Symptoms To Recognise

There are several symptoms that tell you that you may be experiencing gynaecological problems below are some of the symptoms and what they may mean for you health. If you feel that you may be experiencing one or more of these symptoms please consult your doctor, obsteatrician or gynaecologist for further advice.


They have tiny tubes or ducts that open out into the vulva – the folds of flesh surrounding the vagina. These glands play an important role during sex because during sexual arousal they secrete a fluid that acts as a lubricant in the area.

Infection of the Bartholin’s glands is known as bartholinitis.



  • Intense pain around the vagina (because this area has many finely tuned nerve endings)
  • Swelling of the Bartholin’s glands
  • Abscess or collection of pus
  • A painless cyst may form

Causes and risk factors

Bartholinitis may be caused by a variety of bacteria. Usually, the bacteria are the type commonly found on the skin or in the gut, which cause abscesses and infections elsewhere in the body. These are known as staphylococci, streptococci or coliforms. In this case, you may simply have picked up the bacteria from your own skin surface and for some reason, perhaps some sort of brief and temporary breakdown in your immunity, an infection forms.

But another important cause of bartholinitis is gonorrhoea, which is a sexually transmitted infection. If you’re worried that your boyfriend may have passed on this infection, or if you have other symptoms such as a vaginal discharge, you should see your doctor again to discuss this because you’ll need specific antibiotics and your boyfriend will need to be treated, too.

Your doctor should have taken swabs at the time of diagnosis to determine which bacteria was causing the infection, so he or she may be able to tell you immediately if the infection was sexually transmitted.

Treatment and recovery

Treatment consists of antibiotics, painkillers and warm baths. If an abscess or collection of pus forms (or sometimes a painless cyst), an operation may be necessary to drain the pus and remove the gland.

You can have sex again as soon as sexually transmitted infection has been ruled out (otherwise there’s a risk you may pass it on to your partner) and as soon as you feel comfortable. Don’t worry about lubrication – even if both Bartholin’s glands are scarred or removed there are plenty of other glands in the area producing lubricant fluids during sex.



Endometrial cancer symptoms

The most common symptom is abnormal vaginal bleeding, either after the menopause or between periods. Occasionally, women complain of blood-stained vaginal discharge, lower abdominal pain or pain during sex.

In more advanced stages of the disease, tiredness, nausea, loss of appetite, weight loss, constipation or pain in the back may occur.


Endometrial cancer causes

The exact cause of endometrial cancer isn’t known. However, certain factors may increase a woman’s risk, in particular being exposed to higher levels of the female hormone oestrogen due to various reasons.

Other risk factors linked to endometrial cancer include:

  • Being overweight (fatty tissue converts other hormones into oestrogen)
  • How many times you’ve been pregnant (oestrogen levels are low in pregnancy)
  • The pattern of your periods (starting periods early, frequent periods or a late menopause all increase oestrogen exposure)

Treatment with tamoxifen – a hormonal treatment for breast cancer and infertility – can slightly increase the risk of endometrial cancer as it has the same effect as oestrogen on the womb, as can long-term use of HRT, particularly if it is high in oestrogen content. Most modern contraceptive pills, however, reduce the risk.

A minority of cases are inherited, particularly if a parent is diagnosed with bowel cancer at a younger age. In these cases patients may benefit from genetic counselling.

Endometrial cancer is most common after the age of 50.


Diagnosing endometrial cancer

Your doctor may take a careful history and carry out an internal examination to check for abnormalities in the neck of the womb.

If they are concerned about endometrial cancer, you would be referred to a specialist and seen within two weeks. Further tests, including an ultrasound and tissue sample of the lining of the womb to look for abnormal cells, are recommended.

Screening isn’t routine, although women known to be at high risk with a family history may be offered regular check-ups with ultrasound scans and biopsies of the uterus.

Endometrial cancer treatments

Treatment depends on how far the cancer has spread and the general fitness of the patient. In majority of cases, surgery is the treatment of choice, involving removal of the womb and ovaries, which may be all that is needed.

In selected cases radiotherapy is offered after surgery to reduce the risk of recurrence. Chemotherapy and hormonal treatment is usually used in more advanced cases. The role of chemotherapy, in combination with radiotherapy is tested in clinical trials in women with high risk of recurrence following surgery.

It’s important to know there is very high cure rate after surgery in early stage endometrial cancer.



What is endometriosis?

Endometriosis is said to be present when cells that normally line the womb are found elsewhere in the body, such as the outside of the fallopian tubes, the ovaries and the bladder.

These cells behave in the same way as those lining the womb so, in response to the female hormones, they grow during the menstrual cycle and bleed during a period.


Causes of endometriosis

It’s not known exactly what causes endometriosis, but there are a number of theories.

It may arise because of retrograde menstruation when, during a period, blood flows back towards the fallopian tubes rather than leaving the body in the usual way.

Immune dysfunction may allow endometriosis to develop in those women unable to fight off the endometriosis cells, or metaplasia (the process of one cell type changing into another) may enable endometriosis cells to appear in parts of the body where they wouldn’t normally be found.

It can also run in families.


Symptoms of endometriosis

Symptoms of endometriosis may include painful and/or heavy periods, pain during intercourse, pelvic pain, infertility and lowbackache. But many women with endometriosis don’t get any symptoms at all and are not aware that they have it.

Around 2 million women in the UK are thought to have endometriosis. It’s most common between the ages of 25 to 40. There’s no proven way of preventing it, but some women find that, following pregnancy, they no longer experience any problems.


Treatments for endometriosis

Treatment of endometriosis can be complex and prolonged, especially in more severe disease.

Painkillers and anti-inflammatory medication may be used to relieve symptoms. Treatment may also involve hormonal drugs that suppress ovulation and menstruation, allowing the disease to regress. This is used for women who don’t wish to conceive.

In more severe endometriosis, especially when drug treatments are not proving very effective, surgery may be recommended. For women who still wish to become pregnant, surgical removal of the endometriotic tissue (for example using diathermy or laser) usually with keyhole surgery, may be an option.

For those who have completed their families and for whom non-surgical treatment has not worked, there may be several possible surgical treatments which can help with symptoms, ranging from conservative surgery such as laser treatments to destroy endometriotic deposits in the pelvis to more radical treatments such as total hysterectomy with bilateral oophorectomy (removal of the ovaries) and treatment of visible endometriosis deposits and internal scarring.

Emotional support is very important.




Also known as myomas or leiomyomas, fibroids are firm, round lumps that develop in women of all ages and races. As many as 40 per cent of women over the age of 35 have them. In fact, some research suggests that if you looked hard enough for tiny fibroids, you’d find them in every woman.

In most cases, fibroids are no trouble at all. Although a type of tumour – thought to form from muscle cells in the walls of the womb’s blood vessels – they are benign (they don’t spread around the body or become cancerous). Many women aren’t even aware they have them.



For a number of women, however, fibroids cause significant problems. Possible complications include:

  • Heavy periods (menorrhagia) and anaemia
  • Abdominal pain
  • Bloating – large fibroids can cause a visible tummy bulge
  • Urinary problems – pressure from large fibroids on the bladder can make you feel like you need to go to the toilet more often
  • Painful bowel movements – pressure on the bowel can cause problems such as constipation
  • Miscarriage and premature birth – fibroids are stimulated by high levels of oestrogen and can increase to as much as five times their normal size during pregnancy, getting in the way of a growing baby
  • Infertility – more common among women with large fibroids, possibly because the fibroids interfere with the way the fertilised egg implants into the lining of the womb

Very rarely – in about one in 1,000 cases – a cancer called a leiomyosarcoma may form in the fibroid. Some research suggests these tumours are actually very different from fibroids.


Treatment and recovery

There are a number of treatment options:

  • Hormone treatments – drugs, such as progesterone, can decrease bleeding or shrink the fibroids, but the effects may be temporary. Another group of drugs known as LHRH analogues, which suppress oestrogen production and induce an artificial menopause, may be more effective. There may be risks such as osteoporosis and they obviously aren’t suitable for women who are trying to conceive

A number of different surgical operations to treat fibroids may be offered. These include:

  • Myomectomy – this is an operation to ‘shell’ the fibroids out of the wall of the womb. As the womb itself is preserved, this is an option for women still wanting children. It’s often recommended to women with infertility that may be due to fibroids, although there may be scarring that can aggravate infertility problems. Other complications include serious haemorrhage that can only be stopped by a hysterectomy, and recurrence of the fibroids.
  • Hysterectomy – for many women, hysterectomy is the best option because it removes all chance of the fibroids recurring. But it’s a final step that carries significant risks and may cause an early menopause. Some women find it liberating, while others have problems with depression or lost libido.


  • Endometrial ablation or endometrial resection – this operation destroys the lining of the womb. There are various ways of doing it, including thermal balloon endometrial ablation (which uses a hot balloon to destroy the lining of the womb), rollerball endometrial ablation (using a heated rollerball to destroy the womb) and resection (in which tiny pieces of the lining are removed. The pros and cons of this treatment are not yet proven.
  • Medications such as tranexamic acid or non-steoidal anti-inflammatory drugs eg mefanamic acid, ibuprofen, can help with symptoms of painful,heavy periods but are not treatments for fibroids as such.
  • Uterine artery embolisation (sometimes referred to as UAE or UFE) – this involves blocking the blood supply to the fibroids by injecting tiny particles through a small tube guided by x-ray scans. Research suggests symptoms improve in 60-90 per cent of women, but not enough is known about long-term benefits.
  • Newer treatments including MRI guided percutaneous laser guided ablation or MRI guided transcutaneous focussed ultrasound but these are not yet proven and may not be suitable for all fibroid sufferers.

Which treatment best suits you depends on the size of the fibroids, the problems they’re causing and your individual needs. For example, older women with large fibroids who’ve completed their family may choose a hysterectomy. In younger women still trying to have children, other treatments may be more suitable.

  • If fibroids are diagnosed, don’t fret unnecessarily – they may cause you no problems at all
  • Think carefully before surgery and make sure you choose the right option for you
  • Always report abnormal vaginal bleeding to your doctor

menstrual problems

  • Amenorrhoea. This is the complete absence of periods.
  • Oligomenorrhoea. This is irregular or infrequent periods. Menstruation can occur anywhere between every six weeks and several months.
  • Dysmenorrhoea. Period pains, or dysmenorrhoea, affect 40-70 per cent of women of reproductive age at some time.
  • PMS or premenstrual syndrome. Many women experience physical and mood changes around the time of their period, but for some it can be a particularly difficult time.
  • Menorrhagia This is recurrent heavy bleeding during menstruation. About a third of women describe their periods as heavy. The average blood loss during menstruation is typically about 40ml. With menorrhagia the loss is 80ml or more.

Causes of menstrual problems

Amenorrhoea. If an otherwise normal girl of 16 has never menstruated, this is called primary amenorrhoea. The same diagnosis is given to a girl of 14 who has never had a period if she also fails to show any signs of sexual development, such as breast growth or pubic hair growth.

Secondary amenorrhoea is when menstruation has stopped for over six consecutive months in a woman who has previously had regular periods. Excluding pregnancy as a cause, about 20 to 30 per cent of women experience amenorrhoea for a variable number of months at some time during their reproductive life.

Causes of amenorrhoea include problems with hormonal control from the hypothalamus or pituitary gland (such as under-activity of the gland or a tumour), anorexia and excessive weight loss,depression, excessive stress or exercise, or problems with the ovaries, including:

  • High blood levels of male hormones.
  • Polycystic ovary syndrome (PCOS).
  • Premature ovarian failure.
  • Genetic disorders such as Turner syndrome.

Oligomenorrhoea. This is irregular or infrequent periods. Menstruation can occur anywhere between every six weeks and six months. Many of the causes are the same as those for amenorrhoea.

A common cause is a condition called polycystic ovary syndrome (PCOS). This is a hormonal disorder that affects the ovaries of up to ten per cent of women (or as many as 20 per cent of overweight women). The ovaries have an abnormally large number of follicles – little swellings that develop each month to release an egg.

In PCOS the hormonal changes are complex, including high testosterone levels with associated insulin resistance and abnormal lipid levels. Generally the follicles remain immature meaning that eggs are often not released and the woman rarely ovulates and so is less fertile. In addition to irregular periods, women with PCOS may also have excess body hair and be overweight.

As with amenorrhoea, treatment of oligomenorrhoea depends on the underlying cause and what the woman wants. A woman with infrequent periods may still be fertile and should be advised of this.

Dysmenorrhoea. For about one in 10 women the discomfort and pain of periods is bad enough to interfere with their daily lives. A certain amount of discomfort around the time of ovulation and menstruation is normal, and it has been proposed that it’s related to the movements of the womb and the hormones and chemicals that circulate around the body at that time of the month.

The pain typically occurs in the lower abdomen and/or pelvis and can radiate to the back and along the thighs, lasting somewhere between eight and 72 hours. It may be a constant dull ache or occur as cramps before or during menstruation or both.

Headachesdiarrhoea, nausea and vomiting may accompany it. Sometimes dysmenorrhoea is a sign of an underlying disease.

If there is an underlying disease causing the dysmenorrhoea then this should be treated. Often there will be other symptoms too, such as heavy bleeding or pain or bleeding after intercourse.

The most common diseases associated with dysmenorrhoea areendometriosis and fibroids. Endometriosis is a condition where the cells that make up the lining of the womb are also found in places other than the womb. With each menstruation, this tissue outside responds to the same hormones that control periods and therefore builds up and breaks down and bleeds in the same way as the womb lining. This can lead to inflammation and pain. Fibroids are non-cancerous or benign growths in the uterus. A fifth of women develop them in their lifetime. They can be very small or as big as a melon.

Other less common causes of dysmenorrhoea are previous pelvic surgery and a pelvic infection which can, in some women, lead to significant pain and heavy periods.

PMS. There are more than 150 symptoms associated with premenstrual syndrome (PMS), but the common ones include:

  • Low mood and irritability.
  • Breast tenderness.
  • Bloating.

Typically PMS symptoms appear in the days before a period and cease once menstruation begins. It’s not known what causes PMS but the normal hormonal changes that occur during the menstrual cycle are thought to be involved. PMS severity often increases around hormonal surges, such as puberty and pregnancy. Women aged 30-45 often experience the most severe PMS.

Menorrhagia. Women with menorrhagia may have to use double sanitary protection – towels and tampons – and the heavy bleeding may stop them from doing normal activities because of flooding through clothes, for example. They may also report passing large clots.


Treatment and prevention of menstrual problems

Amenorrhoea. The treatment depends on the underlying cause and what the woman wants. Some women may not view their condition as a problem unless they want to start a family, for example. Conversely, a woman with amenorrhoea may still be fertile and should be advised to use a contraceptive if she doesn’t want to become pregnant.

Oligomenorrhoea. As with amenorrhoea, treatment of oligomenorrhoea depends on the underlying cause and what the woman wants. Again, a woman with infrequent periods may still be fertile and should be advised of this.

Dysmenorrhoea. When there is no underlying cause, simple analgesia with a non-steroidal anti-inflammatory drug such as ibuprofen might be all that is needed. Some women find that going on the combined oral contraceptive pill lessens the discomfort. Others have reported being helped by acupuncture,TENS therapy (a painless way of stimulating the nerves using pulsed energy) or a hot water bottle applied locally to the area of discomfort.

Endometriosis can be treated with hormones or surgery to shrink or remove the problematic tissue, with variable success.

PMS. Lifestyle approaches ranging from diet and exercise to stress management may help. Drug treatments may also ease the symptoms. These include hormonal contraceptives and more potent hormonal drugs. Some may prefer to try non-hormonal alternatives such as vitamin B6 and evening primrose oil or diuretics.

Menorrhagia. In most cases no cause can be found. However, there may be an underlying cause such as endometriosis or fibroids. It’s important to investigate the bleeding and check that it’s not due to something more sinister like cancer of the uterus or cervix.

The treatment depends on the cause. The bleeding can often be reduced with non-hormonal tablets (for example tranexamic acid), oral contraceptives, or by fitting a progesterone-releasing contraceptive coil into the womb, if there is no underlying problem that needs treating. If these don’t work, a woman might want to consider surgery to remove the uterus completely or have the womb lining stripped. She may also need to take iron or folic acid supplements if the blood loss has made her anaemic.



ovarian cancer

Ovarian cancer can occur at any age, but is most common after the menopause. Diagnosis at an early stage greatly improves your chances of recovery.

Nearly 5,500 women are diagnosed with cancer of the ovary every year in the UK. As doctors have realised there are often warning symptoms, although these may be vague and wrongly attributed to other problems, methods of screening women for early signs of the disease are being evaluated. When the disease is caught early, survival rates are much higher, with over 95 per cent of women diagnosed in stage one disease being alive five years later, although the particular type and severity of the cancer are also important factors.

There are several different types of ovarian cancer, but by far the most common – accounting for 90 per cent of cases – is epithelial ovarian cancer, or cancer of the surface layers of the ovary.


Symptoms of ovarian cancer

For women with ovarian cancer in its early stages, symptoms are usually vague, especially in the early stages. It was previously said many women had no symptoms and that the disease went overlooked until it was discovered by chance. In fact, when questioned carefully, many women admitted things weren’t quite right, particularly with gastrointestinal or urinary symptoms, for three to four months before they were diagnosed.

These early symptoms may include:

  • Bloating, pelvic or abdominal pain (especially in the lower abdomen or side)
  • Difficulty eating or early satiety (feeling full very quickly)
  • Urinary urgency or frequency
  • Loss of appetite or weight loss
  • Swelling or pain in the abdomen
  • Pain during sex
  • Constipation
  • Irregular periods

In the advanced stages of disease, there may be loss of appetite, nausea, weight loss, tiredness and shortness of breath. It is infrequent that an obvious symptom such as bleeding from the vagina is present.

Women who develop any of these symptoms, especially if they persist, should get them checked by their GP.


Diagnosing ovarian cancer

A doctor examining for the signs of ovarian cancer will carry out a full pelvic examination, feeling for the presence of an abnormal lump. However, it’s only as a tumour grows and spreads that the symptoms become clearer and the problem easier to diagnose.

Your GP may request some tests, including:

  • Blood tests
  • Ultrasound
  • Laparoscopy – keyhole surgery to look at the ovaries, fallopian tubes and uterus. A biopsy, which means a small piece of tissue is taken from the ovary, will also be done
  • Chest x-ray to check for spread of the cancer into the lungs
  • CT or MRI scan, also to look for any possible spread

If any problems are suspected with the digestive system, an endoscopy will be arranged, to look at the stomach, or a colonoscopy, to look at the lower bowel. If there is a lot of fluid within the abdomen due to ovarian cancer, the consultant will do an abdominal tap, which allows some of the fluid to be drawn off under a local anaesthetic and then the fluid examined under a microscope for cancer cells, or drained off to make the patient more comfortable.

Screening is currently only offered to those at high risk, for example because of a family history, although positive preliminary results of a large UK ovarian cancer screening programme trial were published in March 2009.


Ovarian cancer causes

Scientists don’t yet know what causes ovarian cancer, but some factors are known to increase the risk.

The most important is family history, because the faulty genes that increase the risk of ovarian and other types of cancer can be inherited. In particular you may be at increased risk and offered screening if you have close relatives (sibling, parent or daughter) who’ve had one of the following types of cancer –breastcolonprostate or endometrial (lining of the womb).

Women who have never had a child also run an increased risk of ovarian cancer and the risk increases for women over 50. In addition, women who have previously suffered from breast cancer are twice as likely to get ovarian cancer in the future.

The risk may also be related to how many eggs the ovary releases. Each time an egg is released (ovulation) the surface of the ovary breaks open and the cells on the surface divide to repair the damage, increasing the chances of a tumour developing.

Having children and breastfeeding may reduce the risk, as may taking the contraceptive pill (as it prevents ovulation). Other possible risk factors include fertility treatment, a high-fat diet and being obese.


Ovarian cancer treatments

Surgery is almost always the first treatment a woman with ovarian cancer undergoes. This normally involves removal of the ovaries, the womb and the fallopian tubes, which link the two. Usually both ovaries are removed, unless the patient has only a slow-growing cancer in one and wants her fertility to be preserved. The surgeon cannot always be sure that all the cancerous cells have been removed, so chemotherapy is almost always given as well, to kill any which remain in the body.

However, treatment will depend on your general health, the type of cancer, how far it has spread and the severity or grade of the cancer.

Many cases will continue to respond to multiple courses of chemotherapy. Chemotherapy can be given after surgery, or beforehand in selected cases. Radiotherapy is used occasionally to kill cancer cells in the pelvic area. Ongoing trials are studying hormone treatments and biological therapies.

Many factors increase or reduce the woman’s chance of beating ovarian cancer. The main one is the spread of the disease – if caught early, as with many cancers, it’s much more treatable, particularly if only one part of one ovary is involved. If the cancer involves a whole ovary, both ovaries, or has spread to involve other tissues, the chances of a cure are reduced.

Also important is the type of ovarian cancer – some affect the cells which line the womb, whereas some affect the cells which produce eggs. Both have different cure rates.

Overall the quality of life of ovarian cancer patients has improved considerably over the last ten years.

You may want to have a look at Macmillan’s OPERA tool. This online risk assessment program has been designed to give information about your hereditary risk based on the your personal and family history of breast and ovarian cancer.



pelvic prolapse?

As the muscles, ligaments and supporting tissues in the pelvis become weaker, they are less able to hold in the organs of the pelvis such as the womb (uterus) or bladder.

Gravity pulls these organs down and, in the more severe cases, may appear through the entrance to the vagina.

A variety of problems can occur, depending on where the weakness lies and which organs are able to descend, but in every case there is some degree of prolapse of the vaginal wall, which begins to invert (rather like a sock turning inside out).

  • Prolapse of the womb or uterus is the most common prolapse, affecting as many as one in eight older women to some degree
  • Prolapse of the bladder, known as a cystocele, is less common.
  • Prolapse of the urethra (the tube that carries urine out of the bladder) is known as a urethrocele.
  • Prolapse of the intestines is quite rare, and known as an enterocele or rectocele.

Some experts say up to 50 per cent of women who have had more than one child will eventually develop a prolapse .


Causes and risk factors

Several factors make a prolapse more likely. They include:

  • Age: prolapse is rare in young women. As a woman passes the menopause and levels of the female hormone oestrogen decline, the supporting tissues of the pelvis can lose their elasticity and strength very quickly.
  • Pregnancy and childbirth: this is one of the most important risk factors for prolapse. Pregnancy stretches and strains the tissues of the abdomen and pelvis. Then during labour and delivery of the baby, the pelvic floor is stretched as the baby passes through. Trauma, tears or lacerations during delivery compound the problem.
  • Genetics: research has shown that younger women who develop a prolapse have up to 30 per cent lower levels of collagen (the fibres that form the internal scaffolding of the tissues). This suggests there may be a genetic predisposition, and it certainly seems to run in some families. It is also more common in certain inherited conditions such as Marfan’s syndrome and Ehlers-Danlos syndrome, where there’s abnormal collagen production.
  • Muscular defects: uterine prolapse can occur very occasionally in tiny babies who have a weakness of the pelvic muscles or problems with the nerve supply to the area.
  • Wide pelvic inlet: this is the round gap in the base of the pelvic bones, through which the baby passes during birth and women with this are more at risk because the tissues bridging the gap have to work even harder to hold the organs above in.
  • Chronically increased pressure inside the abdomen: due to obesity or lung disease, for example, helps push the organs down and out.


Symptoms depend on which tissues descend, and how severe the prolapse is.

They may include:

  • A sense of heaviness or pressure in the pelvis.
  • The appearance of a bulge of tissue in the genital area, which can be quite alarming, and is often red and sore.
  • Urinary problems, such as having to urinate more frequently, feeling the need urgently, being incontinent (losing control of the bladder) or, conversely, being unable to pass urine when you need to.
  • Pain in the pelvis or lower back.
  • Sexual problems, including pain and decreased libido.
  • Constipation.
  • Vaginal discharge or bleeding.


Women need to be aware of the risks of prolapse and the steps they can take to avoid it, including maintaining a healthy weight, eating plenty of fruit and vegetables to avoid constipation, and learning correct lifting techniques.

There are also specific exercises to keep the pelvic floor muscles strong, sometimes known as Kegel exercises. For example:

  • Empty your bladder fully and then, while still sitting on the toilet, practice squeezing your pelvic muscles as if you were trying to stop the flow of urine (don’t do this while actually urinating as it can cause a potentially harmful backflow within the urinary system).
  • Practise holding specially designed weighted cones within the vagina.
  • Once you have some awareness of the ‘feel’ of the pelvic floor muscles, repeatedly contract them (but not the gluteal or buttock muscles) 50 to 200 times a day for a few seconds at a time.
  • Some women find it hard to become aware of, and so exercise, their pelvic floor muscles. There are a number of devices that can help. These are put in the vagina where they either mechanically or electrically trigger the muscles to contract automatically. They are fairly simple to use, very discreet and have been shown to improve continence.

You can get expert advice on pelvic floor exercises from a physiotherapist, who’ll be able to teach you the techniques involved. Your GP may be able to refer you to one, or to a local incontinence clinic where the nurses are also trained on this issue.

It’s also important to aim to minimise trauma to the pelvic tissues during childbirth. Some physiotherapists and also some midwives specialise in teaching women how to strengthen their pelvic floor muscles before giving birth, and retrain them after the stretching of the tissues that occurs during delivery of the baby.


Treatment and recovery

Once a prolapse has developed, surgery to fix the affected organs is usually the only way to cure it effectively.

However, another option is to use a device known as a vaginal ring pessary. This is rather like a contraceptive diaphragm or cervical cap. It’s made of silicone or latex, and placed in the vagina to push back the prolapsed organs and hold them in place. Many women happily manage their prolapse this way.



polycystic ovary syndrome?

PCOS is a complex condition. Abnormal control of hormone levels result in tiny cysts developing in the ovaries, and eggs may not be released regularly.


Some women have no symptoms. Most, however, will have irregular periods or no periods at all. Often women with PCOS find it hard to get pregnant. The abnormalities in hormones can cause many other problems too:

  • Acne and excessive body hair (hirsutism) may develop as a result of increased testosterone levels, and some women develop male-pattern balding.
  • Women with PCOS often gain, and find it hard to lose, weight – more than half are overweight, usually with central or apple shaped obesity which is particularly linked to diabetes andheart disease.
  • High blood pressure.
  • A symptom, thought to be linked to insulin resistance is a diffuse velvety thickening and pigmentation of the skin, especially around the neck, armpits, groin, below the breast, and of the elbows and knuckles, known as Acanthosis nigrans.
  • Many suffer embarrassment because of their appearance, and can become socially isolated and depressed.

Causes and risk factors

The precise cause of PCOS is uncertain. Genetics may play a part as it often runs in a family but other factors are important too.

Women with PCOS have abnormalities in the production and metabolism of female and male sex hormones such as oestrogen and androgens, which can lead to raised levels of the male hormones in some. These abnormalities disrupt the activity of the ovaries which become enlarged, with a thick outer capsule beneath which cysts may form (these cysts result from problems with egg production and release).

There is also a lack of sensitivity to the hormone insulin (known as insulin resistance) which controls blood sugar levels. As a result the body pumps out high and higher amounts of insulin, which in turn causes raised levels of blood fats and an increased risk of thrombosis.

Being overweight aggravates this situation, so it can become a vicious circle – women with PCOS are especially likely to put on weight and this worsens the condition, so they put on more weight.

Around five to ten per cent of women have the syndrome. It develops during adolescence with the onset of periods.


Treatment and recovery

Being overweight increases the risk of developing symptoms, so women are advised to determine their ideal weight and maintain it.

Losing just five to ten per cent of body weight may be all that’s needed to correct the hormonal imbalance, thus restoring ovulation and fertility, and helping improve acne and hirsutism.

Hormone therapy is also used to regulate periods, and treat acne and hirsutism.

Other treatments include standard acne treatments and methods to remove excess facial and body hair, such as electrolysis.

Newer treatments include a drug called metformin that counteracts insulin resistance. Although this is not yet licensed, doctors can prescribe it if they feel it’s appropriate. There is also research underway into ovarian surgery.

uterine polyps?

These are soft, red, fleshy tumours of the endometrium (the lining of the uterus or womb).

They vary in size from 1cm – when they contain only endometrial tissue – to 5cm. Larger polyps often contain not just endometrial cells, but also muscular and fibrous tissue from deeper in the wall of the womb.



Polyps are prone to bleeding. Often, the first clue to their existence is bleeding between periods.

Polyps may lie flat against the inside of the womb or be pedunculated, which means they form on the end of a ‘stalk’ of flesh.

Pedunculated polyps sometimes hang down through the cervix, where they may become trapped, cutting off the blood supply (known as strangulation). In this case they may bleed profusely and be painful.


Treatment and recovery

Surgery is usually recommended for polyps, for several reasons:

  • To establish the diagnosis – this is usually done by curettage (scraping out the womb) and examining the tissue in a laboratory. Larger polyps may be missed. Other diagnostic techniques include hysteroscopy (where a thin telescopic device enables the surgeon to look inside the womb) or a hysterogram (a special X-ray of inside the womb).
  • To rule out malignant cancer – most polyps are benign (they just grow larger where they are within the womb and don’t spread or invade other tissues), but it’s essential that some of the tissue is removed (a biopsy) to make sure it’s not malignant as occasionally endometrial carcinoma can form as a polyp.
  • To cure irregular bleeding, by removing the polyp.
  • To try to improve fertility. Polyps may interfere with implantation of a fertilised egg in the lining of the womb, so they’re often removed in an attempt to raise the chances of conceiving.

While polyps can occasionally be biopsied under local anaesthetic, most surgeons recommend that they’re examined and treated under general anaesthetic, especially if a curettage is to be performed as this procedure can be uncomfortable uncomfortable and the surgeon can make a more detailed examination under anaesthetic.

If you’re worried about a general anaesthetic, ask whether the biopsy can be carried out under epidural. However, a general anaesthetic may be better especially as, with modern anaesthetic drugs, recovery is very swift.



In most women with the condition, the appearance of the vulva is normal and the problem lies with the nerve fibres. Although the pain may be felt inside the vagina, the problem’s actually on the outside.

The sensory nerve endings appear to become so sensitive that even light touching of the skin triggers an unpleasant and painful sensation.


The most common symptoms are burning, stinging, irritation, aching or rawness of the genital area. The pain may be constant or it may only occur intermittently – when the vulva is touched, for example. The pain may also be felt around the urethra, back passage, tops of the legs and inner thighs.

Each woman can have different symptoms, with varying degrees of severity.

As with most chronic pain conditions, vulvodynia adversely affects quality of life. Not only can it prevent women from engaging in and enjoying sexual activity, but daily activities may also be impaired. Some women with vulvodynia are unable to exercise, for example, or drive a car. For some, even sitting becomes a challenge.

When a condition has a detrimental impact on work, family and social life, low self-esteem, poor self-image and depression often develop. This can exacerbate the symptoms, dragging the woman into a negative downward spiral.

Causes and risk factors

No definite cause has been established, which means it’s difficult to prevent it. Some theories are that thrush or skin irritation from soaps and bubble baths may trigger it, but what’s clear is that vulvodynia isn’t infectious or related to cancer.

It’s estimated that up to 15 per cent of women suffer with vulvodynia. It can affect women of any age, although it’s more common in younger and middle-aged women. It’s more common among women with sensitive skin or who are stressed, or after having a baby.


Treatment and recovery

A number of different approaches may be tried before vulvodynia is treated successfully.

The drug amitriptyline (most commonly used as an antidepressant but also used to treat pain) has been found to be the most effective treatment. There are several other treatments available, including other antidepressants and anticonvulsants used to treat painful conditions.

Improvement is usually gradual and it’s important to acknowledge that it may take months. Applying creams, lotions and gels (for example, anaesthetic gel) to the vulval area can help, as can using lubricants during intercourse.

If depression is present, this can be treated with counselling and/or antidepressant medication.

Pain and/or stress management counselling are usually recommended.

The following advice may help to relieve symptoms and prevent recurrent episodes:

  • Wear cotton underwear and loose-fitting trousers or skirts
  • Avoid scented toilet paper, bubble bath, feminine hygiene products and perfumed creams or soaps
  • Avoid or limit exercise that puts direct pressure on the vulva, such as cycling, or anything that causes friction in the vulval area
  • Don’t sit for prolonged periods, or use a rubber ring to relieve pressure
  • There is no evidence to suggest that dietary changes such as low oxalate diets or anti-candidal diets help in vulvodynia.
vulval cancer?

Cancer of the vulva – the external opening of the vagina – is considered uncommon. It mostly affects women over the age of 50, although it’s becoming more common in younger women.


Vulval cancer symptoms

The symptoms of vulval cancer may include:

  • Itching, burning and soreness around the vulva
  • A lump or sore visible on the skin
  • Pain or soreness in the area around the vulva
  • Bleeding or discharge
  • Pain or burning when you pass urine

Any of the symptoms listed above can also be associated with other non-cancerous conditions. If you do have any of these symptoms, you should talk to your doctor.

Vulval cancer causes

The cause of vulval cancer has yet to be pinpointed, but some of the suggested causes include:

  • Vulval intra-epithelial neoplasia (VIN), a pre-cancerous change in the skin of the vulva. It isn’t cancer, but it can progress to cancer (although most cases won’t). The most common symptom is itching. Areas affected by VIN may appear swollen, with thicker areas of skin and red, white or dark-coloured patches.
  • The human papilloma virus (HPV) is thought to cause three or five out of 10 cases of vulval cancer. HPV is passed on through sexual activity. There are many kinds of HPV and some are considered more high risk than others. (The types that cause genital warts are only rarely linked to genital cancers, so genital warts aren’t a risk factor for vulval cancer.) The first sign of high-risk HPV infection is often a pre-cancerous change in the surface or mucosa of the affected area. You can find out more about this condition fromMacmillan Cancer Support.
  • Some chronic skin conditions and inflammation are thought to be associated with an increased risk of developing cancer of the vulva. These are lichen sclerosus (also called lichen sclerosis), lichen planus and Paget’s disease.
  • Smoking may increase the risk of developing both VIN and cancer of the vulva.

Diagnosing vulval cancer

Your GP will refer you to a specialist and may arrange for you to have blood tests.

An examination will be performed to identify any abnormal areas of tissue. An internal examination will also be carried out to check the vagina and cervix for any abnormalities. A biopsy will be taken to establish a diagnosis.


Vulval cancer treatments

The treatment options will depend on the type of cancer and its position and size.

Surgery is the main treatment for cancer of the vulva.Chemotherapy and radiotherapy may also be required.

Advice and support


(information sourced from the bbc website


  1. Hi,
    I have been for a test today which was to involve taking a sample from my womb, however the consultant was unable to pass the tube through my cervix. have you any ideas why as he didn’t actually say? I had a scan and all that was said was that my ovaries seemed okay?

    Any help appreciated.

    • Hello

      Really sorry for the late reply I hope we aren’t too late to help you!

      Sometimes it can be due to the way you cervix lies as it may be tilted or quite far back which can make it difficult to reach, Alternatively it may be that there is something blocking it however if this were the case they would carry out a scan to determine the cause of the blockage and if any further action is needed.

      Did you have an ultrasound or any further tests?

      I hope all is well!

  2. Can I just say what a relief to find someone who actually knows what theyre talking about on the internet. You definitely know how to bring an issue to light and make it important. More people need to read this and understand this side of the story. I cant believe youre not more popular because you definitely have the gift.

    • Thank you for your comments i really appreciate them. We are not medical professionals just young women with experiences and anything we can do to raise awareness and help other young women is a step towards saving another life and helping make positive changes to reproductive health education. I am glad you like what we are doing here. Keep your eyes peeled for our upcoming website changes and opportunities!!!

      Love The WombRoom xx

      • I used to take prescription pills (little evesnpixe green ones) but then I got used to them, and had to keep taking more and more.sometimes I’ll take ibuprophen, but from June to October of this year I was on blood thinners for a problem with clotting so I couldn’t take anything for them. The pain is pretty bad. I was home all day again this past Saturday not being able to move because of the pain. I caved and took some ibuprofin and the pain went away.

        • Taking pain killers is good to prevent discomfort but all things in moderation. Ibuprofen are well known anti-inflammatories and are often highly effective.

          If you feel as though this pain is unbearable and could possibly be an underlying sign of further problems I would encourage you too seek the required medical help as soon as possible.

          Kind Regards

  3. I like this weblog very much, Its a very nice place to read and receive information. “People can have the Model T in any colour–so long as it’s black.” by Henry Ford.

    • my cramps well peiord suckx in general i egt sick from it like 2day i got these heat waves then i ended up gaging and i was in so much pain i was on the floor crying cause of the pain it suckx im going to get a physical and get put on the pill cause my peiords are weird i’ll get it then i wont get it again 4 like 3 months which is weird so i need to be put on the pill and im not sexualy active at all im a virgin

      • Hey as we’re not doctors we cannot give you medical advice but woman to woman and as a sufferer of infrequent periods I would say going on the pill is a good way of regulating periods so you know when they will come but it also changes hormone balances within the body and can cause other changes such as breast tenderness, weight gain, weight loss and acne.

        In terms of your pain i would seek further help and investigation into this as it may be a sign of something underlying !

        Let us know how things go

        Lots of Love

  4. The ideas you provided here are quite valuable. Rrt had been such an entertaining surprise to see that waiting for me after i woke up today. They are often to the point and easy to learn. Thank you so much for the valuable ideas you have shared above.

  5. A wonderful job. Super helpful infromtaion.

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