O&G: Women’s Health

One of the problems with constantly being in a public hospital in Singapore is that cases that are seen are the more interesting, the more tragic, the more complicated. And J., halfway through his posting, has seen a fair number of cases.

He is glad to be a man.

That is despite the fact that at all ages, women have a longer lifespan than men. Women in Singapore, once past the age of 55, can expect to live to 83, whereas men can expect to live to 79. Women tend to live longer with disability before they die than men. [1]

J. is still glad to be a man.

If nothing more than because he has a reproductive system that doesn’t have sufficient pathology to warrant an entire specialty to itself.

For practical reasons, let’s restrict these to conditions that are fairly more common. Also, STDs can affect both men and women.

Take pregnancy and labour, for example. For a process that’s supposed to be natural, it seems rather pathological. It is important, at this point, to note that with no proper care whatsoever, 95% of pregnant ladies will give birth to a normal baby.

It would make for very good odds for a wannabe quack private obstetrician, if he wouldn’t get his ass sued off by that 5% and raise his elevated insurance premiums even higher.

There’s all the things that could go wrong. The fetus might not grow well. Pre-eclampsia. Gestational diabetes mellitus. Pre-term labour. Premature rupture of membranes. Placental problems (possibly leading to antepartum haemorrhage). Post-partum problems.

Labour itself isn’t a walk in the park. Besides the length and painful nature of the contractions (made more comfortable by that wonderful method of anaesthesia: the epidural), there’s the risk of prolonged labour, the risk of perineal tears (yet preventable with good episiotomy and episiotomy/perineal tear repairs).

In J.’s Q&A notes, there is this quote: “Pregnancy is the wage of sins. fibroids are the rewards of virtue” – Prof Prasad.

Then there’re fibroids. Ovarian cysts. Often asymptomatic, occasionally problematic, surgically resectable.

Then there’s adenomyosis and endometriosis. A nightmare to treat. One of J.’s professors said that most surgeries, such as resecting the endometriotic tissue, is not the best method. The best treatment is pregnancy. The next best treatment is oophorectomy (removal of the ovaries). These methods are targeted at lowering oestrogen levels.

Take the three most common gynaecological cancers: cervical, endometrial and ovarian. Ovarian cancer is usually asymptomatic so that by the time it’s discovered, possibly by accident, it’s already spread.

J. has decided he’s happy with the luck of the draw.

Despite with the list of erectile dysfunction, testicular cancer, prostate cancer (presents with urinary retention), benign protastic hypertrophy .

1. Statistics Singapore – Measuring Old Age Life Expectancy in Singapore


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