Female Sexual Health
Part 1: Being Aware of Reproductive Cancers
Discussion about female sexual health is often supressed and discouraged, as it is viewed as a taboo. As a result, many women grow up uneducated about sexual and reproductive health, and unaware about ways they can keep themselves healthy in that respect. This piece will be the first of a series of articles, where we will be discussing some important issues relating to women’s sexual and reproductive health, how to seek medical advice, and who to contact.
One of the most important things to do, that doctors encourage, is to familiarise yourself with your body. This is vital, as it allows you to detect any changes that are out of the norm for you (since everybody is different). Unfortunately, a history of suppression of female sexuality (which still takes place in many cultures) has made it extremely difficult for women to be open to having these conversations, and as a result, issues regarding sexual health are often neglected and ignored. This piece will be the first in a series, where we will discuss issues related to female sexual health. In this piece, we will be going over two very important topics: cancers of the female reproductive system, and breast self-examinations.
In the UK, women are invited by the NHS for a pap smear (also commonly referred to as a smear test) from the age of 25 years old. The test is often avoided by women, mostly out of nervousness as it involves a screening of the vagina. However, the test itself is very quick (taking around 45 seconds to swab the cervix) and is performed by very experienced nurses. The sample of cells collected is then sent off to a lab to check for cervical cancer cells, pre-cancer, and human papillomavirus (HPV), which is the virus associated with causing most cervical cancers. Women aged 25 to 49 are invited to a screening every 3 years, whereas women aged 50 to 64 are invited every 5 years. It is extremely important to attend these screenings; while tests come back negative the majority of the time, they are important to detect any changes in cells, which in many cases present no symptoms and can only be detected via pap smear. Cervical cancer has no symptoms in its early stages, but can make you have abnormal bleeding, bleeding between periods, after sex, or after menopause. Abnormal bleeding does not mean you have cervical cancer, but it is important to see a GP if you are experiencing this.
The NHS does not offer regular screenings for other female reproductive cancers, such as ovarian, uterine, vaginal, and vulvar, so it is important you are familiar with your body in order to be able to detect any changes, so they do not go unnoticed. Changes in your menstrual cycle, discharge, and even appearance of your vulva should be discussed with your GP. We will list the symptoms for these cancers below:
This is the cancer of the ovaries, which are the two organs that make female hormones and produce eggs. Ovarian cancer symptoms often present themselves in the form of abnormal bleeding, pressure or pain in the pelvic area, pressure or pain in the abdomen and back, bloating, feeling full quickly while eating, and changes in bathroom habits (constipation, blood in urine or stool). The risk of ovarian cancer is higher in those over 40, those with a family history of ovarian, breast, or colon cancer, and never giving birth.
This is the cancer of the uterus (womb), which is the organ in which the baby grows when a woman is pregnant. Again, symptoms of uterine cancer include abnormal discharge or bleeding, pressure or pain in the pelvic area, and bleeding after menopause. Those at a higher risk are women 50 years old or older, women who are overweight, and having a family history of cancers of the uterus, ovaries, or colon.
This is the cancer of the vagina, which is the hollow channel that leads from the uterus and cervix to the outside of the body. Vaginal cancer symptoms include abnormal discharge or bleeding. Women who smoke, who have HPV, cervical cancer or pre-cancer, have HIV or a weakened immune system are at a higher risk.
This is the cancer of the vulva, which is the area surrounding the opening of the vagina. The symptoms of this include itching, bleeding, or burning of the vulva, or a rash or sores around the opening of the vagina that do not go away. Or, changes in the colour of the skin around the opening of the vagina. These symptoms are common in many other diseases and infections, including STDs and yeast infections, which are fairly common and treated with over-the-counter medication. If symptoms persist, please see your GP. Again, those at risk of vulvar cancer are women who smoke, who have HPV, cervical cancer or pre-cancer, have HIV or a weakened immune system.
Breast cancers are often grouped with female sexual cancers, however, since its symptoms are not present in the vaginal area, we have decided to discuss it separately. Breast self-examinations are highly encouraged by the NHS, and again, allow you to detect any changes to your breast tissue that needs to be addressed by a doctor. Often, we are told to feel for any lumps or bumps in your breast, however, the texture of breast tissue is naturally very lumpy and bumpy, so women examining their breasts for the first time may panic, or not know what they are searching for.
Self-examination of the breasts is easy and quick to do and involves checking for any changes in the breasts. We recommend following the following steps to thoroughly check for any changes:
Check breasts in the mirror. Look for any discolouration, visible bumps, changes in size, bulging, puckering, or dimpling of the skin, redness, soreness, a rash, or any other visible changes or pain in the breasts.
After checking in the mirror, raise your arms up and look for the same changes. Often, lumps and bumps may appear in, or near your armpits as the lymph nodes in that area are sometimes the first to be affected.
Check your nipples. Are there any changes? Any watery or milky discharge? Any yellow fluid or blood? Any puckering or retraction of the nipple? Any bump under or around the nipple?
Feel your breasts while lying down. Use your right hand to feel your left breast, and your left hand to feel your right breast. Move the pads of your fingers across your breasts while keeping a firm touch, moving your fingers in circular motions. You may feel your breasts naturally lumpy texture and panic, but the lumps you are searching for are generally hard and circular. Breastcancer.org recommend the following method:
“Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.”
Ensure you are feeling not only your actual breast, but your armpits, the area up to your collarbones, and cleavage.
Feel your breasts while sitting or standing, with arms up and arms down. This is easiest and most conveniently done in the shower when you are wet and slippery, so your hands can glide easily across your skin. Use the same method described in the step above, checking for any lumps, bumps, or abnormalities.
It is extremely important to be aware of cancers that can affect the female body, as they are often not discussed openly. Also, like with many other illnesses and diseases, the early symptoms are ones that can only be detected by you, so it is vital to be aware of them. Many women will notice abnormal changes to their breasts or vaginal health and will ignore it, as they feel anxious or embarrassed to speak about intimate issues with a doctor. While the majority of the time, these symptoms will most likely be nonthreatening, in some cases, they can lead to the discovery of cancer in the body and catching this as soon as possible increases the chances of a full recovery significantly. So please, if you do notice any changes, book an appointment to see your doctor as soon as possible, and do not feel scared or embarrassed as they come across cases like these every day.
Finally, it is important to erase the shame and stigma around female sexual health. Do not be afraid to speak about these issues openly and confidently, do not be afraid to enquire or ask questions. By being more open with ourselves and others, we can lead the change and empower each other.