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Endometriosis

Endometriosis

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No woman looks forward to “that time of the month.” Dealing with nausea, stomach cramps, mood swings, back pains and fatigue, all whilst facing that undeniable social pressure of pretending to be ‘normal’ and going about your daily activities. Because periods are a natural bodily function… right? It’s not like a cold where you would be rightfully exempted from resuming your daily tasks.

Sadly, sometimes the society we live in doesn’t accurately weigh the impact of periods on our daily functioning. A good example of this is one of the most common gynecological diseases, endometriosis, often going undetected for years because the abdominal pain it causes is dismissed as regular menstrual cramps. Endometriosis is typically a progressive condition. Therefore it’s wise to look out for signs early on and get regular checkups with your VOG to manage any symptoms you have. You can easily channel a VOG in just three taps on oDoc!

What is endometriosis?

The lining of your uterus is made up of tissue called the endometrium. When this tissue grows outside your uterus, it’s known as endometriosis. This disorder causes endometrial-like tissue to grow on your ovaries, fallopian tubes, bowel, and even tissues lining your pelvis.

Unfortunately, this endometrial-like tissue acts as endometrial tissue would — meaning that according to the hormonal changes in each stage of the menstrual cycle, it thickens, breaks down and bleeds. But because it has no way to exit your body, it becomes trapped! This triggers an inflammatory response, and the surrounding tissue becomes irritated, eventually developing scar tissue and adhesions, which are bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other. This leads to pain and other complications discussed below.

Symptoms of endometriosis

Just like all the chocolates we eat on our period are unique in their own way, the endometriosis symptoms experienced by you may differ from that of someone else. Some people experience mild symptoms, but others can have moderate to severe symptoms. The severity of pain you feel doesn’t indicate the stage of the endometriosis you have. You can have a mild degree of endometriosis, but experience agonizing pain or have a severe form of it and have minimal discomfort. That is why it’s important for you to get regular gynecological exams to stay on top of your reproductive and sexual health!

Pelvic pain is the most common symptom of endometriosis. You may also have the following symptoms:

  1. Painful periods – Most women have period cramps, but endometriosis can leave you with debilitating pain. You can get cramps 1 or 2 weeks around menstruation
  2. Heavy menstrual bleeding or bleeding between periods
  1. Painful intercourse – Women might have intense, localized pain during penetration
  2. Infertility – When endometriosis affects the ovaries or fallopian tubes, it may reduce the eggs’ chance of becoming fertilized and implanting into the uterus lining
  1. Painful bowel movements and/or urination
  2. Pain in the abdomen, lower back, or thighs, often lasting throughout the cycle

It’s wise that you get regular gynecological exams, which will allow your VOG to monitor any changes. This is particularly important if you have two or more symptoms.

Endometriosis Treatment

Until endometriosis is better understood, only the symptoms can be treated without the underlying causes. Endometriosis treatment depends on your symptoms and goals.

For example, suppose your goal is to minimize the pain. In that case, you may be prescribed over-the-counter pain medications such as Ibuprofen or hormonal medicines such as the oral contraceptive pill, which can suppress the period and stop mild to moderate endometriosis from progressing. It decreases fertility by preventing the monthly growth and buildup of endometrial-like tissue, reducing the pain.

Other options are available if you wish to conceive, such as undergoing a laparoscopy. In this minimally invasive surgery, your doctor will make small incisions in the abdomen to explore and surgically remove any problematic tissue without damaging your reproductive organs. Even though the name of this surgery sounds scary, most women can go home on the same day as the operation, and it will take roughly five to seven days to recover.

However, if you don’t respond to conservative treatments, your doctor may recommend a total hysterectomy as a last resort. In this operation, your surgeon removes the uterus, fallopian tubes and in some cases, even the ovaries, depending on the severity of the disease.

Life with endometriosis

Living with endometriosis can be difficult as symptoms can significantly impact your quality of life. It may take a toll on your mental health as finding an effective treatment and dealing with the anxiety of symptoms flaring up can be emotionally taxing. It may even cause financial strain depending on the cost of your treatment plan or if your symptoms interfere with your ability to maintain a job. It may also lead to an unfulfilled sex life which may cause a bridge between you and your partner.

To improve your quality of life with endometriosis, it’s good to reduce stress by regularly partaking in leisure activities, exercising and getting adequate sleep. While endometriosis can be isolating, remember that you’re not alone. There are many ways to find support, like joining an online or in-person support group and talking to a mental health professional to work through your feelings. You can easily channel a mental health professional in simply three taps on oDoc!

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What is the pelvic floor and why is it so important?

What is the pelvic floor and why is it so important?

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When you think of exercise, you might think focusing on muscle groups such as the abs, legs, back and arms. While all those areas are important, we can’t forget to exercise the muscles that we can’t particularly see or feel. We’re talking about the pelvic floor muscles. Have you ever sneezed, coughed or laughed and found yourself peeing a little? You’re not alone! This could be due to weak pelvic floor muscles. Problems with the pelvic floor are common and could happen to anyone. Incontinence, painful sex and lower back pain are some of the challenges that can arise due to a weak pelvic floor. Here’s what you need to know!

What is the pelvic floor?

The pelvic floor comprises of muscles and connective tissues that are attached to your pelvis and are vital in supporting your bladder, urethra, intestines and rectum. In women, the pelvic floor also supports the uterus and the vagina. You could think about the pelvic floor as a shelf for your organs, so a strong shelf means a more secure support system for your organs.

How do you find pelvic floor muscles?

A good way to visualize the pelvic floor and its function is to picture these muscles at the bottom of the pelvis. When you have a full bladder and you’re trying to stop urine flow, you’re contracting the pelvic floor.

Another way to find those muscles while standing is to imagine that you need to pass gas but don’t want to let it out. The muscles you’re activating to hold it in, that is those surrounding your rectum and anus, make up part of your pelvic floor.

When engaging the pelvic floor, make sure to use all these muscles that span the bottom of your pelvis. If you only contract the muscles that stop the flow of urine but not the rectal muscles, you’re not getting a full contraction and therefore, the pelvic floor does not get strengthened. Imagine a sensation of hugging your organs from the bottom up.

It’s important to learn how to tighten and relax these muscles for optimal pelvic floor function. As you’re going about your daily routine, check in with yourself to see if you’re contracting these muscles and to what intensity.

Why is it important to maintain a strong pelvic floor?

  • Strengthening your pelvic floor allows you to better support the bladder, bowels and uterus, helping with bladder and bowel control.
  • A strong pelvic floor also protects against uterine prolapse, when the uterus loses support and bulges out of the vagina
  • For women, a strong pelvic floor can help during labor and delivery
  • Strengthening the pelvic floor can lead to better sex for both men and women. Experts say that strengthening these muscles can potentially improve erectile dysfunction issues as well as boost sexual sensation for women.

How do you strengthen your pelvic floor muscles?

Both contracting and relaxing your pelvic floor muscles is key, and not just solely focusing on contraction.

Kegel exercises help with contraction of the muscles.

  • Find the right muscles as mentioned above
  • Imagine you’re sitting on an exercise ball with a marble inside of it. Picture vacuuming up the marble using pelvic floor muscles. Tighten for 3 seconds to lift the marble.
  • Relax for 3 seconds by taking a deep breath in and feel the air pouring into your lungs, your abdomen and down to your pelvic floor like a jug of water.
  • Make sure to not tighten your abs, thighs or butt and to keep breathing instead of holding your breath
  • Do 3 sets of 10 contractions and try to incorporate this exercise throughout your day

Relax your pelvic floor by incorporating some of these movements into your exercise routines.

pelvic floor exercises

You may think pelvic health is not an important factor to consider when looking at your overall health. But a strong pelvic floor can do wonders for you when it comes to your reproductive system, your sex life and your confidence (no leakages!).

If you’re having bowel or bladder control problems or pain during sex, speak to a physiotherapist or sexual health practitioner on oDoc who can help you find the right treatment. Download the app now.

Sources:

  • 9 Things You Might Not Know About A Pelvic Floor And Why It Matters, 2021, Mind Body Green
  • 5 Pelvic Floor Exercises for Anyone and Everyone, 2021, Healthline
  • What are pelvic floor exercises, 2020, NHS
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Sexually Transmitted Infections And Diseases: What You Need To Know

Sexually Transmitted Infections And Diseases: What You Need To Know

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What are STIs and STDs?

Sexually Transmitted Infections (STI) and Sexually Transmitted Diseases (STD) are usually acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. However, these infections can be transmitted nonsexually as well. For instance, from mothers to their babies during pregnancy, childbirth, breastfeeding, blood transfusions or shared needles.

What is the difference between STIs and STDs?

It is the fundamental difference between an infection and disease. Most diseases start with infections. Infection occurs when the bacteria or virus first enters the body and multiplies, progressing it into a disease. Likewise, sexually transmitted diseases initially begin as sexually transmitted infections. 

There are more than 20 known types of STDs/STIs. In Sri Lanka, annual estimates of detected STI cases vary from approximately 60,000 to 200,000, of which government clinics report only 10-15%. About half of these are detected in people aged 15-24. Luckily, most STDs can be treated and cured.

What are the most common STIs/STDs in Sri Lanka?

  • Genital herpes
  • Gonorrhoea
  • Non-gonococcal urethritis (NGU)
  • Syphilis
  • Genital warts
  • Chlamydia infection

What are the most common symptoms of STIs/STDs?

Why is it important to prevent STIs/STDs?

Most STDs can be cured or treated with medication. However, the consequences of ignoring it can include infertility, cervical cancer,  pregnancy complications, congenital disabilities, pelvic inflammatory disease and an increased risk of HIV transmission.

How can the transmission of STIs/STDs be prevented?

The only effective way to completely prevent the transmission of STIs/STDs is abstinence. However, for sexually active persons, consistent and correct use of condoms is highly effective in preventing such infections or diseases.

Questions to ask your doctor?

There has almost always been a stigma around any STD, and it usually trickles down to anyone diagnosed with it. People also feel ashamed that they are somehow damaged. It is important to remember that only a few STDs could be life-threatening. However, with proper treatment, most of it has minimal health impacts. You can have a good life despite having an STD. The majority of it is treatable, and some are even curable. Those STDs for which there is not yet a cure, such as HIV, can still be manageable if adequately taken care of.

Here are a few questions you could ask your doctor:

  1. Should I be checked for STIs?

  2. Can I get an STI by open-mouth kissing?

  3. What if I am pregnant?

  4. Can STIs/STDs cause other health problems in women/men?

  5. How can I prevent having STIs/STDs?

Suppose you are experiencing any of the symptoms mentioned above or need any information on STIs and how to protect yourself or get tested. In that case, you can consult a Sexual Health specialist or an on-demand GP via the oDoc app.

Reference:

  1. What you need to know about sexually transmitted infections, MedicalNewsToday (2021)

  2. Sexually transmitted infections (STIs), World Health Organisation (2019)

  3. What is a sexually transmitted infection?, FPA Sri Lanka (2017)

  4. Types of Sexually Transmitted Infections, Healthy children.org (2015)

  5. How to Reduce Shame and Stigma When You Have an STD, Everydayhealth.com (2019)

  6. How Can You Tell If You Have HIV? HIV.gov (2020)

  7. STD vs STI: Common Types, Symptoms, and Treatment, State Urgent Care (2019)

  8. Sexually transmitted infections (STIs), NHS (2021)

  9. HIV/AIDS in Sri Lanka, The World Bank (2012)

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Family planning? Know your available contraception methods

Family planning? Know your available contraception methods

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Almost all women who are sexually active would have Googled contraception methods. Figuring out which method of contraception is the best for you and your partner can be frustrating. It isn’t spoken about freely and it can be difficult to find out what methods are available to you.  Below we’ve collected all the important information you need to know. We have also explored the pros and cons of each contraceptive method to help you compare your options easily. 

So, here we go.

Firstly, what is contraception?

Contraception, also known as birth control, is the use of artificial methods and techniques to prevent pregnancy.

Birth control – the different types 

There are 5 general types of birth control methods and each works in a different way. Some are temporary and some are more permanent. Some prevent the sperm from meeting the egg whilst some prevent the egg from releasing. Either way, the goal of all the contraception methods is to prevent unwanted and unplanned pregnancies.

It is also important to note that birth control and contraception is not the same as prevention of sexually transmitted infections (STI). Condoms are the only method that prevents the spread and transmission of STI’s so it is advised that you combine the use of condoms with other types of contraception. 

1. Short-acting hormonal contraception

Short-acting hormonal contraception methods adjust the hormone level in the woman’s body making pregnancy much less likely to happen. Some of the commonly used short-acting hormonal contraception methods are the daily use birth control pill and the hormonal injection. Both of these methods require a prescription from your doctor. 

The birth control pill 

There are 2 types of birth control pills available: the progestin-only pill and the combination pill (which contain both progestin and estrogen). 

The hormones released by the pill prevent the release of the egg, the thickening of the uterus and the cervical muscle making it harder for the sperm to enter the uterus. By taking the pill at the same time every day, you maintain a steady level of the hormones in your body, making it a very effective form of pregnancy prevention. 

With perfect use, it’s over 99% effective.

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Effectiveness is time-sensitive, you have to take it regularly at the same time every day for maximum effectiveness
  • Does not protect against STIs

The Hormonal Shot

The hormonal injection is administered by the doctor every 1 or 3 months to the woman. Like the birth control pill, this too prevents the release of the egg and thickens the cervical muscle making it difficult for the sperm to enter the uterus. 

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Once off the shot, it may take up to a year for your menstruation to return to normalcy
  • Does not protect against STIs 

2. Long-term contraception 

This is a good option if you want lasting contraception with little maintenance. Available options include an implant inserted into your arm or an intrauterine device (IUD) inserted into your uterus. These methods are 99% effective at preventing pregnancy. They’ll work for 3–10 years, depending on the particular method you choose. 

Implant

The doctor will place 1 or 2 silicone rods under the skin in the arm of the woman. The rods will release the hormone, progestogen into your bloodstream that prevents the release of egg into your uterus. The hormone also thickens the cervical muscle thus stopping the sperm from entering the uterus. Further, It thins the muscle of your womb making implantation of the egg less likely. 

Pros

  • The most effective type of contraception 
  • Long-term, can be kept for 3-5 years
  • Does not affect sexual activity 
  • Not time sensitive 
  • A good option for women who can’t take oestrogen pills

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs
  • May have side effects such as headaches and breast tenderness
  • Your periods may be irregular or stop

Intrauterine Device (IUD) 

The IUD is a T-shaped copper device which is inserted into your womb by your doctor. There are 2 kinds of IUD you can get implanted, the hormonal IUD or the non-hormonal version. 

The hormonal version releases the hormone progestin, which prevents sperm from fertilizing an egg. It also thins the uterine lining making implantation of the fertilised egg less likely and thickens the layer of mucus over the cervix to help block sperm from entering in the first place. 

The non-hormonal device releases copper ions which has similar effects to progestin. The ion immobilises the sperm making it difficult for them to swim to the egg. 

Pros

  • One of the most effective methods to prevent pregnancy 
  • Requires no effort from you 
  • Long term, can be kept in for 5-10 years
  • Does not affect sexual activity

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs

3. Single use barrier contraception 

Male and female condoms, spermicides and cervical caps are all types of single use barrier contraceptives. As the name suggests, they act as a barrier between the sperm and the egg, preventing the sperm from fertilising the egg.

Condoms

Condoms are a sheath-shaped barrier device made of latex or polyurethane. The male condom is placed over the erect penis and when ejaculation occurs the semen is collected in the condom acting as a barrier preventing the sperm from entering the uterus. The female condom is inserted into the vagina preventing the sperm from reaching the egg. Condoms when used properly are the only form of contraception that effectively prevents pregnancy and STI transmissions. 

Pros

  • They are hormone-free
  • Protects against STIs
  • Has no effect with other medications 

Cons 

  • Interfere with sexual activity and pleasure 
  • Chances of tearing during sex 

Permanent contraception 

If you plan on never having kids you can opt for the permanent contraception methods of Tubal ligation (for women) or vasectomy (for men). They are both simple procedures and they’re almost 100% effective at preventing pregnancy. Recovery time from these procedures usually takes only a few days and have close to no impact on your sex drive and sexual functions. 

During a tubal ligation, both the fallopian tubes are blocked or cut off and during a vasectomy, surgery cuts are made in the vas deferens ( a tube that transports sperms) preventing the sperm from reaching the semen in the testes. Women will still continue to have their periods every month after tubal ligation and men after vasectomy,  will continue to release semen during ejaculation but it will not contain any sperm. 

Pros

  • Permanent contraception 
  • Does not affect sexual activity

Cons

  • Both surgeries are reversible but does not guaranty fertility 
  • Does not prevent STIs

Emergency contraception 

Emergency contraception can help you prevent pregnancy if you have unprotected sex or your birth control fails. There are 2 kinds of emergency contraception pills you can take in Sri Lanka. Please note that emergency pills should not be used as a substitute for contraception.  

Postinor-1 

Postinor One (morning after pill) is a single dose oral emergency contraceptive pill that should be taken within 72 hours of unprotected sexual intercourse. The sooner you take the pill, the higher the effectiveness. Postinor-1 has releases levonorgestrel which delays ovulation and in turn, reduces the chances of fertilisation occurring. Several studies claim that Postinor-1 has the potential to stop 85% of anticipated pregnancies. The tablet is safe to take and does not alter fertility. 

This pill does not have any abortive effect, so if you are already pregnant it will not impact it. 

Postinor-2 

Postinor-2 is a double dose pill. Both the tablets can be taken at once or separately with a 12-hour gap between each. It works the same as Postinor-1. 

It should be noted that the emergency pill will not cause abortion and should not be used as a contraceptive method.

Wondering what the best contraceptive method for you is?

Well, that depends on you and your goal. Speak to your partner and your doctor to decide on the most convenient and most suited method for you. Also, remember there is no 1 method that suits all. Feel free to experiment with each method till you find one that suits your liking. 

If you want more information or would like to speak to a Gynaecologist on the best form of contraception you do so via the oDoc app. 

Sources

  1. FPA Sri Lanka. (2017, January 6). Contraception | Family Planning Association of Sri Lanka. http://www.fpasrilanka.org/content/contraception
  2. Tesch, D. (2021, July 23). 5 types of birth control options: which is best for you? HealthPartners Blog. https://www.healthpartners.com/blog/how-to-figure-out-which-type-of-birth-control-is-right-for-you/
  3. WebMD. (2016, November 18). FDA Explains Pros, Cons of Permanent Birth Control. https://www.webmd.com/sex/birth-control/news/20161118/fda-explains-pros-cons-of-permanent-birth-control
  4. Vasectomy: Treatment & Information – Urology Care Foundation. (202–12-01). Urology Health. https://www.urologyhealth.org/urology-a-z/v/vasectomy
  5. Johns Hopkins Medicine. (n.d.). Tubal Ligation. Retrieved August 3, 2021, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation
  6. WHO. (2020, June 22). Family planning/contraception methods. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
  7. NHS website. (2021, March 12). Contraceptive implant. Nhs.Uk. https://www.nhs.uk/conditions/contraception/contraceptive-implant/
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Let’s Talk About HPV

Let’s Talk About HPV

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In Sri Lanka, sexual health is a topic rarely spoken about in the open. The taboo and social stigma surrounding this subject may inadvertently lead to sexually active Sri Lankans unaware of how to maintain a healthy sex life. Practicing safe sex is central to this as well as reducing the spread of sexually transmitted diseases (STDs), such as HPV.  

Perhaps you’ve heard about HPV but have been hesitant to ask about it with your loved ones or your doctor. Perhaps you’re sexually active and would like to know how to be safe with your partner, and having an understanding of HPV is one such way to do that.

Well, let’s talk about it!

What is HPV?

The human papillomavirus (HPV) is one of the most sexually transmitted infections in the world today. There are more than 150 different strains of HPV. Depending on the type of strain, HPV can cause warts anywhere on the body. Warts appearing on your genitals is very common. Up to 80% of sexually active adults will get an HPV infection of the genital area at some point in their lives, although many who carry the virus don’t even know it. 

You don’t need to panic if you find a wart on your body since the vast majority of warts are benign and non-threatening but speaking to a VOG doctor will ease your concerns. For a small number of women, certain strains of HPV can cause changes in the cervix that can become cancerous if not treated.

How do you get HPV?

HPV is spread by direct skin contact through vaginal, anal and oral sex with a partner who already has a genital HPV infection. Non-genital HPV infections can occur through skin to skin contact, such as shaking the hand of someone who has a wart on their finger.

What are the symptoms of HPV?

Symptoms of HPV, if they arise, typically appear in the form of a cauliflower-like growth called genital warts. They can also appear flat. Warts can be found around the vagina, anus, mouth and throat as well as the penis and groin. Symptoms usually take weeks or even months to develop after initial exposure. 

Non-genital warts can be found on the rest of the body, especially hands, face, neck, chest, and soles of feet. Some warts can be inside your body, therefore, impossible for you to notice. And in some cases, there might not be any symptoms at all.

How can your doctor diagnose HPV?

Your doctor can diagnose warts by examining the area. Most of the time, warts don’t need to be biopsied unless the doctor is concerned that the warts could be cancerous. A biopsy entails removing a small piece of tissue and examining under a microscope. 

If it’s possible that you have genital warts, your doctor will ask you about your sexual activity. 

  • For women, your VOG doctor will do a pelvic exam and pap smear. This includes removing cells from the cervix to test whether the cells are cancerous. An HPV test, which checks for the actual virus, can also be performed as well. 
  • For men, a physical exam can be performed. 

In the unlikely event that cancer is diagnosed, please speak to a doctor to further discuss the course of treatment.

How do you treat HPV?

Most warts can be treated at home with topical creams prescribed by the doctor. Other long-lasting methods of wart removal include:

  • Cryotherapy (freezing)
  • Cautery (burning)
  • Surgically removing the wart

In some cases, the wart may return. Therefore, you should take preventative measures to reduce the likelihood of getting an HPV infection.

How do you prevent an HPV infection?

Taking preventative measures is of critical importance when it comes to reducing your risk of infection or further spread of the virus. 

Practicing safe sex can greatly reduce the likelihood of getting an infection. This includes maintaining a low number of partners as well as the consistent use of condoms. 

The Centers of Disease Control and Prevention (CDC) recommends all children to be vaccinated before they become sexually active to prevent infection of high-risk strains of HPV. 

For all the ladies out there, an important preventative measure that you can take is visiting your VOG doctor on an annual basis for your routine check up. Your doctor may perform a pelvic exam to make sure everything is normal in your vagina, vulva, uterus, cervix, rectum, ovaries and fallopian tubes. Your VOG doctor might suggest performing a pap smear as well. Pap smears are important as it involves examining cells from the cervix under a microscope to identify any abnormal cervical changes such as precancerous cells. 

We hope you have a better understanding of HPVs now but if you have more questions or are concerned about other issues related to sexual health, you can get in touch with sexual health and VOG doctors on oDoc.

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