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Top 5 Gynecologic Signs You Should Not Ignore

1.  Pelvic Pain

There are a host of things that can lead to pelvic pain. Often times, patients strongly believe that the only possible source of pelvic pain is the uterus and/or ovaries. Although these are probably the most common causes of female pelvic pain, other common causes are related to the bladder or the intestines. Believe it or not, for example, chronic constipation can be a source of abdominal pain, pelvic pain and pain during sexual intercourse. Additionally, there is a condition of the bladder, sometimes referred to as the bladder pain syndrome or interstitial cystitis, that can result in pelvic pain, urinary frequency, pain during sexual intercourse and bladder pain.  It is important to understand that pelvic pain can be complex and warrants a thorough investigation.  This investigation may include, but is not limited to, physical exam, imaging (usally ultrasound) and/or surgical evaluation.
 
2.  Vaginal Odor and Itching
Often I see patients who are concerned about vaginal discharge. Vaginal discharge is an interesting phenomenon. It often can change based on the hormonal changes related to your menstrual cycle. The presence of vaginal discharge does not always mean there is an infection present. One indicator that vaginal discharge is abnormal is when it is accompanied by a vaginal odor. Vaginal odor can be a sign of poor hygiene but also can be a sign that there has been a disruption in your normal vaginal flora. A common vaginal infection that classically has an odor is bacterial vaginosis. Another sign that vaginal discharge is abnormal is when it is associated with itching, redness or general irritation of the vulva. A common vaginal infection with these symptoms is the well-known yeast infection.
 
3. Postmenopausal Bleeding
The average age of menopause is about 51 years old. Menopause is defined as a cessation of your period for one year. This means that you have gone one year without a period. Any bleeding, after this year, is referred to as postmenopausal bleeding. Postmenopausal bleeding is not normal. It can be light and only seen on the toilet paper when wiping. Alternatively, it can be bleeding that is similar to a period. I repeat. This is not normal. Postmenopausal bleeding should always be evaluated. It can be a sign of the presence of masses within the uterus that need to be removed, such as polyps. It can also be the sign of endometrial or uterine cancer.
 
4. Breast Lump
Despite recent controversy over the past few years regarding the value of self-breast exams, I continue to encourage my patients to perform self-breast exams. Think of it this way. You are with your breasts more often than your doctor is. You know what your breasts feel like and are more likely to detect a change faster than if you waited for your yearly clinical exam with your health care provider. I am certain that just about every Gynecologist knows a patient who performed her own breast exam at home and found a lump that was confirmed to be breast cancer. When you perform a breast exam, I encourage you to feel for lumps. If you feel something firm like a frozen pea, that is not normal. You should also make note of any changes in your skin, such as changes in skin color and/or texture. Also, look at your nipples. Do they usually stick outward and suddenly one nipple is turned inward? Lastly, report any nipple discharge that is not related to breastfeeding to your health care provider. I encourage you to go to nationalbreastcancer.org/breast-self-exam and read about self-breast exams. You can even set up your personalized early detection plan. This plan with your permission will email you or text you reminders of when you are due for your self-exam, clinical exam or mammogram.
 
Self-breast exams alone, however, are not sufficient to screen for breast cancer. Mammograms are necessary to assist with early detection of breast cancer. Ask your health care provider, about his or her recommended guidelines for how often you should have a mammogram. The National Breast Cancer Institute recommends a mammogram every 1-2 years for women over the age of 40. I typically follow the guidelines set forth by the American College of Obstetricians and Gynecologist. They recommend annual screening mammograms for women beginning at the age of 40.
 
5. Vulvar Skin Lesions or Moles
Okay, so I know this sign does require some self-evaluation. Every now and then you should look at your vulva with a mirror. If you see any lesions (e.g., bumps or patches), moles, sores, ulcers or even dry areas, you should schedule an appointment for an evaluation. If you have an area of concern accompanied by itching, irritation or even bleeding, this can be even more concerning. You may need a biopsy of the area. I do not recommend that you simply allow your provider to treat your symptoms without knowing a diagnosis. A biopsy (taking a piece of the skin in the area of concern), which is a simple office procedure, can help lead to a diagnosis and rule out the presence of precancerous or cancerous changes of the vulva. Not all lesions need biopsies. Some may need to be cultured. Some lesions have such a classic appearance and set of associated symptoms that a biopsy is not necessary (for example, herpes). If you have an area of concern and it has already been treated for 3-6 months without resolution of symptoms, I strongly recommend that you inquire about having a biopsy.
 
I hope this list is helpful to you. Early detection of conditions often begins with education and self-awareness.

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