up ultrasound, depending on the size and type of cyst.

      Larger cysts may need to be removed because there is a greater risk that they may twist the ovary which cuts off its blood supply, and if not untwisted will cause the ovary to die. This is called ‘ovarian torsion’, and you’ll definitely know if you have it because it is incredibly painful, to the point where even morphine won’t touch the pain. It requires emergency surgery to untwist the ovary and remove the cyst. In most cases the ovary itself can be saved if the blood supply returns on untwisting.

      The biggest ovarian cyst I’ve ever seen was in a young woman and was 24cm across. She was supermodel-slim, and finally went to her GP after spending a fortune on pregnancy tests, because she couldn’t understand why they were all negative, yet she looked seven months pregnant. A big tummy is a slightly unusual way for a cyst to present. More common symptoms include:

       abdominal pain – this may be constant, occasional or during sex

       constipation – due to pressure on your bowel

       wanting to pass urine more often – due to pressure on your bladder

       a change in your periods – irregular, heavier or lighter.

       The risk of a cyst being cancerous in a pre-menopausal woman is very low, ranging from 1 to 3 in 1000.7 (See Chapter 4 for more about polycystic ovaries.)

       Should I be worried about ovarian cancer?

      Ovarian cancer is so rare before the menopause and ovarian cysts do not increase your risk.

      An estimated 5–15 per cent of ovarian cancers are inherited, most often caused by mutations in the BRCA1 and 2 genes, which are also associated with breast cancers. If you have close family members (e.g. mother, sister, grandmother) affected by ovarian cancer, particularly at a young age, you may be eligible for genetic testing, which should be discussed with a genetic counsellor.

      An estimated 21 per cent of cases of ovarian cancer are directly related to lifestyle factors including smoking, poor diet and lack of exercise,⁸ so keeping active and eating well is one of the best ways to prevent the disease.

      There isn’t currently any screening for ovarian cancer, as there isn’t yet a test that is accurate enough. Remember that screening means identifying women who may have a disease but do not have any symptoms.

      If you experience any of the following symptoms more than twelve times per month, you should be investigated:

       Persistent bloating

       Feeling easily full after eating and/or loss of appetite

       Pelvic or abdominal pain

       Needing to pass urine more often, or as a matter of urgency

       Change in bowel habit

      THE СКАЧАТЬ