Facts and Recent Updates - Women Specialist Centre

Coming soon-Urine test to detect HPV

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Time for some cold hard facts: if you’re sexually active, there’s a very high likelihood that you have HPV, an infection “so common that nearly all sexually active men and women get it at some point in their lives,” the Centers for Disease Control and Prevention (CDC) says. While the vast majority of HPV infections go away on their own, specific high-risk strains can cause cervical cancer.

That’s why women get Pap smears, a procedure that tests for cervical cancer among women. Part of the procedure is collecting cells that are then tested for strains of HPV (as well as many other things). It’s not exactly pleasant or popular, and some women avoid them altogether. But there may be an alternative, according to a new meta-analysis published in the BMJ.

The analysis looked at 14 studies suggesting the possibility of diagnosing HPV by identifying HPV DNA sequences. The research showed that urine HPV tests had an overall sensitivity — the proportion of positive results identified — of 87%. Urine tests were also 94% correct in identifying negative tests. Compared with cervical samples collected during a Pap, urine tests had a 73% overall sensitivity in correctly identifying positive high-risk HPV strains 16 and 18 and had a 98% specificity for identifying negative test results.

The results don’t yet offer bottom-line advice; since each study was relatively different, the authors suggest that urine tests may be an option for women who do not partake in consistent cervical screening or who live in countries where self-sampling may be simpler and more cost effective.

Researchers concluded from the studies they analyzed that urine tests for HPV have good accuracy, though more research is needed to confirm how they could be used in clinical setting.

Common Health Conditions that Affect Women

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Common Health Conditions that Affect Women
August 20, 2014 Women

Over hundreds of years, the female form has been seen as a figure of perfection in art and sculpture but in the everyday world, a woman’s body usually becomes the cause of a lot of stress and worry. So, what can women do to care for themselves in the long-term?

There is no magic cure for female ailments and this is why efforts to improve general well-being is so important. The key is to have awareness and to lead a healthy, fulfilling lifestyle that works for you.

Consultant obstetrician and gynaecologist at the OBGYN Women’s Specialist centre in Subang Jaya and senior lecturer at Monash University School of Medicine, Dr. Sharad Ratna, reveals details on some of the most common women’s health conditions.

Menopause, which is the time in a woman’s life when she stops ovulating as well as perimenopause which is the transition phase leading up to it, can be a rollercoaster ride. It’s not a walk in the park for many women mainly due to two points: the impact of symptoms on quality of life and an increased risk for certain conditions like heart disease or osteoporosis which can also be due to age.

For troublesome symptoms, hormone replacement therapy (HRT) can be considered for short-term relief over a period of one to two years. Dr. Sharad explains, “In the short term it has been found to be beneficial for early symptoms like hot flushes, night sweats and dryness.”

Another option is to take plant estrogens found in food sources such as soy, black cohosh or red clover. Every woman manages menopause in a different way, some through lifestyle measures alone. Moreover, the balance of risks and benefits for treatment options such as HRT varies for each individual.

Cool tips for hot times

Stress and anxiety relief: Meditation, yoga, swimming, taking up a new hobby or interest.
Be active in the day and get up at around the same time each day so that it’s easier to fall into deep sleep at night. Your bedroom should be dim, quiet and cool to quell those sleep disturbances.
Use a vaginal moisturizer or vaginal estrogen for dryness.

Breast Cancer
While not exclusive to women, breast cancer is the most common cancer for women, globally. Genetic factors, family history and reproductive factors like getting your period early or your menopause late are some of the known risk factors. Early detection is crucial to improving survival rates.

Breasts of all shapes and sizes need to be cared for in order to stay healthy. Dr. Sharad shares the following tips for women:

• A monthly breast self-examination.

• Clinical breast examination by a gynaecologist or breast specialist

• Ultrasound scanning of the breast on a yearly basis.

• Women aged 50 and above should get mammograms every 2 years and women below that age should talk to a doctor on how often to have a mammogram.

Breast Self-Examination
If you’re still menstruating, arrange your monthly self-examination for a few days after your period has ended. Here’s how to go about it:

1. Mirror: Observe your breasts for any swelling, puckering, dimpling or other unusual changes, first with your hands on your hips, then clasped behind your head. Squeeze the nipples to detect any discharge.

2. Shower: While standing in the shower, run your finger pads over each breast in a circular motion (the size of a coin) to detect lumps. To ensure the entire breast is covered, slowly move your hand up and down from above to below the breast or in concentric circles from the outer edge to the nipple. Vary the pressure of touch for different tissue thicknesses.

3. Lying down: Lie down with a towel or pillow under one shoulder so that your breast is evenly flattened out. Repeat the steps taken in the shower.

Polycystic Ovarian Syndrome
Polycystic ovarian syndrome is a disorder where ovulation is chronically irregular or absent, as regulatory hormones fail to cyclically rise and fall and excessive androgens are produced in the body.

According to Dr. Sharad this is one of the causes of irregular periods. Weight management is highly recommended for women who are overweight and having irregular periods. The birth control pill is used for long-term management, which Dr Sharad says is also “fantastic for long-term prevention of ovarian cancer, endometrial cancer and benign breast disease”.

Endometriosis involves the tissue lining the uterus — endometrial tissue — growing outside of the uterine cavity. They remain functional and sloughs off as tissue and blood and cause inflammation, scarring and pain in the pelvic area.

Sexually Transmitted Infections (STI)
Douching “does not prevent sexually transmitted infections or pregnancy”, explains Dr. Sharad. Good bacterium that normally reside in the vagina keeps the environment acidic, a protective barrier against infection by ‘bad’ bacteria. Any disruption to this effect of normal flora crowding out ‘bad’ bacteria decreases protection against sexually-transmitted infection (STI).

Having a sexually-transmitted infection like genital herpes, Chlamydia or Gonorrhea increases the risk of acquiring HIV (human immunodeficiency virus) because of breaks or inflammation of the genital tract lining and skin.

Safer Sex Practices
• Both you and your partner may choose to undergo STI testing to know your status.

• Always use a condom during vaginal or anal intercourse. A dental dam or cut-open condom can be used to prevent direct contact during oral sex.

The most effective method of preventing STI’s is to abstain from having vaginal, oral or anal sex.

Pelvic Inflammatory Disease
Pelvic inflammatory disease is an infection of the upper genital tract that could involve parts such as the ovaries, endometrium, uterine muscular wall and the lining of the pelvis below the abdominal cavity. The main risk factors are failing to observe safe sex practices and contracting sexually-transmitted infections.

Cervical Cancer
Cervical cancer is mainly caused by persistent infection of high-risk types of human papillomaviruses. Many sexually active men and women can get infected with HPV, which mostly clears up on its own but not always. Safe sex practices, including the use of condoms and having a mutually monogamous relationship, are strongly advocated. Precancerous cells in the cervix are detected through the Papanicolaou test, also known as a pap smear.

Stress Urinary Incontinence
Stress incontinence is triggered by actions that cause the pressure in the bladder to exceed the limit at which urinary sphincters are closed. Underlying weakness in bladder control muscles can be improved by regular pelvic muscle exercises. Weight management and quitting smoking will help control the frequency of episodes.

Pelvic Floor Exercises
Incorporate a set of each into your daily routine, three to four times a day.

• Slow contractions: Sitting or lying down with knees bent, pull in your pelvic floor muscles slowly and hold the contraction for as long as you can. Rest for 4 seconds before repeating for a set of 10 slow contractions.

• Quick contractions: Practise pulling in your pelvic floor muscles in quick succession, holding it in for just 1 second before relaxing.

Ovarian Cancer
Unlike cervical cancer, no screening tool exists for early detection of ovarian cancer. However, recurring symptoms to watch out for include persistent bloating and increased size of the abdomen, pelvic and abdominal pain as well as urinary urgency. Ovarian cancer, is more common in older women, and may spread to other sites in the body if not treated early on.

High Blood Pressure and Diabetes During Pregnancy
Towards the later stages of pregnancy, gestational diabetes can develop when, the pregnant woman’s body fails to moderate high blood glucose levels. Women with untreated gestational diabetes risk getting pre-eclampsia which is defined as high blood pressure after the 20th week of gestation with protein detected in urine, a condition that may necessitate induced delivery of the baby.

In a Nutshell…
“The general take-home message is that you have to have a good lifestyle. It all comes back to that,” says Dr. Sharad, who also emphasises the importance of exercise, a healthy diet, not smoking, and avoiding excessive alcohol consumption as well as practising safe sex.

Stress management and spirituality — on top of what is mentioned above — lowers the risk of getting other diseases common in women too such as colorectal cancer, depression and dementia.

Self-Care Know-How
1. Always write down concerns or questions you want to ask your healthcare provider in a personal notebook with your health management plan and list of current medications or supplements, if any.

2. Ask for professional support and guidance in implementing lifestyle or behaviour changes that you can’t handle on your own to set out an action plan or “contract”.

3. Knowing how to deal with personal stress or who to reach out to your support network sets the foundation for a healthy outlook, enabling you to focus on the next steps you can take

the Fertility Files

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12 Smart, Simple Strategies to Boost Your Fertility
August 20, 2014 Fertility

Trying to bring a child into this world is an emotionally trying process at the best of times. It gets even more stressful when a woman finds it difficult to conceive. It takes one year of unsuccessful attempts to conceive, for a couple to be medically assessed for infertility.

About half of the couples, who cannot conceive within a year, usually succeed the following year if they keep on trying. This is because, it is not unusual for women to take up to two years to fall pregnant .

Barring any underlying medical causes for infertility, what can you and your male partner look out for, to improve the chances of conceiving?

Keep a Lid on Stress
Far from being a buzzword, stress has acute and chronic effects on your body, especially over time. Finely regulated reproductive hormones can be thrown out of whack when your body is stressed. While it is understandable that trying to conceive can be stressful it is important to keep in mind that this stress can have unintended adverse effects on the likelihood of conception. Meditation, deep breathing, guided imagery and yoga can all help reduce stress.

Establish a Fertile Window
Your chances for successful conception are boosted when you know when your body is ovulating, that is the cycle when a mature egg is released from your ovary. Since sperm can last for up to a few days in the uterus and fallopian tubes, plan for regular unprotected sexual intercourse during this time period.

Contrary to popular belief, not all women can expect to ovulate on day 14 of their menstruation cycle. The key is not to stress out over precise calculation and arrangement. One way to track your fertility pattern is to measure basal body temperature (the lowest temperature attained by the body during sleep) upon waking every morning using a special thermometer — which is not surprisingly called a basal body thermometer.

This thermometer can detect a small rise of 0.3˚C or 0.4˚F. This spike occurs after ovulation. Start on the first day of your menstrual period and plot the measurements on a chart. You are most fertile two to three days before ovulation and 12 to 24 hours afterwards. Alternatively, you can roughly subtract 14 days from the length of your menstrual cycle to estimate the day of ovulation.

Have Fun and Do it Often
While it seems too obvious, hectic work and lifestyle (with baby planning on top of everything else) can get in the way of enjoying the experience. Becoming parents really doesn’t boil down to being scientific or micromanaging every little aspect of your life, which is likely to stress you out instead. So, whether it’s once a day or two to three times a week, take the time to relax and have it your way. For men, it’s a myth that frequent ejaculation decreases male fertility, and there is evidence that sperm concentration and motility remains normal. A renewed supply of semen is likely to increase the chance of fertilising the egg.

Stub it Out
Both active and passive smoking contributes to infertility, being associated with increased abnormalities in the egg and sperm, reduced reproductive function in women and lowered sperm count and motility in men. Women who smoke accelerate the rate of egg loss and may have menopause a few years earlier than non-smokers. Furthermore, a smoke-free household is crucial as exposure to tobacco smoke is associated with Sudden Infant Death Syndrome (SIDS) in babies. Smoking cessation takes time and willpower (and often a few tries) so ensure you or your partner have sufficient resources and support before setting a quit date.

Drink Less
Wine or beer or ‘hard’ liquor, whichever form of alcohol you consume, may disrupt hormonal regulation of the reproductive cycle and make it harder to conceive. The safest option is to avoid alcohol altogether if you’re trying for a baby or if it’s not possible to abstain from alcohol, limit consumption to one to two standard drinks once or twice a week. For men, excessive alcohol consumption may affect libido and sperm quality in the short term. Pregnant women should not drink alcohol at all due to the risk of permanent harm to the developing fetus.

Screening for STI
Get tested for sexually transmitted infections first, ideally before having regular unprotected sex with your partner. Chlamydia and gonorrhoea are often asymptomatic, if untreated, may lead to pelvic inflammatory disease (PID) and other upper genital tract infections, which can cause infertility. Moreover, vaginal discharge caused by infections or sexually transmitted diseases can hinder sperm entry and survival.

While not based on scientific evidence per se, there is no harm in taking up yoga to reduce stress and help you cope better. Practising yoga improves blood flow and releases tension from your body. However avoid poses that cause you strain or tightness.

Caffeine Consumption
Chugging down more than five cups of coffee a day or the equivalent in caffeine consumption is linked to decreased fertility. Moderate caffeine consumption of one or two cups of coffee a day appears to be fine for fertility and pregnancy.

Be Discerning with Lubricant Use
Vaginal lubricants can damage sperm and decrease its motility, stopping the sperm from reaching cervical mucus conducive to its survival. Try ramping up foreplay instead or simply using warm water. Polymer-based lubricants purported to be sperm-friendly is another (pricier) option.

Avoid Anabolic Steroid Use
The use of steroids to build muscular form in the long term leads to testicular shrinkage and infertility. Testosterone is an anabolic steroid which is naturally produced but are also taken in the form of synthetic derivatives by body-builders. Accumulated in the body, it suppresses hormonal signals that stimulate natural production of testosterone and sperm. The effect on sperm production is usually reversible but may take months to reverse.

Maintain a Healthy Weight
Among other risks to health, both obese (BMI of over 30) and underweight women (BMI under 19) can experience an increase in the time to successfully conceive. If you carry excess weight into pregnancy, complications during pregnancy such as gestational diabetes or hypertension can result in harm to you and/or the baby.

Eat Well and Live Well
Practising a healthy lifestyle is crucial as there is still insufficient evidence for special ‘fertility diets’ that purportedly boost fertility. If you have ovulatory dysfunction, for example, in polycystic ovarian syndrome, leading a balanced lifestyle can improve your chances of success. Stick to the principles you know. Data from a large observational study highlights the benefits of avoiding trans-fat and soft drinks as well as the consumption of proteins and iron from plant sources, unsaturated vegetable oils, complex carbohydrates rich in fibre and full-cream milk. Folic acid supplementation prevents neural tube defects in the baby-to-be.

Doc Tips
Consultant obsterician and gynaecologist at the OBGYN Women’s Specialist centre and senior lecturer at Monash University School of Medicine, Dr. Sharad Ratna, shares the following tips to boost chances of conception:

For women
– Take folic acid supplementation

– Track your menstrual cycle to ascertain when ovulation will occur, roughly in the middle of a 28-day cycle.

For men
– Do not wear tight underwear

– Avoid excessive exposure to heat such as from hot spas or the sun

Preconception Health
Preconception care is important for women and men in during their reproductive years and not only for those who are planning to conceive. Why? Apart from addressing lifestyle and health issues which will help improve well-being, it increases the likelihood of a healthy baby being born from unplanned pregnancies. If you are planning for a baby, these measures should be considered, months in advance:

Taking folic acid supplements daily, on top of eating healthily and exercising regularly.
Quit smoking, drinking alcohol and illicit drug use.
Managing your weight is especially pertinent if you are overweight, obese or underweight.
Ensuring any medical condition(s) you have are well-controlled, such as high blood pressure, diabetes, asthma, epilepsy, to avoid it affecting your pregnancy in the future.
Discussing your need for medications you are taking, including over-the-counter medicines and herbal supplements with your doctor and whether you should continue taking it before and after becoming pregnant.
Making sure your vaccinations are up-to-date and avoiding contact with toxic chemicals, cat or rodent faeces and other potential health hazards.
Testing for sexually-transmitted infections which may affect both your fertility and the baby’s health.

Did you know…?
Cervical mucus of fertile quality is discharged in the greatest amount right before ovulation. Similar to raw egg whites in colour and consistency (clear and slippery), generally you are most fertile two to three days before and during the first signs of wetness

Preparing for a pap smear

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What to Expect When You See a Doctor for a Pap Smear
August 20, 2014 Featured Stories, Women

While the average woman or man on the street may not be familiar with the Papanicolaou test, many of us would have heard of or undergone this cervical cancer screening test by its more well known name – the pap smear or pap test.. While popular misconceptions and myths abound surrounding the pap test, it’s time to clear the air.

How Does it Help?
In the developing world, where screening and treatment may be limited or non-existent, cervical cancer is the leading cause of cancer death, according to the World Health Organization.

As a screening tool, the pap test determines who is at risk of developing cervical cancer by detecting precancerous changes as early as possible allowing swift intervention for treatment. It is important to note that abornomal pap test results rarely means the person has cervical cancer and further investigation is needed.

The pap test involves taking a sample of cells in a part of the cervix called the transformation zone, which is often where cells may undergo abnormal changes or growth. Cellular abnormalities are further evaluated by colposcopy and/or biopsy before a diagnosis can be made. The colposcope is a low-power magnification device that allows lesions to be seen and ascertain whether a biopsy is needed. Tissue sample from the cervix is collected in a biopsy.

What Causes Cervical Cancer?
Almost all cervical cancers are causally related to infection by the human papilloma viruses (HPV) which doesn’t go away. Only certain types of this group of viruses cause cancer, whereas a few low-risk types cause genital warts – a common sexually transmitted infection. Many sexually active people will have HPV at some point in life, but most do not notice it because these infections tend to clear up on their own, with time.

Even short term infections from high-risk types of the virus result in little or no changes to cells in the cervix even though these high risk viruses have the ability to cause cervical or anal cancer. Persistent HPV infection by cancer-causing types, however, is a risk factor for cervical cancer. Another name for abnormal lesions is cervical intraepithelial neoplasia (CIN) which can range from a minor infection to a more serious one.

Low grade abnormalities can arise due to infections or postmenopausal changes as well. The timeline for ‘high-grade’ precancerous cells to develop into an invasive carcinoma takes around eight to 12 years in most women, presenting a window of opportunity for timely screening and treatment.

Precancerous changes within the cervix usually do not cause outward symptoms, which is why pap testing is so important. When cells become invasive, abnormal vaginal bleeding between periods or after intercourse is one of the early signs of cancer.

Abnormal vaginal discharge can be yellowish and foul-smelling or tinged with blood and the fluid component of blood (serous fluid). Other advanced symptoms include anaemia, pelvic pain and weight loss.

How Regular is Regular?
How often a pap test should be undertaken varies with the individual and her risk factors, so a discussion with your doctor is essential. Generally, women who are been sexually active are recommended to start from the age of 21 and get a pap test every two years, or more frequently if they have certain risk factors.

Having been vaccinated against HPV does not replace getting regular pap tests. You will have to get it done more frequently if an abnormal result was found and go through follow-up tests like colposcopy.

Menopause does not protect against cervical cancer, which develops over many years, so older women should remain vigilant. However, if you are over the age of 65 and have had normal pap test results for the last 10 years or so, you may not need to get tested any longer.

How to Prepare
According to consultant obstetrician and gynaecologist at the OBGYN Women’s Specialist centre in Subang Jaya and senior lecturer at Monash University School of Medicine Dr. Sharad Ratna, a pap test could potentially “cause a mild degree of discomfort but not excessive pain.” Apart from arranging for the test to be performed at a time when you’re not having your period, Dr. Sharad says that there is no preparation necessary beforehand for the procedure to take place. “It makes no difference to the results.”

For those of who haven’t been inducted, the pap test is a quick procedure usually conducted during a pelvic examination. Lying on the exam table with a sheet over your stomach and legs, with your feet in the holders at the end, the doctor will insert a plastic or metal speculum and brush the inside the cervix to obtain a sample of cells.

Setting Stigma Aside
While misconceptions exist in society that unfortunately leads to social stigma on getting a pap test, this screening tool has brought about a decrease in mortality and morbidity from cervical cancer for women worldwide.

An equivalent test does not exist for many other gynaecologic cancers, such as ovarian cancer, which is more insidious and may often be picked up only in advanced stages of the disease.

Risk Factors
Another reason to quit lighting up: Women who smoke have an increased risk of developing cervical cancer. Smoking cessation is especially important if abnormal cells have already been detected in the cervix. Exposure to second-hand tobacco smoke increases the risk as well.
Sexual Habits: Having multiple sexual partners, a history of sexually transmitted infections (STI’s) and not using barrier contraception such as condoms during sex increases the risk of developing cervical cancer. Women on the oral contraceptive pill should still practice barrier contraception.
Strength of the immune system: Women with a weakened immune system, such as those who have human immunodeficiency virus (HIV) or who are taking immunosuppressant drugs, are at higher risk of developing cervical cancer, and of having the disease progress more quickly from abnormal cell changes to invasive lesions.

Protective Measures
Apart from undergoing regular pap tests, the following helps protect you from cervical cancer.

Not having vaginal, oral or anal sex and skin-to-skin contact.
Getting all three doses of the HPV vaccine before becoming sexually active.
Consulting your doctor about getting tested for HPV.
Using a condom reduces the risk of transmitting HPV from one person to another (with correct use), though it does not provide complete protection due to possible viral infection of genital areas not covered by the condom. Condom use is however linked to reduced cervical cancer rates.
Having a mutually monogamous relationship with your sexual partner lowers the risk of sexually transmitted infections.

The HPV Test
The HPV test is specific for the types of virus that are linked to cervical cancer incidences. HPV infection is common in women below the age of 30, when most are able to develop an immune response to eventually clear it from the body.

Women who are 21 years old or older would therefore only need it routinely as follow-up for an abnormal pap test result, or post-treatment check-up.
However, if you are over 30 years of age, it may be recommended as part of your regular screening because of an increased risk of cervical cancer.

Inside pregnancy: weeks 1-9

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Inside pregnancy: labour and birth

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Manopause?! Aging, Insecurity and the $2 Billion Testosterone Industry

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The sign over the clinic door says Low T Center, as in low testosterone, as in not enough man juice in the tank. Inside, the place is musky with masculinity. The spacious suite is situated in a handsome office building in the prosperous North Texas suburb of Southlake, staffed by attractive female receptionists who welcome patients into the “man cave.” ESPN plays on the flat-screen near a bar stocked with drinks and snacks. The rooms are decorated with autographed football jerseys and other sports memorabilia. A he-man with a firm handshake named Mike Sisk is the proprietor, but he’s no doctor. Instead, Sisk is enough of a businessman to realize that America’s beer bellies could be worth their weight in …

This appears in the August 18, 2014 issue of TIME.

Ending the war on fat

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For decades, it has been the most vilified nutrient in the American diet. But new science reveals fat isn’t what’s hurting our health


The taste of my childhood was the taste of skim milk. We spread bright yellow margarine on dinner rolls, ate low-fat microwave oatmeal flavored with apples and cinnamon, put nonfat ranch on our salads. We were only doing what we were told. In 1977, the year before I was born, a Senate committee led by George McGovern published its landmark “Dietary Goals for the United States,” urging Americans to eat less high-fat red meat, eggs and dairy and replace them with more calories from fruits, vegetables and especially carbohydrates. By 1980 that wisdom was codified. The U.S. Department of Agriculture (USDA) issued its first dietary guidelines, and one of the primary directives was to avoid cholesterol and fat of all sorts. The National Institutes of Health recommended that all Americans over the age of 2 cut fat consumption, and that same year the government announced the results of a $150 million study, which had a clear message: Eat less fat and cholesterol to reduce your risk of a heart attack
This appears in the June 23, 2014 issue of TIME.

Must Do Health Tests for Women(from Urban Health magazine)

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Must Do Health Tests for Women

We are often bombarded with alarming statistics related to diseases such as breast cancer, which is the main type of cancer that affects women in Malaysia and around the world. While there is no question that regular health checks are essential for women — which ones should you prioritise and how often should you be tested?

According to Dr Sharad Ratna, obstetrician, gynecologist and founder of Subang Jaya OBGYN Women’s Specialist as well as senior lecturer at Monash University, Sunway Campus, the first thing to think about when it comes to health checks is whether the tests are being conducted by trained medical personnel. He recalls meeting patients whose tests were performed in unrecognized screening centers and who later discovered that the results were misinterpreted. This is a dangerous thing as misinterpreted results cause anxiety or sometimes even a false sense of reassurance, which affects peace of mind and could pose a health risk.

“For example, a test result showed that bacteria was detected in the vagina and this made the patient worried. The presence of bacteria in the vagina is normal — it is a matter of type and severity. In this case, the test results were nothing to worry about but the patient was anxious when she was told about the results, believing that she had contracted a sexually transmitted disease,” reveals Dr Sharad.

Many health screening centers package tests with the purpose of raising sales revenue. Therefore, you may end up paying a huge amount of money for these tests, which may turn out to be unnecessary. Worse, you are indirectly supporting unscrupulous test centres that are out to make a quick buck. Dr Sharad stresses that screening tests should only be performed when necessary and should provide benefits rather than cause anxiety.

“All health screenings should fulfill the Wilson’s criteria for screening which emphasises the important features of screening programmes,” says Dr Sharad.  For women, the must-do gynaecological health screenings are screenings for cervical cancer, breast cancer and ovarian cancer.”

The gynaecological health screenings Dr. Sharad recommends include the following:


Women should have regular gynaecological assessments and pelvic ultrasound scans to detect cervical cancer or pre-cancer, fibroids and ovarian cysts.

If you have a family history of cancers such as breast cancer, ovarian cancer or bowel cancer, an examination by a gynaecologist is best whereby a pelvic ultrasound scan and a blood test may be recommended.

A specific blood test will be carried out which includes tumour markers and genetic markers to detect the presence of cancers or if further medical attention is needed.

 Aside from a gynaecological assessment, other health screenings that Dr Sharad recommends for women are:


In some countries, a pap smear is recommended for women above the age of 21. “However, a woman should get herself regularly tested one year after becoming sexually active,” says Dr Sharad. Pap smears, which are also known as Pap tests or HPV tests, can detect any abnormalities in the cervix (the neck of the womb)such as the presence of human papilomavirus (HPV), which causes cervical cancer at the high risk level and genital warts at the low risk level.

The doctor uses a lubricated speculum to open the vaginal canal and will collect cells from the outer opening of the cervix. You may feel a little pressure but the procedure usually causes minimal to no pain. If you do experience discomfort or pain, be sure to let your doctor know.

Sexually active women are encouraged to have a pap smear yearly for the first few years after their sexual debut. If the results turn out to be normal for the first few years, your doctor may recommend a pap smear every 2-3 years instead.

You will need cervical cancer screening if

  • You are sexually active
  • Have multiple sexual partners
  • Your partner has previously engaged in sex with other partners
  • You practice unprotected sex
  • You are a smoker

The American Cancer Society also recommends women between the ages of 30 to 65 to have a pap smear plus a HPV test every five years as part of a cervical cancer screening.


“Self breast examinations should be conducted every month during a woman’s menstrual cycle,” says Dr Sharad. A girl should practice monthly breast examinations from the first month she gets her period. Self breast examination is a simple technique which can be done in the comfort of the home.

Performing this examination monthly will help a woman detect changes or lumps in her breast, which may be an indication of breast cancer. Log on to the Breast Cancer Welfare Association Malaysia’s (BCWA) website at www.breastcancer.org.my for guidelines and techniques on how to conduct a self breast examination.


The breast ultrasound scan is basically a scan of the breasts while a mammogram is an x-ray of the breast. Mammograms and breast ultrasounds are effective when it comes to breast cancer screening. In Malaysia, women aged 40 and above, are recommended to make an appointment for an annual screening

Dr Sharad advises women with relatives who had breast cancer to go for a breast ultrasound scan or mammogram 10 years before the cancer was detected for the family member. For instance, if you know of an immediate family member who was diagnosed with breast cancer at the age of 40, you are advised to get yourself screened from the age of 30.


Colorectal cancer is the third biggest killer among women in Malaysia. Colonoscopy or sigmoidoscopy is used to screen and diagnose colorectal cancer. This type of cancer generally exhibits no symptoms but be on the lookout for blood in the stools, diarrhea or abdominal pain.  The American Cancer Society recommends both men and women above the age of 50 to undergo colorectal screening.


Postmenopausal women are at high risk for osteoporosis due to the hormonal changes they face at this stage. Women who have experienced menopause and who have a family history of osteoporosis should go for a bone density measurement test.

Dr Sharad says that DEXA is one of the best options available as it involves scanning your entire body to measure bone density. However, he advises that one of the best ways to guard against osteoporosis is to exercise and to eat a diet rich in calcium and Vitamin D. Specific medications are also available for menopausal women and can help combat bone density issues.


A cholesterol test is done via a blood test, which helps to determine the buildup of plaque, which narrows or blocks arteries in your body. There are no evident warning signs or symptoms for high cholesterol, which is why a cholesterol test is very important.

You should ideally opt for a cholesterol test in your 20s and if you have a healthy cholesterol level, you should go for the test every five years. A cholesterol test is especially important if you are overweight, practice a sedentary lifestyle and have a family history of high cholesterol or heart disease.


Non-communicable diseases like diabetes are on the rise so a blood sugar level screening is recommended for men and women of all ages. Blood sugar tests are simple and quick and may just save your life.

If you cannot resist those sugary treats and oily food, be sure to take the necessary precautions and get yourself checked yearly.

As Dr. Sharad says, “early prevention leads to detection and cure.” He also reiterates that health screenings should not be conducted on a whim but should be done when necessary.

If a health problem is detected in your results, be sure to immediately make an appointment with a specialist as various helpful treatments are widely available today.

Here’s how you can take control of your health and reduce your risk of getting cancer.

• Stay away from tobacco.

• Stay at a healthy weight.

• Get moving with regular physical activity.

• Eat plenty of fruits and vegetables.

• Limit how much alcohol you drink (or don’t drink at all).

• Protect your skin.

• Know yourself, your family history, and your risks.

• Have regular check-ups and cancer screening tests.

* Information derived from www.cancer.org

There’s a Vaccine Against Cervical Cancer, But People Aren’t Using It

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The only vaccine to protect against cancer, the HPV shot, isn’t being used by young people who could benefit most.

In a new report on immunization rates among young people, the Centers for Disease Control (CDC) reports relatively low numbers of adolescents getting the HPV vaccine, the only vaccine that can protect against cancers — in the cervix, anus and mouth — caused by the human papillomavirus virus.

The new data, published in the CDC’s Morbidity and Mortality Weekly Report, shows that only about one-third of adolescent girls between the ages 13 and 17 got all three doses of the HPV vaccine, which the CDC says is about the same as last year. The shot is recommended to protect adolescents before they become sexually active. Only about 57% of adolescent girls and 35% of adolescent boys for whom the shot is recommended received one or more doses.

The vaccine continues to face challenges from parents concerned that it would promote sexual activity among pre-teens and adolescents, despite data showing that immunized teens aren’t more promiscuous. The CDC data also shows that doctors can play a critical role in discussing the shot with parents and improving vaccination rates. Among parents whose daughters were vaccinated against HPV, 74% said their doctors recommended the vaccine. But the data also showed that among parents who did not vaccinate their girls, nearly half were never told by their doctor that they should consider it. The effect was even greater among boys, where only 26% of parents who did vaccinate their son received any advice from their doctor about it.

To boost vaccination rates, some researchers are investigating whether fewer doses of the vaccine could be effective, and so far those studies look promising.

This appears in the  issue of TIME.