Over the course of her incredible life, activist, poet and storyteller Maya Angelou wrote many wise words that inspired women worldwide. Yet one of her resonant quotes is one that remains sadly unrepresented by her many readers.
“When women take care of their health,” she opined, “they become their best friend.”
While we are quick to offer a helping hand to our children, our family and our friends, when it comes to looking after our own needs we often come up short.
And that is especially true when it comes to issues we find difficult to talk about such as sexual health, incontinence and other intimate matters. Enter Dr Elizabeth Farrell AM, Medical Director of Jean Hailes for Women’s Health who we’ve enlisted to answer a multitude of questions many are embarrassed to ask their own GP.
Why am I passing wind more frequently?
The problem could be twofold. “If you’re not able to control the flatus and so it comes out at embarrassing times, one thing you need to look at is your pelvic floor strength,” says Dr Farrell. “But secondly, are there any other symptoms associated with this increase in flatus? Is there any bloating? Any pain? Any diarrhoea? Are you unwell? Have you passed any blood? We need to make sure that there’s nothing going on in the gut so you need to see your doctor.
Secondly, you need to look at the foods you are eating and whether anything has changed. Are you having more ‘windy’ foods? Another idea would be to see a dietician to check your diet and see if the balance of foods you are eating has a role.”
What about if I’m constantly doing “number twos”?
Unless it’s a short-lived stomach bug – replete with sickness and fever – this isn’t something a healthy body should do, warns Dr Farrell. “If the pattern of your bowel actions are irregular – sometimes constipation, sometimes loose – you may very well have IBS (irritable bowel syndrome). In that case you’d be looking at your diet as the bowel tends to react very much to certain foods or stress.
“Another thing some women have which is a very embarrassing thing to own up about could be faecal incontinence – incontinence of the bowel. Again I would send them to a pelvic health physio to make sure that they are maximising their pelvic floor. I’d also check if it’s because their bowel actions are too loose – so looking at diet, maximising fibre and fluid intake.”
I’ve discovered some lumps on my vulva – is it cancer?
It’s more likely to be sebaceous cysts, says Dr Farrell, adding that vulvar cancer is rare and presents initially as itching but then a lump can develop.
These little sebaceous cysts around the vulva and anus are more likely after menopause. “Most of the time they will be small and don’t cause any trouble but occasionally they can get sore and infected,” she says. “An individual one is simple to remove but multiple ones are much trickier. So in most cases we recommend that women only do something about them if they start to become painful.”
Another cause could be blocked Bartholin’s glands – the glands located on each side of the vaginal opening which produce lubrication during sex. “That’s called a Bartholin’s cyst,” says Dr Farrell. “If it’s infected or an abscess it has to be treated fairly quickly with an operation.”
While these are the two most common causes, it’s important a GP checks you over to rule out other conditions.
Why do I pee when I cough?
“It’s because there is weakness in the pelvic floor muscles,” explains Dr Farrell, adding that the same is true if it happens when you laugh, sneeze or jump during exercise. “When there’s a downward pressure if the tissues are slack, a little bit loose or the pelvic muscles are weak then the bladder neck – where the urethra joins the bladder – will move downwards and a little bit of urine will leak out.”
Dr Farrell advises that a pelvic health physiotherapist is your next go to if you are suffering from what is termed stress incontinence.
“We are like a normal physio,” explains Lori Forner, who recently joined Always Discreet as their pelvic health expert, of her day job. “We look at the muscles, the bones and the joints and see what’s not working normally. If someone is leaking, does it have to do with their pelvic floor muscles not working enough? There are other tissues in there that are like elastic bands – your connective tissue which supports the bladder. So is that the problem? Once that is established, we can then work on a program.”
It won’t be an overnight solution however, warns Lori. “It takes a good eight to 12 weeks for muscles – anywhere in the body – to change with an exercise program that is continually challenging. And the other thing I’d add is that there will be a cohort of people who we can only get 90 per cent better. So that’s where having liners, pads and underwear comes in handy, so that people can continue to exercise and go out with their friends without feeling embarrassed if they have an accident.”
What if I find it hard to make it to the toilet in time?
“Urgency is another form of incontinence which is more distressing,” explains Dr Farrell. “It’s the key in the door, turning on the water, and all of a sudden you think ‘Oh my God, I’ve got to go.’ Urgency tends to increase after menopause a bit but anyone can have it. This happens when the detrusor muscle, the internal muscle of the bladder, is irritable and start to relax before you get to the toilet.”
“The most common form is actually a combination of stress and urgency,” says Lori, who as a pelvic health physiotherapist works with all types of incontinence. “It may be a coordination issue as well as a bit of weakness.”
“Urge incontinence can also be improved with medications and using vaginal estrogen therapy in the post-menopause,” adds Dr Farrell.
Why am I itching down there?
The first thing to note, says Dr Farrell, is that not all itching indicates thrush – a common misapprehension. “In fact, after menopause, unless there are some triggers, women don’t get thrush – because of the change in pH in the vagina, yeast won’t grow. And if the itch has been there a long time, it’s very important a woman gets examined as it could be a condition called Lichen Sclerosus. It can occur at any age, even in children, but the peak group is women over 50 and is usually life long.”
While it has a low risk of vulvar cancer, Lichen Sclerosus is considered an autoimmune condition, so it’s important that not only do you see your GP, but that they examine you and you get treated properly, Dr Farrell stresses.
Do I have an STI?
It’s definitely something you should get checked at any age, but especially if you are over 50, says Dr Farrell. “In post-menopausal women there is an increase in STIs,” she warns of current alarming statistics. “These days when women go out of one relationship and enter another, condoms aren’t at the forefront of their mind –the baby boomer generation mainly used them for contraception.”
Having an STI check and asking a new partner to do the same is the most responsible thing to do, she adds. But if that horse has bolted, Dr Farrell shares the most common first signs which – she adds – you should make an appointment with your GP to have it checked as soon as possible.
- Genital Herpes: “Would be a lesion – a sore or painful ulceration on the vulva or, if you’re having oral sex, potentially around your mouth”.
- Chlamydia: “Tends to be asymptomatic but can sometimes be associated with a discharge. It can cause severe pelvic inflammatory disease.”
- Gonorrhoea: “Sometimes no symptoms but can have a discharge and if untreated can lead to PID. If a woman has unprotected sex then she should have an STI check that will include gonorrhoea.”
- Trichomoniasis: “A fishy smelling, greeny, frothy discharge with associated itching.”