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Sexual Health

  • Understanding Sexual Health

    smiling young woman

    A woman’s sexuality and health needs may change at different life stages. Whether you are a young adult, newly-wed or working professional, being empowered with adequate knowledge about your sexual and reproductive health may help improve your quality of life and prevent future medical issues.

    Find out more about the menstrual cycle, how to manage period pains, common questions surrounding sexual wellness, vaccination and contraceptive methods.

  • The Menstrual Cycle

    woman with stomachache

    The menstrual cycle is regulated by the rise and fall of hormones, and is a natural process whereby the body prepares for pregnancy. About once a month, the uterus grows a new lining (known as endometrium) in preparation for a fertilised egg. In the absence of a fertilised egg, the uterus lining sheds and this leads to the monthly menstruation bleeding. An average menstrual cycle lasts 28 days, but the cycle length and period flow may vary between individuals.

    Menstruation usually starts occurring in females aged 11, and typically stops between ages 45 – 60. Menstrual bleeding usually lasts between 3 – 7 days. The end of the last menstrual period is known as menopause. Menstruation is an important part of being healthy. Talk to your gynaecologist if you experience irregular or heavier-than-usual bleeding.

    What Happens During a Menstrual Cycle?

    The menstrual cycle consists of 3 phases: follicular (before egg release), ovulation (egg release), and luteal (after egg release). The infographic below illustrates the complex interaction of hormones and the changes that occur during a menstrual cycle.

    the menstrual cycle

    Follicular phase (Day 1 of bleeding) – The pituitary gland releases a hormone which prompts the development from follicle to egg in the ovary. This releases estrogen which thickens the lining of the uterus in preparation of the possible embedding of the fertilised egg.

    Ovulation (Day 14) – A mature egg is released from the ovary. The rise in estrogen leads to a surge in hormones that trigger ovulation where the egg enters the fallopian tube and moves towards the uterus. The egg disintegrates within 24 hours if fertilisation does not occur.

    Luteal phase (Day 14 – 28) – The empty follicle collapses after the egg is released and becomes a corpus luteum, which produces the hormone progesterone. This further thickens and nourishes the uterus lining. If fertilisation occurs, the fertilised egg is implanted into the uterus lining and progesterone levels stay high. If no fertilisation occurs, the egg and corpus luteum disintegrates. Estrogen and progesterone levels decline and the menstrual cycle starts again, where the lining of the uterus is shed along with the unfertilised egg.

    A regular menstrual cycle is important for a woman’s health and well-being. Certain conditions such as endometriosis may result in painful menstrual cramps or abnormally heavy bleeding. Consult your gynaecologist if you encounter any changes to your menstrual cycle.

    Managing Period Pain

    Most women encounter some pain during menstruation. While period pain is common, in certain instances, the pain may become unbearable and severe enough to affect daily activity. Dysmenorrhoea is the medical term for painful cramps experienced before or during menstruation. Symptoms include:

    • Pain in the lower back, hips, or inner thigh area
    • Pressure in abdomen
    • Pain in abdomen
    • Bloating or diarrhoea
    • Headache or nausea
    • Breast tenderness

    Mild menstrual cramps may be relieved by the following methods:

    • Place a heat pad on the abdomen
    • Take a warm bath
    • Have adequate rest
    • Exercise regularly
    • Avoid caffeine, salt, and alcohol
    • Refrain from smoking

    Talk to your gynaecologist if you encounter menstrual cramps. Certain medical conditions such as endometriosis may cause period pain. Consult your gynaecologist to find out more.

    References:

    1. Proctor M, Farquhar C; Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 13;332(7550):1134-8.
    2. MedicineNet.com
    3. Wong CL, Farquhar C, Roberts H, et al; Oral contraceptive pill as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD002120.
  • Sexual Wellness

    young couple

    Sexual health is defined by the World Health Organisation as ‘a state of physical, mental, and social well-being in relation to sexuality’. Embracing female sexuality is a vital part of emotional and physical health, and it is important to understand some of the common issues faced by women pertaining to sexual wellness.

    Loss of Libido

    Loss of libido is a sexual dysfunction relating to decline in sexual desire or drive. Medically, low libido is termed as hypoactive sexual desire disorder (HSDD). An international survey conducted by the Global Study of Sexual Attitudes and Behaviours reported that low libido affects as many as 43% of women.

    Loss of libido may develop due to various reasons, be it medical, psychological, or emotional. Getting to the root of low libido can help in the regaining of sexual health. Common causes in women include:

    • High stress
    • Medical conditions such as arthritis, cancer, high blood pressure, heart disease
    • Fatigue
    • Mental health disorders such as depression
    • Hormonal changes during pregnancy or menopause
    • Poor body image or low self-esteem
    • Previous negative sexual experiences
    • Lack of connection with partner
    • Poor communication on sexual needs or preferences

    Loss of libido may affect a woman’s emotional well-being as well as a couple’s relationship. It is important to talk to your gynaecologist to understand your condition and to seek help.

    Reference:

    1. Brotto L, The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Men, 2010

    Pain During Intercourse

    Painful intercourse, known as dyspareunia, may lead to negative emotions and affect a couple’s sexual relationship. Dyspareunia may be felt at entry or as a deep pain during intercourse.

    Pain during penetration may be due to the following factors:

    • Inflammation or infection of the genital area or urinary tract
    • Insufficient lubrication or foreplay
    • Injury or trauma due to prior surgery or childbirth

    Deep pain may also be felt during intercourse. This usually occurs with deep penetration and may be pronounced at certain positions. In such instances, dyspareunia may be due to:

    • Certain medical conditions such as pelvic inflammatory disease, endometriosis, fibroids, or cysts
    • Tissue scarring due to prior surgery

    If you experience pain during intercourse, talk to your gynaecologist to understand your condition.

    Genital Itching

    Experiencing itch at the female genital area may be a symptom of certain medical conditions such as vaginal infection, sexually transmitted diseases and allergy, or skin irritation.

    The following steps should be taken to avoid genital itching:

    • Wipe from front to back after urination or bowel movement
    • Avoid chemical products that may upset the acidic balance of the vagina
    • Eat a well-balanced diet
    • Wash the genital area well when bathing

    If you suspect that you have genital itching due to certain medical conditions, talk to your gynaecologist to find out more.

    References:

    1. World Health Organisation
  • HPV Vaccination and You

    group of happy women

    The human papillomavirus (HPV) infects the reproductive tract and causes cervical cancer, which is the 10th & most common cancer affecting women in Singapore. Globally, cervical cancer is the 4th most common cancer in women, with an estimated 266,000 deaths and 528,000 new cases in 2012. In women, HPV may also cause mouth and throat cancers, cancer of the vulva, vagina, anus, as well as genital warts. HPV infection can be transmitted through sexual contact.

    HPV vaccination causes the body’s immune system to produce antibodies that then protects against HPV infection. The HPV vaccine is delivered in 3 shots, and is recommended for all girls and women aged 9 – 26. However, studies have shown that the HPV vaccine is beneficial for women above 26 as well. In the United States, the recommended age is up to 45 years old and in Europe, there is no age limit at all. Talk to your gynaecologist to find out if the HPV vaccine could benefit you or your child.

    References:

    1. National Cancer Centre Singapore Cancer Statistics
    2. World Health Organisation (WHO) Human Papillomavirus Vaccines Position Paper
  • Contraceptives & Birth Control Methods

    young couple

    Today, many forms of contraceptives are available for effective birth control. Common contraceptive methods include:

    • Natural family planning
    • Female condom
    • Male condom
    • Vaginal ring
    • Contraceptive patch
    • Oral contraceptives
    • Injectables
    • Intrauterine device

    Talk to your gynaecologist to understand more and select the method which best suits your need.

  • Sexual Health During Pregnancy

    expectant couple

    Pregnancy should not hamper the sexual relationship between parents-to-be, as long as your pregnancy is progressing normally. The amniotic sac, uterus muscles and thick mucus plug that seals an expectant mother’s cervix helps guard the developing fetus against any form of shock or infection. However, pregnancy may bring about hormonal or mood fluctuations and physical changes to a woman’s body that may dampen her sexual drive.

    Talk to your obstetrician to understand more. If you experience any bleeding or spotting during early pregnancy, your doctor may advice you to delay sex. Women who encounter the following conditions may also be cautioned to delay or avoid sex:

    • History of vaginal infection
    • Heavy bleeding
    • Presence of cervical weakness
    • Presence of low-lying placenta

    References:

    1. Quilliam S. 2010. Sex during pregnancy: Yes,yes,yes! J Fam Plann Reprod Health Care. 36(2):97-98

    Consult your obstetrician if you have any concerns.

    This content is for informational purposes only and should not be construed as medical advice.

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