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Hi there! I am a member of femalenetwork.com and I came across a particular area of the site. I am hoping someone can help me. I am afraid of going to gynecologists here in the Middle East because I don't trust practitioners here. I had a gyne in the Philippines, but sad to say I lost contact with her. My problem right now is the area down there (outer labia). I always had this problem before and my great gyne always had a solution for it.

It all started when I went to swim in a pool that did not have chlorine. I thought it was OK and nothing will happen to me, but I was wrong. After a day I had an irritation down there. It was just itchy, and I did not have a discharge like before. However, I could not help but scratch it and that's when I noticed a bump. I don't know what it was and now it's swelling. I don't know what to do. I feel so uncomfortable and it's painful when I walk and sit.

My mother recommended penaten cream and water mixed with vinegar. So I followed it, making some of the soreness go away, and it doesn’t itch any longer. But the pain and swelling is still there. I don't remember what my gyne gave me before, but I recall it was a cream. Please help me.

Vhea

Many conditions can cause itchiness and swelling in the labial area. What would be necessary is to describe the location, character of the discharge, and timing of the symptoms.

To adequately describe the location, you may use this diagram:

 

If it is just the labia majora (or labium majus) and labia minora (or labium minus), look closely using a mirror at the itchy area: do you observe any wounds or ulcers (small excavated breaks in the surface), discharge, or vesicles (clear fluid containing bubble like blebs)? Inspect likewise the inner surface the labia extending into the outer vagina.

If the area is just red but with accompanying white cheese-like discharge then it might be yeast infection. If it has vesicles, it may be a herpes infection. If it has ulcers, find out if it is of infectious origin and check if it is acquired through intercourse. Apart from yeast, bacterial vaginosis (an overgrowth of natural vaginal bacteria called Gardnerella) and organisms such as Trichomonas and Neiserria gonorrhea (the latter two are sexually transmitted) are common causes of vaginal discharge. The treatment for each infection is varied and specific. One suppository, cream, or ointment may not cure all infections. Yeast can be treated with an antifungal cream, ointment, or oral medication such as fluconazole, nystatin, miconazole, or clotrimazole. Vaginosis and trichomonas respond to metronidazole either in tablet form or in suppository. These medications and creams need to be used continuously for at least one to two weeks to be effective. One or two applications will definitely not suffice. Gonorrhea needs an intramuscular injection of ceftriaxone.

If there is a big swelling coming from the lower half of the labia majora region, it might be a Bartholin’s cyst or abscess. Mild infection may respond to antibiotic treatment but if there is abscess formation (meaning the entire gland is filled with pus), it has to be surgically drained through a procedure called marsupialization. This is done under regional anesthesia and helps prevent recurrence.

Lastly, some substances such as chlorine, scented liners, or some types of feminine wash may cause allergic reaction in our vulvar area. These can be treated with steroid cream. However, take utmost care when steroids have to be used. The presence of infections--either superimposed on an allergic reaction because of scratching, or an infection that was wrongly assessed to be an allergy--precludes the use of steroid containing medications because this will aggravate or cause a flare up of the infection.

The most important thing to do, therefore, is to get a good assessment of the condition from a health professional so appropriate treatment can be applied.

 

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Dear Dr. Angela Sison-Aguilar,

I'd like to know the "first steps" in consulting a gyne. I'm 23 years old and haven't consulted a gyne and planning to do so soon. Are there any steps to take prior to the visit? What should I expect during the consultation? Would I need to do some tests during my 1st consultation? Around how much would it cost me? Do I need to bring my partner with me? I found the "need" to consult a gyne when I noticed I've been having discharges for a long time already. I'm not sure if these are still normal discharges. Please help! Thanks!

Jackie

Dear Jackie,

All women are encouraged to see their gynecologists at least once a year. Gynecologists are really primary care physicians for women the same way pediatricians are for children. We don’t need to get pregnant first before we see our gyne.

Many women are encouraged to see their gynecologists most especially if they have symptoms such as dysmenorrhea, irregular periods and unusual vaginal discharge. There might be some conditions that can be investigated and help extended earlier if we go through the check up as promptly as we can. Outside of these symptoms, the gynecologist may have some advice as to how we can maintain healthy habits to avoid disease.

The gynecologist will ask baseline data about your medical and family history. She will also record the onset, duration, amount and character of your menstrual periods. Your obstetric history will also be noted as well as your sexual history and other habits like smoking and alcohol intake. It’s like an annual physical designed for women.

 

'Many women are encouraged to see their gynecologists most especially if they have symptoms such as dysmenorrhea, irregular periods and unusual vaginal discharge'

It is best to have ourselves examined right after our period has ended. If we are sexually active, we can have a pelvic examination done and a Pap smear to screen for cervical cancer taken. Some imaging studies such as a pelvic ultrasound may be requested if it is necessary. A clinical breast exam will also be performed to validate your own self breast examination findings.

The cost will depend on the gynecologist you go to. It usually will cost you a couple of hundred pesos but you may avail of a free consultation at many government facilities.

A discharge may be due to a yeast infection if it is itchy. It may be from an overgrowth of regular bacteria in the vagina called bacterial vaginosis if it has a fishy odor. Or it may be from a sexually transmitted infection such as trichomonas or gonorrhea. Whatever the cause, it is best that the discharge is promptly investigated.

It would be helpful if your partner is with you. Not only will he be sensitive to your concerns, he can likewise benefit from counseling and treatment if sexually transmitted infection is diagnosed.

Sincerely yours, Dr. Angela G. Sison-Aguilar

 

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Need help when it comes to feminine health? Dr. Angela is willing to share her expertise with you. For questions regarding feminine health, pregnancy and other Gyne-related matters, just send an e-mail to webmaster@femalenetwork.com!

"What are the common symptoms to ovarian cancer that we must watch out for?"

 
Ovarian cancer is the fifth leading type of cancer among females with increasing incidence in women in their 40s according the Philippine statistics compiled by our Department of Health. Ovarian cancer is quite difficult to detect in the early stages unlike cervical cancer. Hence the case mortality (risk of dying for every case detected) is higher for it even in developed countries like the United States where only one out of five cases are detected early enough to achieve successful treatment (93 per cent survival rate in five years), as observed by the American Cancer Society in 2007.
 
By the time the dreaded symptoms of ovarian cancer are felt, such as abdominal enlargement either due to the tumor or to the fluid within the abdominal cavity produced by the tumor, the cancer is already in the advanced stages.
 
A yearly pelvic exam helps early detection of the tumor. This can be performed by the health provider after a pap smear is performed. A pelvic ultrasound (transvaginal preferably for greater accuracy) can be added if additional funds are available to detect ovarian enlargement or masses not felt by the examiner. The latter is especially more important among women who are overweight or obese, thus making examination difficult. It is also indicated for women who have symptoms such as nearly a month’s persistence of pelvic pain, feeling full or bloated, and/or a frequently urgent need to urinate.

 

'The mortality rate for ovarian cancer is higher than cervical cancer because it is more diffcult to detect'

 
Women at higher risk of having ovarian cancer should visit their health provider annually—these are women above 40, those who have never had children or those who have a family history of breast or ovarian cancer. Blood markers may be requested, such as CA-125. The interpretation of such results, however, should be done by the health provider since there are many conditions that may cause an elevation of CA-125 apart from ovarian cancers alone.
 
Surgery and chemotherapy are the mainstays in the treatment of ovarian cancers. The success of the treatment will depend on the staging of the cancer. It is not known for sure how we can prevent this type of cancer but it will help immensely if we are able to detect it early.