From The Straits Times    |

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When Deborah*, 26, missed her period for two years, she didn’t bother to see a gynaecologist to get things checked. “With hindsight, it’s a scarily long time, but you always think, ‘ah, maybe next month it’ll come back’,” she admits. “I didn’t seek medical advice because I wasn’t in pain.

And frankly it was a huge convenience: It meant no mess, no cramps, no need for birth control.” She was remarkably blase: “Since my health didn’t seem to be affected and I wasn’t emotionally unstable, I didn’t feel compelled to do anything.”

So here’s the thing: We see dentists regularly; we see a GP when we feel woozy; we take medication when we’re under the weather. You’d think that when it comes to our own reproductive system, we’d be as kiasu. Not quite so, apparently.

While I might not have the same health issues that Deborah had, I too drag my feet when it comes to getting a sexual-health screening. I got my fi rst Pap smear at 29, and at 30, have yet to make an appointment with a gynaecologist. I’ve just never bothered out of sheer laziness; never underestimate the power of procrastination.

I wanted to know if I was in the minority, so I did some asking. Out of the 33 women I asked (who are in their 20s and 30s), 19 told me they have never once seen a gynaecologist, and frankly, aren’t bothered.

When asked if they chose to see a GP for sexual health issues, the majority also said no. Of the 14 who have, some told me that the impetus was for reasons like missing periods or wanting to get pregnant. And for some, even a health scare isn’t enough to push them to seek medical attention.


Why? “No symptoms = No big deal”


So I spoke with three gynaecologists, who echoed the same observation: Most patients only come to see them when they exhibit symptoms.

“Once in a while, a patient would come in for a problem and say it’s her first time seeing a gynae, even though she should be doing her Pap smears on a regular basis,” says Dr Paul Tseng, consultant obstetrician and gynaecologist, Thomson Medical Centre. “These patients never think it would be an issue, and they can’t be that unlucky. They might be shy, or they might think there have been no symptoms. They don’t feel vulnerable.” Dr Ann Tan, obstetrician and gynaecologist, Mount Elizabeth Hospital, also adds that “the frequency of such checks is still uncertain among many women”.

But here’s your wake-up call: Once you start having sex, you should start seeing a gynaecologist.

Why? Because you might literally be sleeping with the enemy. Take cervical cancer, which lies low and takes its time to manifest. “While cervical cancer has symptoms which include unscheduled bleeding between periods, there are no symptoms of cervical pre-cancer,” says Dr Pamela Tan, obstetrician and gynaecologist specialist, Thomson Medical Centre.

“The time from human Papillomavirus (HPV) infection to cancer development is often around 10 years, because the pre-cancer stage is long.” This is precisely the time that you should be having your screening, so that signs can be detected at this stage.

If you are unlucky enough to have cervical cancer, if you had gone for checks, it could have been picked up much earlier. “Doing a Pap smear or an HPV test means you’re picking it up in the pre-cancer stage, which is easy to treat and has a 90 per cent curable rate after treatment,” says Dr Pamela Tan. 

She describes cervical cancer in young women in their 30s as “truly a tragedy” and adds: “You would think that with all the public awareness and education about cervical cancer screening, this would be an era where cervical cancer is practically eradicated. However, we still detect cervical cancer in young patients, and often they have never had a Pap smear in their lives.”


“Let’s (not) talk about sex, baby”

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If we hold off on Pap smears, I’m not surprised when doctors then reveal that hardly anyone approaches them for general screenings for sexually transmitted infections (STIs). I believe this is down to a fear of being judged.

My partner and I both decided to go for an STI check in the early stages of our relationship. His doctor applauded him for taking the initiative, telling him “most men never bother”, whereas my doctor (who wasn’t my regular GP), asked me if I was getting married and couldn’t mask her surprised look when I said I was not.

My experience only highlights the uncomfortable fact that for many, sex still seems to be perceived as taboo. But the fact is that as long as you’re sexually active, you should be doing your due diligence with your doctor.

Dr Pamela Tan believes that most Asian women first see a gynae when they are pregnant or are thinking of getting pregnant.

She observes that single Caucasian females (even teenagers) are more open about asking for contraceptive options and Pap smears.

“There may be a social stigma among single Asian females that if you see a gynaecologist, it connotes that you’re sexually active and perhaps more liberal in values. Asian women may thus still feel uncomfortable going for gynae consultations.”

Many of us have an upbringing that eschewed talking about the biological aspects of sex, so seeing a gynaecologist is never at the forefront of our minds. Take Annabelle*, 25, who only saw a gynaecologist for her erratic periods as the last resort. “People don’t know why they should see a gynae,” she believes.

In an attempt to stabilise her irregular periods, she tried Chinese medication, Japanese treatments and changing her diet, relenting only when these failed. Her gynaecologist informed her that she was low in certain hormones and gave her blood tests. “I didn’t think it was so serious that I’d need to see a gynae,” Annabelle confesses. “I felt like maybe I could explore other options instead.”


Why? “Sex Talk is Taboo”


In a time when women are claiming ownership of their sexuality, why are we still so lacking in terms of sex education?

I’m not talking about the act itself, but more importantly, the way our reproductive system works and what we should do to protect it. When I attended a panel discussion by Aware on the topic (titled “Let’s Talk About Sex. But How?”), I found myself seated among parents, educators and teenagers.

All spoke about insufficient discussion of sex in schools, where the advice is still largely prescriptive: Don’t have sex, don’t get pregnant. If we have never engaged in a frank discussion about our bodies and self-protection in our formative years, is it any wonder that many of us still see the gynaecologist as the bogeyman?


So what can we do?


I can’t change the way I was brought up, or expect an overhaul of sex education here. I also can’t change everyone’s mindset about sexual taboos.

But here’s what we can do: It might be too late to have that awkward sex talk with your parents when you’re in your 30s, but you can start with your friends.

“My close friends don’t talk about their sex lives in detail – it just doesn’t come up,” says Carole. “Sexual health is only mentioned if someone has an issue like a cyst or period problems.” Clearly, we’re not just tight-lipped with the professionals.

But among those we trust, why not open up?

Talk about periods, sex, what you do for protection, any odd symptoms that you’re worried about. But most importantly, get yourself a gynaecologist whom you’re comfortable with, and see him or her regularly. Because what you don’t ask, you won’t know.

Those terrible cramps you’re inured to or that discharge you’ve assumed is no biggie could be a sign of a bigger issue.

Why rely on Google when you can have a face-to-face conversation with an expert?

It is time we talked about sex without fear of being shamed or wondering what others think. I’m here to say that there is a need, a real one. Sexual health is so much more than what you get up to in the bedroom – it’s about protecting your body. And that’s a perception that we need to encourage.


This article was first published in the February issue of our magazine.