services

Gynaecology

Our clinic is dedicated to providing gynecological care for women of all ages. Our goal is to provide personalized, high quality, accessible care from adolescent until after menopause .We focus on care for the well-women (preventive care) as well as cutting edge treatment for known reproductive and gynaecological disorders. These include abdominal, laparoscopic, vaginal and hysteroscopic procedures. We are accreditated to perform these procedures at any of the six private hospitals in Singapore.
Laparoscopic surgery (key-hole surgery)
Laparoscopic Surgery (key-hole surgery) involves the direct visualization of abdominal and pelvic organs via the introduction of a small fiber optic lens 5-10 mm in size (with a built in light source) into the abdominal cavity. Entry to the abdominal cavity is achieved by making a small incision at the level of the umbilicus (navel), inserting a multipurpose access port, and passing the fiber optic lens through the port into the abdomen. Additional access ports may be placed in strategic places along the abdominal wall in order to facilitate the passage of multiple specialized surgical instruments. The net effect is to permit the surgeon to perform intra-abdominal/pelvic surgery without the need of a large surgical incision. Again, post operative pain is substantially decreased and post operative recovery time is minimized.

Procedures traditionally performed through "open" incisions are now routinely handled through laparoscopic interventions. Examples of these procedures are diagnostic procedures, destruction of endometriosis lesions, hysterectomies, surgeries for subfertility, removal or drainage of ovarian cysts, removal of ovaries and/or Fallopian tubes, bilateral tubal ligation and evacuation of ectopic (tubal) pregnancies.

Dr Seng has been performing laparoscopic surgery for the past 10 years including ovarian cyst removal, hysterectomies, fibroid removal and fertility surgery. Please call for a consultation to learn more about your options.
vaginismus
Vaginismus is a condition marked by involuntary spasms of the vaginal muscles, brought on by the fear of vaginal penetration. As a result, any attempt at intercourse, tampon use, or even a routine gynecological exam is not just painful, but virtually ¬impossible.

If you think you have vaginismus, know that you are not alone. Up to 7% of women worldwide suffer from this condition . Vaginismus is often overlooked or mis¬diagnosed by health care providers unfamiliar with this condition.

Vaginismus is also commonly misunderstood by both partners in a relationship. women would think they are unnatural and men would think their partners are not relaxed and too anxious.

Vaginismus is an involuntary and uncontrolled fear of penile penetration resulting in an inability to have pain-free intercourse. The fear is so great that it is usually accompanied by severe anxiety, often to any form of penetration. For many women, intercourse is impossible. Vaginismus accounts for 1-7% of unconsummated marriages worldwide and effects women in many different cultures.

Mild to Severe Vaginismus

It is important to understand that this sexual pain disorder can have different levels of severity. While some women have mild vaginismus resulting in painful intercourse (dyspareunia,) others are so severely afflicted that intercourse is intensely painful or impossible. The pain from attempted intercourse is often described as burning, with some describing the pain as being cut with a knife, and others talk about being rubbed with sandpaper. The after effects of pain can last for hours to several days.

Is muscular spasm the cause of Vaginismus?

Researchers in the field argue whether or not "spasm" of the muscles is present.In mild cases of vaginismus, muscular spasm may not be apparent but In severe cases of vaginismus, spasm is invariably present, especially at the vagina opening. Classically women with sever vaginsmus would give a history that intercourse is like "hitting a wall" or "hitting a brick wall"

Fear and Anxiety; Hallmarks of Severe Vaginismus

As women experience pain with attempted intercourse, they begin to develop a fear and anticipation of pain with repeated attempts at intercourse. Soon major anxiety develops with even the thought of penetration. This severe anxiety carries over into gynecological exams where penetration with a digit or speculum may be impossible. This shows that vaginismus is so much more than a sexual pain disorder – it affects many other facets of these women’s lives.

Vaginismus: Psychologic vs. Physiologic

Vaginismus can be both psychologic and physiologic. This could be a natural protective defence mechanism against pain. The body tends to establish natural defenses against pain and injury. For women with vaginismus, the fear of penetration due to perceived or actual pain sets up a reflex that tightens the vaginal muscles. in severe cases of vaginismus invariably show severe spasm of the entry or other vaginal muscles. In this way, the body is saying “no entry” to protect itself against pain.

Summary

Vaginismus is a complex sexual pain disorder that interferes with the ability to have comfortable enjoyable intercourse. Often the cause is not clear, but the manifestations tend to be similar with heightened vaginal muscle tightness, or spasm especially of the entry muscle, making intercourse impossible. It is accompanied by varying levels of fear and anxiety to penetration.

Treatments for Vaginismus can be effective, especially for the less severe forms of vaginismus:
  • Kegels and Dilation Using a series of Kegels and combining this with dilators can help women who have minimal anxiety and the ability to tolerate some forms of penetration..
  • Hypnotherapy works by allowing patients to reduce their levels of anxiety and work toward penetration. It may also be helpful in cases of childhood abuse.
  • Sex Therapy addresses methods to achieve more intimate relations progressing to intercourse. Although sex therapy may not work in the more severe cases, this is a useful post-procedure to help patients overcome their continued fear of penile penetration and libido issues they may have.
  • Psychotherapy is designed to help patients overcome the anxiety of penetration. CBT (cognitive behavior therapy) has its advocates. Less severe cases of vaginismus respond to this form of treatment.
  • Physical Therapy is helpful in moderate cases of vaginismus by incorporating manual stretching. Dilators are often recommended as part of the treatment. This may be combined with Biofeedback to help women lessen pelvic floor tension.
  • Biofeedback teaches patients how to lessen pelvic floor tension. It can be valuable in the less severe patients with vaginismus, but requires a probe in the pelvic area which may make the more severe cases of vaginismus uncomfortable.
  • Anti-depressants and anti-anxiety medication may be of help, but too often patients complain of an altered state of mind.
  • Excess alcohol use has been used by a number of my patients feeling that this will help them relax enough to tolerate intercourse. Since most of my patients don’t smoke, and very few drink, this is a path that goes nowhere. Even if they manage to have penetration, they continue to have high levels of anxiety without the alcohol. The same is true of hallucinogenic drugs. Excess alcohol is NEVER recommended.
  • Hymenectomy rarely cures vaginismus. Some of my patients have had two hymenectomies. The second one doesn’t help either.
  • Vestibulectomy, in which a cuff of vaginal mucosa is removed surgically, is done in the more severe cases and appears to give good results. This however is a major surgical procedure and requires six weeks of healing. Some patients continue to have pain in the scar tissue.

Summary:Treatments for Vaginismus

Though there is very little scientific literature proving the efficacy of the above treatments, there appears to be enough experience that they could work for the right person. Even when the muscle relaxing injection treatment with dilation is used, patients may need additional support after the procedure. Some patients do fine and make rapid progress, while others may struggle with continued fear of penile penetration, relationship issues, and low libido. The partner sometimes struggles with erectile dysfunction. A therapist is essential for these more difficult cases to achieve the goals of comfortable intercourse. Muscle relaxing injection by itself without post-procedure support is likely to fail, and this is why we are so adamant about maintaining communication with our patients.