Gynaecology Services

Uterine Fibroids

A fibroid is a non-cancerous growth of smooth muscle and fibrous tissue of the womb. This often occurs during a woman’s child-bearing years. They are not associated with an increased risk of uterine cancer and only 1% ever become cancerous.
Most women with fibroids have no symptoms but some may experience heavy menstrual bleeding, prolonged menstrual periods, pelvic pressure or pain, frequent urination, difficulty emptying the bladder, backache and infertility. Treatment options range from observation to symptom control with medication or surgery.

Endometriosis

Endometriosis is a common condition characterized by growth of endometrium (the tissue that normally lines the womb) outside the womb or in the muscle layer of the womb (adenomyosis). It most often appears in the ovaries, fallopian tubes, surface of the uterus, bladder, bowel and rectum.
Women may complain of heavy—sometimes irregular—menses, painful periods, pain during sex, pelvic or lower abdominal pain as well as infertility. Endometriosis treatment is directed at either the relief of pain or infertility and involves observation, medication or surgery depending on the severity of the condition.

Ovarian Cysts

An ovarian cyst is a fluid-filled sac arising from the ovary. Cysts may occur at any point in a woman’s life and can vary in size and number. They may be normal (e.g. functional cysts which occur at a particular time in the menstrual cycle) or pathological.
Symptoms include abdominal distension, pelvic pain, deep pain during intercourse, discomfort during bowel movements, irregular or heavy menses and even the frequency of urine. The treatment depends on the age of the patient, size and nature of the cyst and the severity of the symptoms. Treatment may involve observation, medication or surgery.

Menstrual Problems & Hormonal Imbalance Treatment

• Many women experience some form of vaginal bleeding during their lives, and it is considered abnormal when it occurs not during your expected menstrual period, if the flow is heavier or lighter than normal, or if the bleeding patterns change or the bleeding lasts longer or shorter than normal.
• This could be the result of hormonal imbalances, abnormal lining of the womb, polyps, fibroids or cancer.
• Investigations include blood tests, ultrasound scan, direct visualization with a hysteroscope and biopsies. Treatment will depend on the cause and may involve hormonal medication and minor or major surgery

There are many forms of contraceptives available. As every woman is unique, there is no “one size fits all” when it comes to contraception.
Women have many reasons for seeking contraception. Contraception allows women to choose when to have a baby. Responsible contraceptive practices also help to reduce the number of unwanted pregnancies and abortions. The final decision depends on the stage of the couple’s reproductive cycle, medical factors, costs of contraceptives, whether they want permanent or temporary/reversible contraception, socio-economic factors and religious factors.

Pap Smear

A routine pap smear is the most common screening method for detecting cervical cancer. It is a painless procedure that accurately detects over 90% of cervical cancers, even before symptoms develop.

A speculum is first inserted into the vagina to properly visualize the cervix. Cells from the cervix and vagina are taken using a small brush to be examined for any abnormalities. Early pre-cancerous changes in the cervix can be detected in this way and treated, thereby preventing cancer from developing.

All women who are sexually active or have had sexual intercourse in the past should have regular Pap smears

Appropriate treatment can then be performed based on test results. Treatment of pre-cancerous changes of the cervix include laser vaporization, LEEP and cone biopsy with laser or knife.

Cervical cancer is closely associated with the Human Papilloma Virus (HPV). There are 100 types of HPVs but only 15 of them are categorised as “high risk types” which cause cervical cancer. The two most commonly found types are HPV types 16 and 18 which are responsible for 70% of cervical cancers. HPV infection is mainly spread through sexual intercourse and can be asymptomatic.

Gardasil®

Gardasil® vaccine offers protection against cervical, vaginal, vulva and anal cancers, in addition to pre-cancerous changes of the cervix and vulva and genital warts caused by HPV types 6, 11, 16 and 18. The majority of infected individuals are asymptomatic and can unknowingly transmit the infection, which is why the HPV infection affects up to 50% of sexually active couples.

Both women and men can receive Gardasil®. It is best administered to persons with no previous HPV infection, although those with previous HPV exposure can still benefit from it. It consists of three doses given at 0, 2 and 6 months.

This vaccination is designed to prevent infections and not treat them. Routine Pap smear screening is still recommended post-vaccination as it is not meant to be a substitute.

Cervarix®

Cervarix® vaccine protects against HPV types 16 and 18 that are associated with cervical pre-cancerous disease and cancer. The ASO4 adjuvant incorporated into Cervarix® induces a sustained immune response. Cervarix also provides cross protection against HPV types 45 & 31, which are the 3rd and 4th most common causes of cervical cancer globally.

The vaccination regime comprises of three doses, given at 0, 1 and 6 months. Women should still continue with their regular pap smear screening after vaccination.

• Menopause is a natural event in a woman’s life and usually occurs between 45 - 55 years old. Entering menopause can be beautiful but menopause is different for everyone. Some women notice little difference in their bodies or moods, while others may find it difficult to cope. It is therefore important to understand how to manage menopause and overcome the symptoms.

• Short-term symptoms can range from hot flushes to night sweats, headaches, tiredness, palpitations, irritability, insomnia, depression, anxiety, aches and pains, loss of libido and feelings of not coping as well as before.

• Long-term changes may include hair loss, dry wrinkly skin, vaginal dryness, discomfort during intercourse and urinary incontinence.

• More serious concerns are the increased risks of heart disease, stroke, osteoporosis and cancer of the breast and ovary.

• We will advise you on lifestyle changes for symptom control, exercise, healthy diet and screening. We believe in a multi-faceted approach to menopause management with nutritional supplements, alternative/herbal remedies, phyto-oestrogens and bone-strengthening medication to strengthen and restore your inner radiant glow.

• Phyto-oestrogens are oestrogen-like compounds found naturally in certain plants (beans), fruits and herbs. They are natural anti-oxidants and act like human oestrogens found in your body by maintaining bone density and facilitating calcium absorption.

We believe in regular health screening to prevent illnesses. This involves physical examination and blood, urine and radiological tests for the early detection of diseases. Some diseases may have no symptoms but early detection along with prompt treatment results in better long term prognosis and successful cure. This is why making good lifestyle choices is the best thing you can do to stay healthy.

We offer a variety of screening packages specially devised to suit women of all ages and needs.

1. Young women - This package is recommended for women below the age of 40 years who are concerned about their well-being. It includes a detailed physical examination with the relevant ultrasound and blood tests.
2. Wellness - Designed for women above the age of 40 years to screen for early signs of cancers and menopausal conditions. It consists of a physical examination, together with a series of medical, radiological and laboratory investigations.
3. Pre conception - This package aims to assess and prepare women planning for pregnancy. The purpose is to identify existing or potential risks which may affect the woman or her baby should she conceive. In addition to the comprehensive examination and investigation, we also provide valuable advice on issues pertaining to conception and improving fertility.

Laparoscopic Surgery

Laparoscopy is also known as key-hole surgery. This method of surgery enables a gynaecologist to view the inside of the abdomen and pelvis to look for any abnormality, problems or damage to the internal organs without having to make large incisions in the skin. This is performed under general anaesthesia.

A small tube connected to a light source and a camera is first inserted through the umbilicus. The camera then relays images of the abdomen or pelvis onto a television screen.

Laparoscopic surgery is commonly used to treat endometriosis, pelvic adhesions, fibroids, ovarian cysts, ectopic pregnancy and also assess tubal patency for infertility. Some of these surgeries may not require an overnight stay in hospital. Laparoscopy for endometriosis

Laparoscopy removal of the womb

The advantages of laparoscopy over open surgery are a faster recovery time, quicker return to normal daily activities, less pain after surgery and reduced requirement for pain-relieving medicine, minimal scarring and a reduced stay in the hospital. Hysteroscopic Procedures

Hysteroscopy is a minor surgical procedure used to examine the inside of the uterus (womb). It is carried out using a narrow tube called a hysteroscope which is connected to a camera and a television system at the end.

Hysteroscopy is performed in a day surgery centre with local, regional or general anaesthesia, or with mild sedation. It can be combined with other surgical procedures and can be diagnostic or therapeutic in nature. It is frequently used to investigate causes of heavy or irregular periods, inter-menstrual bleeding, pelvic pain, unusual vaginal discharge, repeated miscarriage and infertility.

Urinary Incontinence & Utero-Vaginal Prolapse Surgery

Stress Urinary Incontinence

Stress urinary incontinence is the involuntary leakage of urine which occurs as a result of physical activities like coughing, sneezing or jumping. These activities put pressure onto the bladder, resulting in urine leakage especially if the bladder is full. Occasionally, women may experience leakage when they are pregnant.

Stress urinary incontinence can be treated with physiotherapy first. If this fails or if the condition is severe, then surgery is performed. Tension-free vaginal tape obturator (TVT-O) surgery is now the surgical treatment of choice for urinary incontinence. Urinary incontinence could also occur as a result of drinking too much alcohol, caffeine or fluids. This leads to increased urine production and leaking before one is able to go to the toilet.

Uterine prolapse

Uterine prolapse occurs when the ligaments and pelvic floor muscles are damaged or weakened, resulting in the uterus protruding into and even out of the vagina. This usually affects post-menopausal women although women of all ages can also be affected. It is usually a result of a difficult childbirth or lack of female hormones (oestrogen).

Physiotherapy in the form of pelvic floor exercises may be helpful for mild prolapse. However, if symptoms do not improve or are severe and begin to affect one’s lifestyle and daily activities, then surgical repair will be needed. In addition to treating and diagnosing the various forms of urinary incontinence and pelvic organ prolapse, we also manage recurrent urinary tract infections and voiding difficulties.

Tension-free vaginal tape, vaginal hysterectomy, pelvic floor repair (with or without a mesh) and sacrospinous fixation are some of the various therapeutic surgeries that we perform.

Tension-free vaginal tape obturator (TVT-O) system for urinary stress incontinence

Urge Incontinence

Urge incontinence is a condition where one feels a sudden intense urge to urinate and there is an involuntary loss of urine before one is able to reach the toilet. This can be medically treated.

The Paediatric and Adolescent Gynaecology clinic deals mainly with the gynaecological health of children and adolescents.
This area involves menstrual abnormalities, polycystic ovary disease, genital tract abnormalities, genital infections, endocrine disorders affecting the female reproductive tract, adolescent sexuality, etc.
The range of cases seen at the clinic includes the following:
menstrual disorders in girls aged 19 and below

• polycystic ovarian disease in teenagers
• primary amenorrhoea and delayed puberty
• secondary amenorrhoea in girls aged 18 and below
• vulvovaginitis/vaginal discharge in girls aged 18 and below
• uterovaginal dysgenesis/agenesis
• gonadal dysgenesis/agenesis eg. Turner’s Syndrome
• precocious puberty