Chalk it up to cultural censorship, lack of sexual health education or whatever you can come up with. But one thing is for certain, women’s health is taboo. Talking about our period, oral sex, abortion, masturbation is just one big no-no. On March 8, it’s International Women’s Day, so to celebrate what the United Nations calls “the historic struggle to improve women’s lives,” BK Magazine sat down with three gynecologists and asked the questions many women just don’t ask.
Our Experts
Yaowaluk Rapeepattana, M.D.
Obstetrician-Gynecologist
Samitivej Sukhumvit Hospital (133 Sukhumvit 49, 02-711-8000. www.samitivejhospital.com)
Papakorn Mingmitpattanakul, M.D.
Obstetrician-Gynecologist, specializing in infertility
Bangkok Hospital Medical Center (2 Soi Soonvijai 7, New Petchburi Rd., 02-310-3000. www.bangkokhospital.com)
Saengduan Chindavijak, M.D.
Obstetrician-Gynecologist, Gynecologic Oncologist
Bangkok Hospital Medical Center
MIND THE GAP
What’s the best way to clean my vagina?
Yaowaluk Rapeepattana: Using water or herbal solutions is the best option. Stay away from chemical products and refrain from cleaning it more than once or twice a day. It’s like your face; don’t clean it too much or too little because it can cause irritation and inflammation.
Does waxing or trimming my pubic hair have any hygienic value?
Papakorn Mingmitpattanakul: Waxing is not recommended. When you wax, you open up the hair follicles increasing the opportunity for bacterial infections.
What counts as abnormal vaginal discharge?
YR: It is difficult to generalize what or how much is normal but you will realize when you have a problem. Abnormal discharge will cause itchiness and pain and will usually exude a smell.
What are the main causes of yeast infection?
Saengduan Chindavijak: Yeast infection is a very common problem in Thailand due to the high consumption of antibiotics, usually related to treating skin and acne problems. This consumption creates an imbalance in the body. Such infections have little to do with being “dirty” and, aside from antibiotics, it can be caused by mental stress or physical exhaustion.
How can you treat a yeast infection?
YR: You should only treat a yeast infection when you are showing symptoms such as too much discharge, irritation or pain. This can be done
with locally available suppositories and creams that will treat the condition.
THE CYCLE OF LIFE
What’s better: tampon or pad?
YR: Using a pad is better because we live in such a hot and humid country. When you insert a tampon, the heat and humidity allows for more bacteria to grow. These bacteria create toxins, which can enter your circulatory system and cause toxic shock syndrome. Tampons are better in cold, dry climates.
What is pre-menstrual syndrome or PMS?
SC: Symptoms include depression, mood swings, impatience, bloating, insomnia, pains and aches, they’re all caused by the changes in your hormone levels. It’s normal to suffer from PMS a week before your menstrual cycle.
How can I reduce the symptoms of PMS?
SC: A low hormone dosage of the birth control pill can help regulate your cycle and your PMS. Plus, as an added bonus, it also helps improve your skin condition.
SEXUAL HEALING
Is it healthy for a woman to masturbate?
YR: Masturbation is good. It’s healthy because it helps you to release tension. And anyway, it’s better than having sexual contact with someone who you don’t know. Right? To keep it clean, take a shower before hand.
Are there any health risks from having anal sex?
YR: Go for it, as long as your sexual partner agrees. I mean, if you enjoy it together, why not? However, I would recommend that you perform vaginal intercourse before anal intercourse, otherwise you could get a bacterial infection.
Is it safe to swallow sperm?
YR: Spitting or swallowing sperm are both fine, if your partner doesn’t have any sexually transmitted diseases or sexually transmitted infections. Healthy people have clean sperm!
What sexually transmitted diseases (STD) should sexually active women get tested for?
SC: The four main STDs you should get tested for include syphilis, Hepatitis B, Hepatitis C and HIV. If you are sexually active with multiple partners, you should test for HIV every six months, since that’s when the antibodies start to show on the test.
YR: Look, I recommend sexual activity with a single partner. But even then you should tell your man to use a condom. I don’t believe Thai men have single partners. So if you have doubts, be safe.
Can you get STDs from Oral Sex?
YR: You should be cautious and make sure that there are no ulcers in your mouth or on your partner’s penis.
SEX, CERVICAL CANCER AND ACRONYMS
Is it true that being sexually active can increase my risk of getting cancer?
YR: The Human Papilloma Virus (HPV) is classified as an STI (sexually transmitted infection) as 90% of all cases result from sexual contact.
SC: Persistent or long term HPV infection will give you a greater chance of getting cervical cancer.
YR: There are many kinds of HPV, hundreds in fact. The most common among Thai women are types High Risk HPV 16 and 18.
How do I check to see if I have a HPV?
YR: I always recommend my patients to screen for HPV once they reach 30. When you go in for your pap smear or pelvic exam, ask your doctor to also check for HPV. If you’re younger than 30, there is an 80% chance that the virus will clear up naturally. But when you’re over 30, this drops to 30%, so women over 30 should really be aware of this virus.
Can my boyfriend get himself checked for HPV?
YR: Men’s bodies react to the infection differently, they carry the germs and pass it onto their sexual partner, and it’s pretty much impossible to screen men for HPV right now.
How can I reduce my chances of catching it?
YR: Depending on how much you want to spend, there are two types of HPV vaccines. One that inoculates against types 16 and 18 and one that vaccinates against types 16, 18, 6 and 11 (6 and 11 are genital warts). Either way, the vaccine is 70% effective because it only covers these particular types of HPV. Nevertheless, girls and women age 9-50 should get the vaccination.
SEX WITHOUT THE BABIES
What contraceptives should I use?
PM: The most efficient ones on the market right now are progesterone hormone injections and Implanon. Implanon, which is a small tube surgically placed in your arm, has a 0.2% chance of pregnancy in three years. The treatment to have the tube inserted costs around B10,000. Progesterone injections are only B100.
Can contraceptives have any long-term effects?
PM: With progesterone injections, you will have to wait a year after your last procedure before you can get pregnant. With Implanon, you only have to wait two months. Also, the progesterone injection has side effects such as bleeding and weight gain.
So what kind of contraception do you recommend for different age groups?
PM: For teenagers, I recommend condoms because it covers both STDs and pregnancy, and with condoms you only have a 7% chance of getting pregnant in a year. For women that have never had children, use the pill, which has a 3% chance of pregnancy in a year. You just have to choose the right method for you, and it’s the job of the health coordinator of family planning branches to point out what’s suitable for you.
Can you get the morning after pill here?
PM: Yes, you can have it prescribed by a doctor at a hospital or you can buy it over the counter.
When do I take the morning after pill?
SC: You have to take it 24 hours after sex. After that the efficiency rate will decrease: by 72 hours, it’s 50% lower. If taken correctly, the success rate is around 90% but it also depends on your ovulation cycle—if you had sex during the peak time for pregnancy and take the pill, it won’t work as well. Also, the pill can cause bleeding and disrupt your menstrual cycle. While there are no long-term effects, I do not recommend taking the morning after pill; its accuracy is really low compared to other contraceptives.
How To Check Your Breasts
You should carry out a self-examination monthly after you pass the age of 25. Dr. Wichai Vassanasiri says the ideal time to do it is anywhere between 7-10 days after your menstrual cycle because the breasts are soft and any lumps (which can be potentially cancerous tumors) can be felt more easily. Here’s how to do it:
Look
- Face the mirror and raise your hands up to see if you have any dimpling.
- Put your hands on your waist then push down. Muscles around the breasts will contract. Again, check for dimpling.
Feel
- Do this in the shower. When your skin is slippery, it’s easier to feel any lumps.
- Inspect your left breast with your right hand and your right breast with your left hand.
- Press your fingers on the outside of your breasts and circle inwards, to wards the nipple, clockwise then counter-clock wise. Make sure you cover the whole breast. Repeat from the nipple to the outside.
- Repeat with an up and down motion.
- Repeat with a radial motion.
- Repeat steps 3-5 while lying down.
- Squeeze the nipple to check for any discharge.
Wichai Vassanasiri, M.D.
- Head of Surgical Oncology Unit Phramongkutlao Hospital
- Consultant Breast Surgeon Samitivej Sukhumvit Hospital
Q&A Abortion
Illegal in Thailand, it remains one of our society’s biggest taboos. We speak to Dr. Papakorn Mingmitpattanakul (see Experts).
Is abortion illegal in Thailand?
Technically, yes, but we do have situations where the law allows for abortion. The first is if the birth puts the mother at physical risk, the second is if the baby faces abnormalities that will decrease its chances of survival and the third is if the abnormalities of the child will put the mother at risk mentally. Incest and rape are also grounds for abortion but they have to be reported to the police and go through the process of documenting the crime.
What are the major issues surrounding abortion in Thailand?
The major problem is the lack of knowledge. The government does not provide enough information about safe sex to the public, especially teenagers. If we are so concerned, we should spread the knowledge about safe sex and then abortions will be reduced.
How safe are illegal abortion clinics?
We don’t have official studies or figures. But some women do come to us after an illegal abortion. There are capable people working at these clinics, but it’s still dangerous. There are very few cases of deaths, but sometimes we do get women who suffer long term effects because their wombs have been so damaged or their fallopian tubes have been destroyed.
Can an abortion affect your future chances of bearing children?
You can get an infection from an abortion and have serious problems, sometimes you can get scars inside the womb or the fallopian tube can get blocked. Both problems can cause infertility.
How many times can a woman get an abortion?
Quantity is not important—it all depends on the quality of the procedure.
How can we reduce the social stigma around abortion in Thailand?
The most important thing is to increase people’s understanding of the topic, increase the levels of knowledge, education and information available.
bk asks: What is it about women that you men don’t understand?
Phalatphon Prushyapinun, 26, marketing officer
They often ask you where you want to eat when they already have a choice in mind. When you give them a choice of your own, they always say no. So why ask?
Harit Pitakjakpipop, 28, teacher
They constantly bug us about why we’re so into IT and technology when they do the same about stars and gossip.
Anurak Tangtrongchana, 26, application filing officer
Women are picky, especially when they shop. They’ll look at a million things, try all of them on and won’t even make a purchase.
Sean Burton, 40, teacher
The fact that they have to make everything so complicated.
Panupong Premvaranon, 23, graphic designer
Their obsession with anything on SALE. Women don’t care how far they have to travel and they might not even end up buying anything, but the fact that there is a sale somewhere means they’ve got to go.
Praveen Pilli, 23, yoga instructor
A lot of women are more concerned about a family life, love and emotions rather than their careers.
