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Women’s Health (Gynaecology)

A woman’s life is marked by a range of physical and physiological changes, right from menstruation through the late stages of menopause.

At Pantai Hospitals, we offer our female patients comprehensive care every step of the way, whether it is diagnosing and treating endometriosis or easing menopausal symptoms. With proper attention, gynaecological concerns can be identified and managed effectively by allowing for early detection. This is essential for effective preventive and remedial measures.

The team of gynaecologists are equipped to provide patient-centred consultation, assessment and treatment with the utmost sensitivity and respect.

Gynaecological conditions and symptoms

A female's internal reproductive organs are the vagina, cervix, uterus, fallopian tubes, and ovaries.

To learn more about gynaecological conditions and symptoms, select one of the following icons.

The uterus or womb is an inverted pear-shaped organ with thick muscular walls. It is located within the pelvis, between the bladder and rectum.

The uterus is composed of three layers: the outer peritoneal layer, the middle muscular layer, and the innermost lining, known as the endometrium. The endometrium thickens and prepares for implantation each month during the menstrual cycle, and if pregnancy does not occur, it is shed during menstruation.

On top of that, the muscular walls of the uterus can stretch and expand to accommodate a growing foetus. During labour, the muscular walls contract to push the baby out through the cervix and the vagina.

Conditions related to the uterus:

The cervix is the lower part of the uterus that extends into the vagina. Occasionally, it is referred to as the 'neck of the uterus.' The cervical os, an aperture located in the cervix, is capable of expanding during childbirth to facilitate the passage of the baby through the vaginal canal.

The cervix produces mucus that assists in the movement of sperm through the reproductive system and can vary in consistency throughout a woman's menstrual cycle to support fertility.

The cervix is also a crucial site for routine cervical cancer screening tests such as Pap smear that help detect any abnormal cells that could be a sign of cancer.

Conditions related to the cervix:

The vagina is a muscular tube-like structure that connects the external genitals (vulva) to the cervix. It is approximately 7cm to 9cm in length. The opening of the vagina is located between the urethra (where urine comes out) and the anus. The vagina is often called the birth canal as it provides the passageway for the delivery of a baby.

Conditions related to the vagina:

The ovaries are a pair of oval-shaped organs located in the pelvis on either side of the uterus. They produce, store, and release eggs (ovum) into the fallopian tubes during ovulation. The ovaries also produce hormones such as oestrogen and progesterone, important for regulating the menstrual cycle and maintaining reproductive health.

Conditions related to ovaries:

Fallopian tubes are also known as uterine tubes that connect the ovaries to the uterus. Each tube is about 10cm long. The fallopian tubes are divided into several parts: the infundibulum, ampulla, and isthmus. The infundibulum is the funnel-shaped opening at the end of the fallopian tube nearest to the ovary. It is lined with finger-like projections called fimbriae that help to sweep the egg released from the ovary into the tube. The fertilisation of the egg by sperm usually occurs at the ampulla.

The inner lining of the fallopian tubes is made up of ciliated cells and secretory cells. The cilia are hair-like structures that move in a coordinated way to help sweep the egg towards the uterus. The secretory cells produce substances that nourish the sperm and the developing embryo.

Conditions related to the fallopian tubes:

Click the “+” symbol on the uterus diagram below to find out more about gynaecological conditions and symptoms.

Screening and diagnosis for gynaecological conditions

Gynaecological examinations serve several purposes. The most important thing is to diagnose any abnormalities as quickly as possible. The sooner the treatment, the better the chances of managing or recovering from the condition.

Pelvic examination

A pelvic examination is a visual and physical examination of a woman's reproductive organs. You might need a pelvic examination to:

Assess gynaecological health: A pelvic examination is often part of a routine physical examination to find possible signs of ovarian cysts, sexually transmitted infections, uterine fibroids, or early-stage cancer. They are also performed during pregnancy.
Diagnose a medical condition: A pelvic examination is recommended if there are gynaecological symptoms such as pelvic pain, unusual vaginal bleeding, abnormal vaginal discharge, or urinary problems.

Colposcopy

Colposcopy is a procedure that allows the physician to take a close look at a woman’s cervix and vagina using a special instrument known as a colposcope.

The colposcope helps to identify or rule out the existence of any pre-cancerous condition in the cervix tissue. If a Pap test shows abnormal cell growth, further testing, such as a colposcopy, is required. This procedure may also be suggested for women with genital warts.

Laparoscopy (Pelvic Endoscopy)

In laparoscopy, a rigid viewing tube called a laparoscope, is inserted through a small incision in the abdomen, just below the navel. Fibreoptic cables permit the physician to visually inspect the abdominal and pelvic organ for abnormalities.

In addition, various instruments may be passed through the scope or other insertions to obtain fluid or tissue sample for laboratory examination.

Laparoscopy is used to:

Determine the cause of acute or chronic abdominal or pelvic pain or fluid accumulation in the abdomen.
Detect, evaluate, and treat abnormalities affecting the female productive organs in the pelvis; these include endometriosis, ectopic pregnancy, pelvic inflammatory disease, and abnormal growths (tumours, cysts, adhesions, or fibroids).
Detect pelvic abnormalities that prevent pregnancy and test for patency of the fallopian tubes as part of an infertility evaluation.
Obtain a tissue biopsy in organs to confirm suspected cancer of the abdominal or pelvic organ.

Treatment options for gynaecological conditions

Hysteroscopy

A hysteroscopy looks inside your womb using a narrow telescope with a light and camera at the end, called a hysteroscope, which is passed through the vagina and cervix into the womb without any incisions.

The procedure is used to investigate many gynaecological symptoms including:

Heavy periods
Bleeding - unusual or postmenopausal
Pelvic pain
Recurrent miscarriages or difficulty in conceiving

Fibroids and polyps can be diagnosed using a hysteroscope. It can also be used to treat gynaecological conditions such as removing fibroids, polyps, displaced intrauterine devices (IUDs), and scar tissue that can cause absent periods and reduced fertility.

Laparoscopy

Laparoscopy is keyhole or minimally invasive surgery. It has a number of advantages over open surgery which include faster recovery time and shorter hospital stay, less side effects such as pain, bleeding, and scarring.

Diagnostic laparoscopy is used to see inside the abdomen and pelvis and to take biopsies. It can diagnose endometriosis and investigate cancer. A small tube with a camera and light source, called a laparoscope, is inserted through small incisions in the skin.

The procedure can also be used to treat problems in this area such as:

Endometriosis
Remove scar tissue
Ectopic pregnancy
Female sterilisation
Remove an ovarian cyst
Treat fibroids
Remove lymph nodes in cancer treatment
Remove the womb or ovaries

It is usually performed under general anaesthetic.

Anterior vaginal wall repair

Anterior vaginal wall repair is a surgical operation to restore a sinking vaginal wall, known as a prolapse, and performed under general or spinal anaesthetic.

Symptoms of a vaginal wall prolapse include:

Unable to empty your bladder fully
Full feeling bladder all the time
Vaginal pressure
Bulging at the opening of your vagina
Urine leakage when coughing, sneezing, or lifting
Pain when having sex
Bladder infections

During the procedure the surgeon will move the vagina back into its correct position, tightens bladder support and removes any bulge in the vagina.

Hysterectomy

Hysterectomy is a surgical method to remove a woman’s womb. Following a hysterectomy, a woman cannot become pregnant so it is normally the last treatment option if other options are unsuccessful.

A hysterectomy treats:

Heavy periods
Chronic pelvic pain
Non-cancerous tumours called fibroids
Prolapse of the uterus
Cancer of the womb, ovaries, or cervix

There are many types of hysterectomy including:

Total hysterectomy: The womb and cervix are removed.
Subtotal hysterectomy: The upper part of the womb is removed, and the cervix and ovaries are left in place.

There are several ways a hysterectomy can be performed:

Vaginal hysterectomy: Performed entirely through an incision made in the vagina under general, spinal, or local anaesthetic, with no visible scars.
Laparoscopic hysterectomy: Tiny incisions made in the abdomen and vagina allow laparoscope and instruments to be inserted. This minimally invasive surgery is performed under general anaesthesia.
Abdominal hysterectomy: An incision is made on the abdomen under general anaesthesia.

Hormone Replacement Therapy (HRT)

Hormone replacement therapy (HRT) replaces hormones that are at a lower level as you approach menopause. Menopause is described as when a woman permanently stops having periods, and she can no longer get pregnant.

HRT can relieve symptoms of the menopause such as:

Hot flushes
Mood swings
Night sweats
Vaginal dryness
Reduced sex drive

Treatment for miscarriage

A miscarriage is defined as the loss of a pregnancy in the first 20 weeks. After a miscarriage, pregnancy tissue can be left in the womb. It will naturally pass out of the womb over time, or it can be removed earlier by taking medication that will cause the tissue to pass or by surgery.

Stress incontinence treatment

Stress incontinence is when the bladder leaks urine during physical activity, such as when:

Sneezing
Coughing
Changing position
Lifting something heavy

It is caused when the pelvic floor or sphincter muscles become weakened. Behavioural changes, pelvic floor muscle exercises and medicines are normally the first line of treatment. Surgery is recommended if these have no success.

Surgical options for stress incontinence include:

Tape procedures: Tape holds up the urethra in the correct position.
Sling procedures: A sling is used to support the bladder neck and urethra.
Colposuspension: Laparoscopic or open surgery to lift the tissues between your bladder and urethra.
Artificial urinary sphincter: Replacement urinary sphincter.

Frequently Asked Questions

What are the 5 essential screenings for women?

Please note that these are recommended ages. Your doctor will advise you if otherwise.

Basic health screening
Ages: 18 years and above
How often: Once a year
Cervical cancer screening (Pap Test)
Ages: 21 to 65
How often: 3 years once
Did you know that HPV is the leading cause of cervical cancer? Learn more about HPV Vaccination in Malaysia to protect yourself from cervical cancer.
Breast cancer screening (Mammogram)
Ages: 40 to 74
How often: 2 to 3 years once
Colorectal cancer screening
Ages: 50 to 75
How often: 10 years once
Bone density test
Ages: 65 and older
How often: 3 to 5 years once

Learn more about 7 health screening tests that every woman should go for.

Who and when should visit a gynaecologist?

Gynaecology refers to the specialty that treats medical conditions that affect the female reproductive system - cervix, uterus, ovaries, fallopian tubes, and vagina. A gynaecologist’s focus is on the non-pregnancy aspects of a woman’s reproductive health. These include:

Menstrual disorders – menorrhagia (heavy menstruation), amenorrhoea (absence of menstruation), dysmenorrhoea (menstrual cramps)
Endometriosis
Hormonal imbalances
Infertility
Sexually transmitted infections (STIs)
Urinary tract disorder
Pelvic pain
Pelvic or uterine prolapse
Estrogen therapy
Menopause
Ovarian cysts
Pelvic inflammatory disease (PID)
Fibroids
Urinary incontinence
Gynaecological cancers
Polycystic Ovary Syndrome (PCOS)
Vaginal infection

What do you need to know before meeting a gynaecologist?

Once you schedule an appointment with an Obstetrics and Gynaecology specialist, the doctor will initially ask you a series of questions about your condition or symptoms.

An OB/GYN appointment may involve several types of examinations. The examination that an OB/GYN may choose to perform depend on the reason for a patient’s visit, their sexual activity and age.

These examinations include:

External genital examination: Involves an observation of the area around the vaginal opening, such as the labia, vulva, and clitoris.
Pelvic examination: Annual examination for women who are sexually active, which involves detecting abnormalities which affect the vagina, ovaries, cervix, and uterus.
Breast examination: Involves a check for lumps, as well as physical changes or abnormalities on the breasts, underarms or area below the clavicle that could indicate the presence of breast cancer.
Pap smear: An examination that involves the collecting cells from the cervix to test for cervical cancer. It is performed every two to three years for women who are, or have been, sexually active. If two consecutive yearly results are negative, subsequent examination can be done every three years.
Ultrasound screenings
Colposcopy: An examination and treatment of the internal vagina walls.
Cervical biopsy: An examination of the cervix.
Endocervical curettage: Cutting/removal of abnormal growth lesions inside the cervix.
Endometrial biopsy: An examination of the uterus lining.
Hysteroscopy: An examination of the inside of the uterus/womb.
Speculum examination: An examination of the vaginal wall with a plastic or metal device.
Pregnancy testing

Fertility

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