This article is on implanon.
It is a soft plastic, thin, 4cm rod that is injected just underneath the skin of your inner arm under local anaesthesia, where it release progesterone hormone slowly over 3 years. It is a birth control method that is 99% effective in preventing pregnancy by prevent egg release (ovulation) and thickening the cervical mucus. It also has additional functions of treating heavy periods and bad menstrual cramps.
It can be inserted (or removed) in the clinic as long as you are not pregnant, and takes 7 days to start working. It has not been shown to be associated with weight gain.
The implanon does not protect you against sexually transmitted infections (STIs) – you should use condoms in addition for that.
Common (affecting 1-5% of patients):
Uncommon (affecting 0.1-1% of patients)
Rare (affecting <0.1% of patients):
You can have an implanon inserted immediately after giving birth, although most women will wait until they recover from childbirth before having one inserted.
There should be no change required in your lifestyle – you should be able to go back to work and your usual activities (including shower) on the day of implanon insertion. Remove the pressure bandage the evening of insertion, and the waterproof dressing a few days later. You may resume your arm exercises after the initial discomfort and bruising following insertion have stopped.
See your gynaecologist earlier for a check-up if you:
You can try for pregnancy immediately after your implant is removed as there is no delay to your fertility returning. Do take note of preconception care.
Genital warts are small lumps that occur on or around the genitals. They are caused by Human Papilloma Virus (HPV) infection, although most people with HPV either do not develop warts (and pass on the infection unknowingly) or go for a long time before developing them. Close skin-to-skin sexual contact (not necessarily penetrative sex) is required to pass on this virus. Most warts are caused by HPV 6 or 11. It is one of the most common sexually transmitted infections (STI).
They usually look like one or more small, skin-colored or pink lumps on the skin. Appearance of warts can vary from person to person – some are soft whilst others may be firm. Warts can develop on the outer skin of the penis (for men) and on the vulva, vagina and cervix (for women). They can also occur on the skin around the back passage.
Most of the time, warts have no symptoms. Depending on their location, they may sometimes cause irritation or discomfort.
Tests are usually not required for diagnosis of warts. A physical examination of the external genitalia and a vaginal examination is performed, and warts diagnosed based on their typical appearance. As people with warts may have other sexually transmitted infections (STIs), checks for other infections may be recommended.
Do not use over-the-counter wart creams sold in pharmacies for genital warts. A third of warts may disappear without treatment over 6 months. Treatment options include imiquimod cream, surgical removal, or laser treatment.
Your sexual partner should get checked for genital warts or other STIs.
Warts are not cancerous, however people with genital warts are at higher risk of having other HPV infections which may be cancer-causing. Do keep up-to-date with cervical cancer screening (for women).
Yes, they can come back even after being cleared with successful treatment. This is usually because of a re-activation of the virus infection and not necessarily due to a new infection. Treatment remains the same.
There is a vaccine available that protects against HPV 6 and 11. Condoms partially protects you from getting HPV infection (as skin that is exposed can still get infected), and also helps to protect against other STIs. Either avoid sex until warts have disappeared or use barrier protection consistently.
An abortion involves terminating a pregnancy (TOP). This can be for various reasons and can only be performed by a licensed gynaecologist. Different countries have different regulations regarding TOP. In Singapore, TOP can only be performed when a viable pregnancy (with a heartbeat) has been confirmed inside the uterus, and after 48 hours following compulsory abortion counselling. The legal limit is up to 24 weeks of pregnancy.
Your gynaecologist will need to take a detailed medical history, do a pelvic examination and perform a transvaginal pelvic ultrasound to determine how many weeks you are pregnant. Vaginal swabs to rule out sexually transmitted infections (STIs) may be offered. Serial blood tests to measure your pregnancy hormone (b-hcg) may be needed if the pregnancy is still early and cannot be seen on ultrasound. You will also need blood tests to check your blood count and blood group.
For early pregnancy, there are 2 methods – medical and surgical.
This is suitable for pregnancies up to 70 days old. It is 80-90% effective and involves taking oral tablets (which may need to be repeated) that will induce cramps and bleeding. The tablets can be taken at home. If bleeding is heavy and continuous, you will be advised to go to the Emergency Department. Risks of medical abortion include:
You should expect cramps and bleeding to start within a few hours of taking the tablets, which will be like a heavier-than-usual period that will last for 1-2 days, following which the cramps and bleeding will slow down after you pass out clots and pregnancy tissue. Your gynaecologist will schedule a follow-up appointment with you after the bleeding has settled to check that the medical abortion has been successful.
This is suitable for pregnancies up to 11 weeks. It is 95% effective and involves a day surgery procedure under general anaesthesia. A thin vacuum tube is inserted into your uterus through the cervix to remove the pregnancy products through suction. This takes 5 to 15 minutes and most women will be able to go home on the same day. You will be asked to take some oral tablets 3 hours before the procedure to prepare your cervix (neck of the womb) – this may cause some cramps and spotting. Risks of surgical abortion include:
If your pregnancy has gone beyond 12 weeks, you will need to undergo MTPT. This involves hospitalisation of at least 2 days, with vaginal tablets inserted every few hours. The process may feel like a mini-labor, with cramps and bleeding before the pregnancy is passed out. There will be painkillers given, and the risks are similar to medical abortion above.
20% of women may have incomplete MTPT and require surgical evacuation of uterus. This procedure is similar to surgical abortion.
Multiple abortions can be harmful for your physical and mental health. If you are not planning for pregnancy, there are many birth control methods available. Most can be started immediately after your abortion – do speak to your gynaecologists about the options available for you.
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