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What women should know about their sexual health

Women’s health matters account for more than a quarter of a GP’s time. Here are seven things that your doctor would love you to know about your sexual and reproductive health.

1. Keep tabs on your periods. Women often go to their GP to talk about changes in their periods, but can be stumped when it comes to the details. If you know the number of days in your cycle, how long it lasts, how regular it is, and whether you are getting any odd symptoms like bleeding in between your periods or after sex, your GP will find it a lot easier to assess and manage any menstrual irregularity. Don’t be too anxious if your periods are slightly irregular for one month – our bodies are complicated. Hormones and cycles can change depending on lots of things including diet, stress, exercise – so keep any eye on your periods and if they do indeed continue to be irregular or you develop any additional symptoms visit your GP, but a one off change is not often something to worry about.
2. Contraception can be trial and error. It takes some women years to settle on a form of contraception they are comfortable with. As long as a certain type of pill is not contraindicated (for example the combined contraceptive pill is not recommended if you have had a DVT or you suffer from migraines) it’s often a case of trial and error. I recommend to my patients that they note any undesired side effects with the different contraceptives so that your GP can offer you alternatives based on these side effects. Monitor your appetite and weight, observe your cycle, your moods and be vigilant to new headaches and migraines. Ensure you’re doing everything you can to keep yourself safe and mitigate the risks of being on the pill, by checking your breasts regularly, knowing the signs of a DVT and how to prevent it, don’t smoke and try to and stay within a healthy weight range. Don’t be scared to consider longer acting forms of contraception like the coil or the implant, people often shy away from these because they consider them more invasive, but they are still the most effective forms of contraception and the any complications you may have been told by a ‘friend of a friend’ are fairly rare.
3. Delayed periods after stopping contraception are normal. It can take several months for your period to come back after stopping contraception, so don’t be scared if you don’t have a period immediately post-pill. For most it will only take between 1 and 3 months to start producing enough hormones to get back to your normal rhythm, but it can take up to 9 months after depot (injection) contraception cessation and up to 6 months after stopping oral contraception. There can be other underlying causes for delayed periods, like Polycystic Ovarian Syndrome (PCOS), thyroid problems or hormonal imbalances so if it still hasn’t returned by this time, then you should see your GP to have it investigated. It’s important to remember that even if your period has not recommenced you may still be ovulating and can still fall pregnant, so do use other forms of contraception if you aren’t looking to start a family.
4. Tell your GP the truth about your sexual history. You may find it embarrassing when a GP asks you about your personal risks of a Sexually Transmitted Infection (STI.) Some patients may think it’s easier to deny having unprotected sex, and divulging number of sexual partners or activity, but it is incredibly important to be transparent. Risks need to be discussed openly and early – not only to avoid you passing on a potential infection but also to avoid developing serious complications including infertility. Whilst it may seem preferable to see the friendly face of your own GP for a sexual health screen, a trip to the Genitourinary Medicine (GUM) clinic may be the right choice in certain situations. Often these clinics have longer appointments to assess your risks and symptoms, and are also able to test for a larger number of sexually transmitted conditions. Many GUM clinics can also provide answers straight away and treat any positive test results that day, which unfortunately your GP will be unable match. GUM clinics can also conduct “contact tracing” which is where they will contact your sexual partners anonymously for you, ensuring that any STI gets stopped in its track without you needing to call up exes you hoped never to speak to again!
5. Don’t ignore health red flags. It can be easy to dismiss symptoms, or attribute them to other benign things. Symptoms like bloating can be so widely experienced, and can be due to common conditions like Irritable Bowel Syndrome or constipation. But it can also be a symptom of ovarian cancer, so it is important to be aware of changes in your body. There are certain reproductive system red flag symptoms that you should never ignore. These include bleeding in between periods, bleeding after sex, deep pain on having sex, unexpected weight loss, unexplained change in discharge, and pelvic pain or masses. If you experience any of these symptoms you should see your GP immediately.
6. Remember the fertility clock is ticking. Be a power woman, and tick all the boxes of things you want to strive for and achieve, but don’t forget that unfortunately the biological clock is real. You are born with a set number of eggs, and at every menstruation you lose at least one, so as you age, your number of available eggs to be fertilised are on the decline, and so is their quality. It is widely accepted that fertility decreases significantly after the age of 35 and the time it takes to fall pregnant can be much longer. So if you’re thinking about motherhood, make sure you’re as healthy as you can be and don’t waste time getting down and dirty – once you have been trying to fall pregnant for a year, see your doctor to investigate this further.
7. Understand your vaginal flora. Discharge is normal, but if it starts to smell fishy, or you are getting some vaginal irritation and itching it may be that your vaginal flora has been disrupted, and you may have developed thrush or bacterial vaginosis (BV). Most people know the tell-tale signs of these conditions and are able to treat it themselves with over the counter medication. For those that aren’t sure which of the two conditions they may have, there are also kits available to buy that give a definitive diagnosis. If you have any concerns about your symptoms or the symptoms aren’t getting better with over the counter treatments it is important to see your GP, to talk it through and for an examination and swabs. Sometimes recurrent thrush can be a sign of an underlying condition like diabetes, or these symptoms may be masking an STI.

Whilst it is always admirable when a patient takes their health into their own hands, and tries to understand and manage their condition, there is no replacement for the reassurance your doctor can give you. Please do speak to your GP if you have any concerns about your sexual and reproductive health.