DESPITE more public health campaigns about the importance of women going for pap smears, the number of cases of gynaecological cancers are not falling, says oncologist Dr Serena Sia.

Regular pap tests are key in the fight against cervical cancer, but many women still neglect their two yearly check-up, or are from a low socio-economic background and unable to make screening a priority.

Armed with new evidence and better technology, the government is launching a new cervical screening program in December it hopes will improve early detection and help save more lives.

While the current pap test can detect abnormal cell changes, the new cervical screening test will detect the human papillomavirus virus that can cause the abnormal cell changes, prior to the development of cancer.

• CT scan of a patient undergoing brachytherapy for cervical cancer, showing the expected radiation dose delivered to the tumour site.

Under the new program, the two yearly pap smear for women aged 18 to 69 will be replaced by a five yearly papillomavirus test for women aged 25 to 74.

The government says that screening women under 25, for the last 20 years, has not reduced the rates of cervical cancer in that age group and that treating abnormalities that normally resolve themselves can lead to pregnancy complications in later life.

Women will be due for the first cervical screening two years after their last pap test.

For those unfortunate enough to have already developed a gynaecological cancer, surgery is not inevitable, and many tumours can be treated with non-invasive, external beam radiotherapy.

Dr Sia says the treatment is mostly used for cervix and endometrial cancer (lining of the uterus).

“If the cancer is picked up very early, then surgery is the preferred option, but if it’s picked up afterwards then radiation therapy in combination with chemo is usually used, because surgery would mean removing lots of surrounding tissue,” she says.

“In addition, there are some cancers like vulva and vagina, where because of the location, surgery would be devastating and involve removing the organ, so in that case, we use radiotherapy at an early stage too.

“Each radiotherapy session lasts only ten minutes and normally takes place over five weeks.”

Genesis Cancer Care is the only WA clinic to use the ground-breaking brachytherapy to treat cervix cancer, where an applicator inserted into the uterus delivers a high burst of concentrated radiation.

“Lots of studies have shown that if you combine the external radiotherapy with the brachy treatment, there is a higher survival rate,” says Dr Sia.

“It’s a very effective complementary treatment.”

Dr Sia says the three cancers she treats the most are cervix, ovarian and womb (uterus), while vulva and vagina cancer are also seen, but less common.

What is Genital Cosmetic surgery (GCS)?
Female genital cosmetic surgery covers several different procedures that women undergo for a variety of reasons. It is sometimes also referred to as vaginal rejuvenation. The procedures can include:
Labiaplasty – Surgery to the labia minora (inner lips) and less frequently, the labia majora (outer lips), which involves reducing the size of the inner lips so they do not protrude below the outer lips. Some women have labiaplasty because their labia causes them chafing, irritation and also limits their participation in activities such as bike or horse riding. Contraindication: This is contraindicated for women who have a gynaecological problem, such as infection or a cancer.
Vaginal Tightening (vaginoplasty)
– Childbirth can overstretch the vagina, reducing tone and strength. Childbirth can also result in vaginal & uterine prolapse and urinary incontinence which can be corrected during this procedure. This procedure can revitalise the sexual experience for women and their partners.
Perineoplasty – Reconstruction of the perineal area to restore and tighten the malformed tissues of the region. Quite often perineoplasty is done together with vaginal tightening.
Clitoral Phimosis – Clitoral phimosis occurs when there is scarring of the clitoris that it is partially or completely ‘buried’. This painful condition can be the result of blunt trauma, chronic infection, or poor hygiene. Clitoral hood reduction combined with labiaplasty is required for this condition when conservative measures fail. Hence, this should not be considered a cosmetic procedure.
Clitoral hood reduction – Reduction of the hood of skin which surrounds the clitoris, exposing the glans (or head) of the clitoris that lies underneath. A clitoral hood reduction is aimed at providing more stimulation, therefore, heightening a woman’s sexual pleasure.
G-spot augmentation – Involves injecting a substance such as collagen into the g-spot in order to enhance its size and, therefore, theoretically also a woman’s sexual pleasure. The effects lasts 3-4 months on average.
Hymenoplasty – Reconstruction of the hymen, predominantly performed for religious or cultural reasons.
What are the risks and complications of GCS? GCS carries with it the associated risks of surgery, such as reaction to anaesthetic, bleeding, infection and scarring. Other risks of GCS include: wound breakdown; pain during sex; nerve damage; loss of sensation; labia asymmetry and blood clots.
For treatment enquiries, please contact Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG
Waikiki Specialist Centre – 221 Wilmott Drive, Waikiki
Tel: 08 9550 0300,
Fax: 08 9592 9830

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