HUMAN PAPILLOMA VIRUS (HPV)

Medical experts say that often the culprit in abnormal pap smear results is the human papilloma virus. HPV is a common infection in women and is also the leading cause of cancer of the cervix.

Up to 60 per cent of sexually active women may carry this virus on their cervix, genital area, or skin and be completely unaware of it, as it rarely causes symptoms. Only 1 per cent of sexually active adults have visible genital warts, while other types of HPV are subclinical infections.

The virus can be detected only during the annual pap smear and it is especially important for women diagnosed with the virus to have regular smears.

'While the pap smear is not designed to detect HPV, abnormal changes to the cervix may indicate HPV infection,' said Dr Roland Chieng, an associate consultant obstetrician and gynaecologist with SGH.

Follow-up tests can then be ordered to determine the cause of the changes.

There is no cure for the virus and it may lie dormant in the skin after treatment before becoming visible again. Sometimes, visible warts never return. Treatments for HPV range from acid medicines to creams to laser therapy.

PELVIC INFLAMMATORY DISEASE (PID)

PID refers to the infection of the womb, fallopian tubes and other reproductive organs. If not treated, the fallopian tubes and tissues in and near the uterus and ovaries can be damaged, leading to infertility, ectopic pregnancy (a pregnancy outside the womb), abscess formation, and chronic pelvic pain.

In many cases, PID is associated with two very common bacterial sexually transmitted disease (STD) - gonorrhoea and chlamydia.

The most common way that the reproductive organs are infected is through sexual intercourse. It is not surprising then that sexually active women in their child-bearing years are most at risk.

The only way to protect oneself from PID is to use barrier methods of contraception. And although birth control pills offer no protection against STDs, doctors say they may give some protection against PID by causing the body to create thicker cervical mucus, making it more difficult for bacteria to reach the upper genital tract.

Research has also shown that women who douche - the process of rinsing or cleaning the vagina by forcing water or another solution into the vaginal cavity to flush away vaginal discharge - often may have a higher risk of developing PID as douching changes the organisms that live in the vagina in harmful ways, and can force bacteria into the upper reproductive organs from the vagina.

The symptoms of PID vary from none to severe. A woman may experience mild symptoms or no symptoms while serious damage is being done to her reproductive organs. Those who have symptoms most commonly suffer from lower abdominal pain.

They may also have fever, smelly vaginal discharge, find intercourse painful, or have irregular menstrual bleeding. Because these could be signs of many things, PID often goes undetected.

But when diagnosed, infections can be treated with several types of antibiotics. The problem is that damage to organs cannot always be reversed.

So the best way is to take precautions against sexually transmitted diseases - for example, by using a condom and abstaining from casual sex.

ENDOMETRIOSIS AND FIBROIDS

Audrea Kwang, 19, a student, says she gets menstrual cramps which are so bad that she sometimes faints.

'Sometimes I take painkillers and the pain goes away but I often miss class because of it,' she says.

Miss Kwang suffers from endometriosis, a condition in which tissue which is similar to the lining of the uterus is found outside the uterus. These tissues react to hormonal changes during menstruation, causing cramps and pelvic pain. About 7 per cent of women of reproductive age are affected, but most will not know they have endometriosis.

Though there is no known cause for the condition, treatment ranges from birth control pills, which are taken continuously to relieve symptoms in many patients, to surgery to destroy the cells that are outside the uterus.

Dull pain in the abdomen and heavy and painful periods can also be a sign of uterine fibroids.

Fibroids are common, non-cancerous growths on the womb muscles.

If the fibroids do not cause any symptoms, doctors will let them be. Dr Chieng said women who are close to menopause usually do not need surgery as the fibroids shrink once the level of the hormone oestrogen declines.

If the woman is of child-bearing age, then the fibroids are removed individually. Experts say the good thing about surgery is that it preserves the woman's fertility and is most useful where there are one or two large fibroids.