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Have you ever had an episode where you had to cross and uncross your legs in public due to the itchy sensation below? Or an episode of urgent need of the bathroom to scratch the itchy genitalia? The symptom may sound trivial, but it can profoundly impact our lives, affecting our daily routine and causing embarrassment when socialising with others.

genital itch
Genital itch can be embarrassing and negatively affect your social life.

How common is genital itch?

Genital itch is a common medical symptom that can occur in anybody. It is a non-discriminative symptom, regardless of your educational or socioeconomic background. 

What are the causes of genital itch?

Genital itch symptoms can be broadly categorised into dermatological versus infectious/sexually transmitted disease STD-related causes.

Dermatologically related genital itch:

STD-related genital itch:

genital warts
Genital warts can cause itching and red bumps.

Other causes of genital itch:

Some various bacteria or parasites can cause symptoms of itch over the genitalia when the infection is left unattended. This includes chlamydia trachomatis, Neisseria gonorrhoea, Mycoplasma Genetalium, Gardnerella bacteria, Trichomonas parasites, etc. These are commonly associated with sexually active people. If you are having trouble with genital itching and you are in a sexual relationship, do discuss it with your doctor and consider further screening for sexually related infections. These bacterial/parasitic-related sexually transmitted infections are treatable, and they do not resolve on their own unless treated with the correct medications.

A genital itch can be an embarrassing symptom to present to your doctor. Nonetheless, the condition is manageable if the right cause is determined and dealt with.

When should I see my doctor?

You are encouraged to see your doctor when your symptoms persist and cause impairment and nuisance to your daily routine. 

Further red flags to note and consider seeing your doctor if you have:

Although 'itch' is a generally benign symptom, it may be a tell-tale sign of a more serious medical condition that requires treatment. Do see your doctor if the genital itch symptoms are not improving or if you develop any of the red flags discussed above.

genital itching treatment
Make an appointment with your doctor if you notice symptoms of genital itching.

What will my doctor do?

As genital discomfort or itch can be a private and embarrassing condition, you are encouraged to see a doctor that you are comfortable with.

Your doctor will obtain a relevant history of your symptoms and relevant social/sexual histories. Your doctor will then physically examine your genitalia region for skin integrity. In females, your doctor may request, with your consent, a vaginal examination. In males, your doctor may request, with your consent, to examine your scrotal and penis region. Depending on individual conditions, your doctor may examine the rest of the body for other relevant body signs associated with your symptoms. Your doctor may also offer various tests in the form of blood, swab, scrape, or even urine tests depending on the working differential diagnosis. 

How can I treat my itchy genitalia?

The treatment and management of itchy genital symptoms depend on the cause. In dermatological causes, your doctor may offer topical medicated cream as a steroid, antifungal, or antibacterial to manage the symptoms. In more severe cases of concern with fungal infections, your doctor may prescribe oral antifungals to manage the symptoms. Lifestyle advice to reduce triggers that irritate dermatological symptoms will be discussed.

If the underlying cause is an untreated infection, you may be offered targeted treatment through oral medication, cream, or even procedures such as cryotherapy or electrocautery. 

Discuss your symptoms with your doctor, allow your doctor to examine your condition, and discuss the treatment options available to manage your genital itch symptoms with your doctor.

What will happen if I do not treat my itchy genitalia?

Although itch can be a completely benign symptom that potentially resolves spontaneously, if the symptom is not addressed appropriately, one may miss or delay diagnosing an underlying medical condition. In the event of dermatological-related itchy genitalia, if the underlying skin condition is not addressed, one may have recurring symptoms in the near future. In the event of infectious-related itchy genitalia, one will have an untreated infection and be at risk of developing complications from the infection and spreading the disease to people around you. 

You don’t have to suffer genital itch alone…

There are effective treatments to manage the itch in the genital region. Understanding the possible differentials and having the courage to seek medical help are paramount steps to take to take control of your health and your overall quality of life.


  1. Raef HS, Elmariah SB. Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front Med (Lausanne). 2021 Apr 7;8:649402. 
  2. Krishnan A, Kar S. Scrotal Dermatitis - Can we Consider it as a Separate Entity? Oman Med J. 2013 Sep;28(5):302-5. 
  3. Savas JA, Pichardo RO. Female genital itch. Dermatol Clin. (2018) 36:225–43. 
  4. Fischer GO. The commonest causes of symptomatic vulvar disease: a dermatologist's perspective. Australas J Dermatol. (1996) 37:12–8. 
  5. Connor CJ, Eppsteiner EE. Vulvar contact dermatitis. Proc Obstet Gynecol. (2014) 4:1–14. 
  6. Gopinath H, Karthikeyan K. Genital scabies: Haven of an unwelcome guest. Indian J Sex Transm Dis AIDS. 2020 Jan-Jun;41(1):10-16. 
  7. Thorstensen KA, Birenbaum DL. Recognition and management of vulvar dermatologic conditions: lichen sclerosus, lichen planus, and lichen simplex chronicus. J Midwifery Womens Health. 2012 May-Jun;57(3):260-75. 
  8. Swamiappan M. Anogenital Pruritus - An Overview. J Clin Diagn Res. 2016 Apr;10(4):WE01-3. 
breast lumps
Breast lumps must be checked out by a specialist.

Breast lumps are uneven bumps and growths you can feel over your breasts. It is commonly found in women but can occur in men as well, though less common.

More than 25% of women will encounter breast lumps in their lifetime. Thankfully, most of these breast lumps are benign (non-cancerous). In Singapore, according to the Singapore Cancer Registry Annual Report 2021, breast cancer remains the most frequent type of cancer occurring in women over the past 5 years. From 2017 to 2021, this occurrence comprised nearly 30% of all types of cancer.

What signs and symptoms of breast lumps should you be aware of?

You should see a doctor if you notice any of the following:

As these symptoms may be red flags suggestive of breast cancer, early evaluation and treatment are paramount as they can be life-saving.

doctor breast checkup
Your doctor will obtain further information through examinations and tests.

What can I expect when I see my doctor for breast lumps?

Your doctor will obtain a history to understand the timeline and progression of the breast lump(s), a family history of any medical conditions related to breast issues, and will physically examine both your breasts and armpit region. Depending on individual symptoms, risk factors, and concerns, your doctor may recommend imaging scans to evaluate the breast lump(s).

What are the non-invasive tests available for screening breast lumps?

Common screening/imaging options for breast lumps include:

The modalities of screening for breast lumps may differ from patient to patient as this depends on the patient’s symptoms, age, risk factors, and general medical background. You are advised to consult your doctor first to understand your symptoms and, secondly, to examine the area of concern physically. This will allow your physician to guide you on the screening option that is best suited for your individual needs.

Mammograms should be done per your doctor’s recommendation for early detection of breast cancer.

What are the common causes of breast lumps?

As mentioned, thankfully, the majority of the breast lumps are benign. The 2 common causes of non-cancerous breast lumps are breast fibroadenoma and breast cysts. However, occasional breast lumps can be due to a more sinister cause, such as breast cancer. Hence, it is important to get yourself checked if you have any breast lumps.

fibroadenoma and cysts
Benign breast conditions can cause breast lumps.

What is breast fibroadenoma?

Breast fibroadenoma is a common non-cancerous breast finding that usually presents with palpable lumps. They typically develop during puberty or early reproductive ages due to the exposure and sensitivity of oestrogen hormones. The breast tissues, under the influence of oestrogen, will then grow, intertwining with the breast glands and ducts, leading to the formation of a solid nodule (lump).

What are breast cysts?

Breast cysts are common benign breast condition. Breast cysts are lesions that are fluid-filled in nature. Breast cysts may come and go over any part of the breast(s), which can be influenced by the level of oestrogen hormone in a person. Big cysts can cause pain and discomfort in some women. Small breast cysts are usually left alone with regular monitoring by your doctor. In large, uncomfortable cysts, your doctor may offer a procedure to drain out the fluid of the cysts.

What is breast cancer?

Cancer happens when the cells in a person’s body cannot stop growing. If the cell growth is out of control and occurs in the breast cells and tissues, you can develop breast cancer. The breast cancer cells can grow bigger with time and spread to the surrounding tissues through the bloodstream and lymphatic drainage. Over time, they can disseminate to other organs of the body.

Although most breast lumps are not dangerous, a breast cancer diagnosis should not be delayed and missed as early detection and treatment can be potentially life-saving. In the late stages of breast cancer, the cancer cells can affect other parts of the body, eventually developing into cancer.

Please see a doctor if you have a breast lump!

What are the risk factors of breast cancer?

Below are the factors that determine your risk for breast cancer:

It is worthwhile speaking to your doctor about lifestyle measures to reduce your risk of exposure to breast cancer.

early detection
Early detection of breast cancer increases your chances for proper treatment and management.

What is the role of early detection of breast cancer?

Although there is no absolute way to prevent breast cancer, early detection with appropriate screening may be life-saving. Treatment for early stages of breast cancer is curative. Hence, don’t wait and take a chance; screen and treat early.

What are the current breast cancer screening guidelines?

Monthly breast self-examination should be performed at home regularly. Your doctor can guide you on how to examine your own breasts and the pitfalls to look out for. You are advised to consider routine mammogram screening annually from age 40 to 49 and two yearly routine mammograms from age 50 and above.

As guidelines are used for the recommendation of the general population, it is still good practice to discuss with your physician which are the suitable breast tests or imaging for you.

Key take-home messages

Breast lumps are common, and most of the findings are not dangerous. However, breast cancer can present as lumps; hence, breast screening is vital for early detection and treatment!


  1. Daly C, Puckett Y. New Breast Mass. [Updated 2022 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560757/
  2. “Singapore Cancer Registry Annual Report 2021,” n.d., https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-ar-2021-web-report.pdf?sfvrsn=591fc02c_0
  3. Luo C, Wang L, Zhang Y, Lu M, Lu B, Cai J, Chen H, Dai M. Advances in breast cancer screening modalities and status of global screening programs. Chronic Dis Transl Med. 2022 May 25;8(2):112-123.
  4. Fiorica JV. Breast Cancer Screening, Mammography, and Other Modalities. Clin Obstet Gynecol. 2016 Dec;59(4):688-709.
  5. “Breast Cancer,” Singaporecancersociety.org.sg, 2018, https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/breast-cancer.html

Vaginitis is an umbrella medical term for ‘inflammation of the vagina’. It is commonly associated with abnormal vaginal discomfort symptoms such as itch, abnormal discharge, burning or pain sensation over the vagina. Chronic vaginitis occurs when the unusual vaginal symptoms occur more than 6 months.

Chronic vaginitis can be a frustrating journey for both patients and physicians. The condition brings in its wake frequent clinic attendees and a cost burden to patients and the healthcare system. With unresolved clinical symptoms, patients often default to medical follow-up at some point, leading to further poor diagnosis and management of the condition.  

This article strives to highlight the medical condition of chronic vaginitis that significantly affects many women’s quality of life and discuss the common practical pitfalls we face in the management of chronic vaginitis. It seeks to empower both patients and physicians to be more insightful of the condition and be proactive and compliant in treating the chronic condition.

Chronic vaginitis
Symptoms caused by chronic vaginitis can impact one’s quality of life and be the source of frustration and discomfort. 

What are the causes of chronic vaginitis?

We can broadly subdivide the causes of chronic vaginitis into infection-related causes versus non-infection-related causes. The top 3 common infectious causes of chronic vaginitis seen in child-bearing-aged ladies are:

Infection female reproductive system
Vaginitis can be caused by underlying infections of the reproductive system.

It is important to be cautious of possible concurrent infection with sexually transmitted diseases such as chlamydia, gonorrhoea, mycoplasma genetalium, herpes, HIV and etcetera. 

Non-infectious causes of chronic vaginitis are usually associated with background dermatological issues such as irritation secondary to topical use of chemical or douche materials, underlying health issues such as eczema and lichen planus, and hormonal changes secondary to menopause.

As each patient may have a different trigger or cause(s) for chronic vaginitis, it is worth seeing your trusted physician for further evaluation.

What is a normal healthy vaginal discharge?

Every female’s vaginal discharge may differ. It is worth noting your baseline (usual) discharge colour, consistency and volume since you were young. Vaginal discharge will be present in every woman. Generally, the discharge is usually colourless to whitish, with no abnormal odour and a healthy normal baseline volume. The discharge consistency can be more ‘albumin-like’ or ‘milky’ during the mid-cycle or ovulatory phase and slowly becomes slightly thicker towards the end of the menstrual cycle.

What are the abnormal vaginal symptoms that I should seek medical attention for?

Symptoms such as vaginal itchiness, vaginal odour, excessive vaginal volume discharge, yellow to greenish copious amount of vaginal discharge, painful intercourse, painful urination, pelvic or lower back pain, and fever may be suggestive of an underlying health condition yet to be addressed. 

In the long run,  unattended chronic vaginitis may develop complications of pelvic inflammatory disease with womb and fallopian tube inflammation and scarring, leading to infertility and chronic pelvic pain presentation.

Please seek medical attention before chronic vaginitis progresses into long-term health complications.

Vaginal discharge
Changes in the colour and consistency of vaginal discharge warrant medical intervention.

What are the common reasons associated with failure of treatment of chronic vaginitis?

1. Lack of clinical swab testing

This is one of the major common scenarios seen in chronic vaginitis or unresolved vaginitis. It is important to consider clinical vaginal swab tests to cast a broader net of diagnostic screening. Without swab testing, there may be a missed opportunity and a time lag in arriving at the correct diagnosis. Furthermore, a person can simultaneously have a few types of vaginal infections, which clinical swab testing can detect at early stages. 

It is unfortunately common for patients to repeatedly visit clinics in hopes of seeking a resolution to no avail. They are usually given various options of medications ranging from tablets to topicals to intravaginal pessaries during clinic visits, only to have their symptoms wax and wane.

Blind treatment may ease the symptoms temporarily by treating the surface infection, while the remaining infection(s) may linger and cause further recurrence of vaginal symptoms. If your symptoms are not recovering, do let your doctor know and consider vaginal swab testing to ensure the condition is managed appropriately.

vaginal swab test
Vaginal swab testing helps cast a broader net of diagnostic screening.

2. We live in a dynamic world 

With the evolution of time, relationships may not work out how we wish to. The new partner that you engage with may be carrying an undiagnosed infection from their previous partner without knowing- unless regular screenings have been done.

An unresolved history of vaginitis may be due to underlying concurrent infection, including sexually transmitted infection(s) that has yet to be addressed. In this situation, with appropriate testing and receiving proper treatment, the vaginitis will resolve. Sexual partners must be screened and treated to avoid reinfection between the couple.

Fortunately, it is becoming common practice to conduct medical checkups between couples and consider regular sexual health screening to address and treat any asymptomatic STIs.

3. The habit of ‘Doctor-Hopping’

This is another common scenario seen in the community. A patient may see Dr A due to convenience for her condition. Subsequently, when there is a resurfacing of similar symptoms, the patient will then consult Dr B, and if the symptoms are not better, a further consult with Dr C. 

The unspoken issue here: whenever the patient sees a new doctor, unless a proper history or examination is taken, the patient may be treated for that ‘snap-moment’ without taking into consideration the previous symptoms, tests that were offered or treatment that was received. This leads to poor patient care as there is no continuity of care. The constant change of medical providers reduces their ability to fully comprehend patients’ conditions, subsequently failing to provide the comprehensive care that patients deserve. 

It is ideal and advisable to stay with the same doctor you are comfortable with for the long-term management of the vaginitis condition. This will ensure better overall patient care and allow the best possible treatment to be offered to the patient.

doctor hopping
Doctor-hopping results in a lack of continuity of care.

4. Self-medicating

Given recurring and unresolved vaginal symptoms, a patient may opt for various complementary treatment methods. With the rise of social media and digital resources, there is a wide variety of street medications – that promise and guarantee a cure for vaginitis. 

It is important to discuss with your doctor before embarking on self-treatment, as complementary medications may lack clinical evidence and may not work. This may lead to spending excessively and unnecessarily on treatment that is not beneficial at all. Besides, certain over-the-counter products may even serve as an irritant and exacerbate further the symptoms of vaginitis. 

Societal implication of chronic vaginitis

Vaginitis is a medical condition frequently encountered in females. It is one of the causes that lead to frequent attendees in primary care or outpatient clinic settings. Poor management, poor patient insight, wrong diagnosis, and polypharmacy bring in its wake cost and time burden to patients and health care. Furthermore, without resolution of the symptoms, it can create stress and anxiety for the patient and tension in the relationship between couples as well. 

Can we resolve chronic vaginitis?

Thankfully, the treatment outcome for vaginitis is fair, and it is possible to abort and cure the symptoms.  Empowering and educating female patients on the expectation of normal vs abnormal vaginal health symptoms, the possible causes and pitfall triggers may improve the outcome of this condition. In patients who have exposure to possible vaginal infections, the role of vaginal swabbing is vital to consider to nip the cause(s) in the bud in delivering the proper treatment. Lifestyle triggers can be discussed between doctors and patients to reduce the chances of recurrence of vaginal infection.


  1. Sheppard C. Treatment of vulvovaginitis. Aust Prescr. 2020 Dec;43(6):195-199. doi: 10.18773/austprescr.2020.055. Epub 2020 Dec 1. PMID: 33363301; PMCID: PMC7738700.
  2. Schwebke JR, Gaydos CA, Nyirjesy P, et al: Diagnostic performance of a molecular test versus clinician assessment of vaginitis. J Clin Microbiol 56 (6):e00252-18, 2018. doi: 10.1128/JCM.00252-18
  3. Gaydos CA, Beqaj S, Schwebke JR, et al: Clinical validation of a test for the diagnosis of vaginitis. Obstet Gynecol 130 (1):181–189, 2017. doi: 10.1097/AOG.0000000000002090
  4. Hildebrand JP, Kansagor AT. Vaginitis. [Updated 2022 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470302/
  5. Nyirjesy P, Weitz V, Grody T, et al. Over-the-counter and alternative medicine in the treatment of chronic vaginal symptoms. Obstet Gynecol 1997;90:50
  6. Eschenbach, D, Glob. libr. women's med. Infectious vaginitis (ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10491

Libido, better known as sexual desire or drive, indicates an adult woman’s general health [1]. Libidos are instinctual urges, naturally present for all species to procreate and pass their genetic material to future generations. More importantly, libidos are also pertinent in maintaining a healthy relationship and sustaining a romantic bond with your sexual partner. 

Low libido 
Low libido can be understood as the lack of sexual drive or interest.

Multiple pieces of literature [2] have raised the occurrence of lower libido in Asian women. These are often related to conservatism in Asian society. In the case of Singaporean women, however, it may be fair to deduce that they are more sexually empowered to treat lowered libido proactively. 

A recent study [3] indicated that over half of middle-aged women in Singapore are sexually active; however, many are challenged with sexual dysfunction [4], such as loss of libido. A study [5] by  KK Women's and Children's Hospital also revealed low sexual desire and rarely reaching orgasm are commonly reported forms of sexual dysfunction in women. In this article, we take a deep dive into the issue of low libido and how you may overcome it. 

The science of libido

Libido differs from one individual to another, with many factors contributing to the phenomenon. Women exhibit different levels of libido at different ages, some attributed to natural biological changes and others due to factors unrelated to bodily changes. Symptoms of low libido may include:

Biologically, changes in libido are often due to changes in hormones, such as the gonadal hormone [6], which plays a primary role in maintaining libido. Additionally, the hormones androgen [7], oestrogen [8], and testosterone [9] also play an important role in sexual function. Regulated hormone is important as it fuels a woman's psychosexual stimulation and increases sensitivity and blood flow (important in pleasure sensory). 

At different ages, the levels of these hormones may fluctuate, providing some rationale for varying levels of libido in women. Below are general characteristics of libido levels at different stages. 

Age groupCharacteristics 
20-30High biological drive to reproduce but modest levels of sexual drive Women tend to be more selective about when and whom to reproduce with within these age groups (high sexual selection cognition) [10]
31-44Decline of fertility begins Women’s sexual desire tends to become heightened Women tend to have more sex in these age groups 
45 and aboveA decrease in sexual drive is observed as oestrogen levels begin to drop Progressive decrease in libido as women undergo perimenopausal symptoms Libido in these age groups is mostly mind-induced versus biologically driven 

Biopsychosocial elements of low libido: What causes low libido among women?

While libido patterns can be explained by age group and biological change, many can testify that these do not hold true. This is because libido is not just a biological occurrence but a culmination of biopsychosocial aspects.

It is natural and expected that most women have fluctuating changes in their sexual desires throughout their lifetime. Apart from naturally occurring biological changes in your body, some factors that may affect your libido include: 

Biological factors: 

Postpartum mother
Fatigue and stress among postpartum mothers can be a factor of low libido.

Psychological factors: 

Issues such as prior infidelity can lower libido among women.

Social factors: 

Is there treatment for women with low libido?

Depending on the exact cause of your low libido, the approach to remedy your sexual drive varies. Low libido in women is usually a complex case. Your healthcare provider may offer multifaceted treatment and management upon understanding your condition. Below are some approaches you may take to solve libido issues: 

1. Medical intervention for low libido: How is low libido diagnosed?

Women must conduct routine screening and gynaecological health check-ups to truly understand if there are biological changes in their bodies. For instance, regular screening may reveal thyroid disorders as a source of hormone dysregulation and lowered libido. Similarly, you may also obtain insight into other underlying health conditions or medications masking as a lowered libido issue. 

Sexual dysfunction issues can also be addressed at your nearest sexual health clinic under the surveillance of a registered medical professional. Issues may include fear of penetration, painful sex, and inability to orgasm. With a health professional such as a gynaecologist, you can reduce trial-and-error roulette and get to the crux of the issue. 

Where biological issues are present, your partner may also be able to empathise if they are provided with rational justification of what is behind your lowered sexual interest. This will also avoid straining romantic relationships. 

2. Addressing mental barriers pertaining to lowered libido: Can therapy help libido?

Psychological factors can be just as detrimental to your libido and need not be a life sentence.  Therapies such as Cognitive Behavioural Therapy (CBT) [17] and mindfulness-based therapy (MBT) [18] have been proven scientifically efficient [19] in addressing low libido. If you have not been diagnosed with mental health conditions, one can also perceive this as an opportunity to seek psychological intervention. 

It is essential for mothers with postpartum depression to seek psychological help. Whilst lower libido may strain your relationship, there are also risks to your child's development. Interventions [20] may include pharmacological, psychotherapeutic, and nonpharmacologic options. 

If infidelity issues have occurred, you and your partner may attempt couple counselling or marital counselling for assistance in repairing the relationship. A study [21] has shown that whilst couples with infidelity are significantly distressed and depressed initially, couple therapy intervention induced improvement for up to 6 months posttherapy with optimistic results. 

Couple therapy
Couple therapy can be a powerful tool in addressing low libido issues.

3. Holistically improving your libido: Can food and lifestyle increase sex drive?

There are some lifestyle changes you may attempt to address low libido at home. We suggest implementing these changes only if no significant medical or psychological issues impact your libido. Lifestyle changes includes: 

Foods such as fenugreek and maca are scientifically proven to increase libido.

Can women take the blue pill to improve low libido?

There has been a rise in women attempting to self-medicate for lowered or loss of libido. This includes an increased demand for blue pills also known as sildenafil (Viagra) [26]. Sildenafil is approved by the FDA (US Food and Drug Administration) and permitted for use for erectile dysfunction in men. However, it is not approved for use by women in Singapore due to associated risks and complications, which include: 

Blue pills
Blue pills known as Viagra are not medically approved to treat low libido in women.

Should I see my doctor if I struggle with libido loss?

It would be necessary for you to seek a doctor when libido loss becomes a persistent issue (over a month) and is causing you distress. Loss of libido may mean an increase in the possibility of a Hypoactive Sexual Desire Disorder [27] (HSDD) diagnosis. The key difference between low libido and HSDD is that the latter causes significant distress and lowered quality of life. Additionally, HSSD patients may even feel distressed at the thought of sex and can be averse to even self-pleasing. 

If suspected of HSDD, you will be referred to a gynaecologist and sexual health clinic. Further investigations will be conducted to identify the classification of libido loss, which includes genito-pelvic pain/penetration disorder (GPP/PD), sexual interest or arousal disorder, or a female orgasmic disorder.


If you are struggling with a loss of libido, visit your nearest sexual health clinic for appropriate medical intervention. Attempting to self-medicate may worsen your condition or delay detection of serious health conditions. Remember, working to address your libido is healthy and should not be associated with guilt or shame. 

We hope this article has empowered you to make the best choices for your sexual health. Our vision is that issues pertaining to lowered libido or libido loss garner greater momentum in Singapore and other Asian nations. Contrary to traditional beliefs, a great sexual life is as important to women as to men. 


  1. Meštrović, Dr.T. (2021) What is libido?, News Medical. Available at: https://www.news-medical.net/health/What-is-Libido.aspx (Accessed: 01 September 2023).
  2. Ganesan , A. et al. (2019) Ethnic differences in visual attention to sexual stimuli among Asian and white heterosexual women and men, Science Direct . Available at: https://www.sciencedirect.com/science/article/abs/pii/S0191886919305628 (Accessed: 01 September 2023).
  3. Logan, S. et al. (2021) Sexual inactivity and sexual dysfunction in midlife Singaporean women ..., MATURITAS.ORG. Available at: https://www.maturitas.org/article/S0378-5122(21)00122-5/fulltext (Accessed: 01 September 2023). 
  4. Hatzimouratidis, K. and Hatzichristou, D. (2007) Sexual dysfunctions: Classifications and definitions, The Journal of Sexual Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/17233791/#:~:text=The%20four%20major%20categories%20of,%2C%20orgasm%2C%20and%20sexual%20pain. (Accessed: 01 September 2023).
  5. Loy, S.L. et al. (2021) Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: A prospective preconception cohort study - BMC pregnancy and childbirth, BMC Pregnancy and Childbirth . Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03892-5 (Accessed: 01 September 2023).
  6. Hines, M. (2009) Gonadal Hormones and Human Sexuality’. Available at: https://academic.oup.com/book/9978/chapter/157345062 (Accessed: 01 September 2023).
  7. Wåhlin-Jacobsen , S. et al. (2015) Is there a correlation between androgens and sexual desire in women?, The journal of Sexual Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/25475395/ (Accessed: 01 September 2023).
  8. Nichols , H. (2023) Estrogen: Functions, uses, and imbalances, Medical News Today. Available at: https://www.medicalnewstoday.com/articles/277177 (Accessed: 05 September 2023).
  9. Testosterone therapy for women: Can it improve your sex life? (2019) Women’s Health . Available at: https://www.health.harvard.edu/womens-health/testosterone-therapy-for-women-can-it-improve-your-sex-life#:~:text=But%20testosterone%20is%20also%20a,%2C%20depression%2C%20or%20vaginal%20dryness. (Accessed: 01 September 2023).
  10. Maner, J.K. and Ackerman, J.M. (2015) Sexually selective cognition, Science Direct . Available at: https://www.sciencedirect.com/science/article/abs/pii/S2352250X14000359 (Accessed: 01 September 2023).
  11. Vaginismus (2021) NHS choices. Available at: https://www.nhs.uk/conditions/vaginismus/#:~:text=What%20is%20vaginismus%3F,have%20no%20control%20over%20it. (Accessed: 01 September 2023).
  12. Mayo Clinic Staff (2022) Painful intercourse (dyspareunia), Diseases and Conditions . Available at: https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967 (Accessed: 01 September 2023). 
  13. Mayo Clinic Staff (2022) Postpartum depression, Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617 (Accessed: 01 September 2023). 
  14. Rokach, A. and Chan, S.H. (2023) Love and infidelity: Causes and consequences, U.S. National Library of Medicine I. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10002055/ (Accessed: 01 September 2023). 
  15. Woo, J.S., Brotto, L.A. and Gorzalka, B.B. (2011) The role of sex guilt in the relationship between culture and women’s sexual desire, U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/20349208/#:~:text=A%20large%20body%20of%20literature,constructs%20such%20as%20sex%20guilt. (Accessed: 01 September 2023). 
  16. Domenighetti , G. et al. (2009) Impact of job insecurity on sexual desire: An exploratory analysis, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/19705309/ (Accessed: 01 September 2023). 
  17. Cleveland Clinic Medical Professional (2022) Cognitive behavioral therapy (CBT): What it is & techniques, Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cbt#:~:text=Cognitive%20behavioral%20therapy%20(CBT)%20is,coping%20with%20grief%20or%20stress. (Accessed: 01 September 2023). 
  18. Schimelpfening, N. (2023) How mindfulness-based cognitive therapy works, Verywell Mind. Available at: https://www.verywellmind.com/mindfulness-based-cognitive-therapy-1067396 (Accessed: 01 September 2023). 
  19. Meyers, M., Margraf , J. and Velten, J. (2023) Subjective effects and perceived mechanisms of change of cognitive behavioral and mindfulness-based online interventions for low sexual desire in women, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/37260167/ (Accessed: 01 September 2023). 
  20. Fitelson, E. et al. (2010) Treatment of postpartum depression: Clinical, psychological and  pharmacological options, U.S. National Library of Medicine . Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039003/ (Accessed: 01 September 2023). 
  21. Atkins, D.C. et al. (2010) Outcomes of couples with infidelity in a community-based sample of couple therapy, U.S. National Library of Medicine . Available at: https://pubmed.ncbi.nlm.nih.gov/20438197/ (Accessed: 01 September 2023).
  22. Petre, A. (2023) 7 aphrodisiac foods that boost your libido, Healthline. Available at: https://www.healthline.com/nutrition/aphrodisiac-foods#1.-Maca (Accessed: 01 September 2023).
  23. Scott, E. (2022) 18 highly effective stress relievers, Verywell Mind. Available at: https://www.verywellmind.com/tips-to-reduce-stress-3145195 (Accessed: 01 September 2023).
  24. Kalmbach, D.A. et al. (2015) The impact of sleep on female sexual response and behavior: A pilot study, U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/25772315/ (Accessed: 01 September 2023).
  25. Garone, S. (2019) Sleep consultants tell us how to survive the newborn days, Healthline. Available at: https://www.healthline.com/health/sleep-consultants-share-tips-for-new-parents (Accessed: 01 September 2023).
  26. Sildenafil: Medlineplus drug information (2023) MedlinePlus. Available at: https://medlineplus.gov/druginfo/meds/a699015.html (Accessed: 01 September 2023).
  27. Sissons, B. (2023) Hypoactive sexual desire disorder (HSDD): What to know, Medical News Today. Available at: https://www.medicalnewstoday.com/articles/hypoactive-sexual-desire-disorder (Accessed: 01 September 2023). 

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease (PID) is a severe inflammatory infection of the female reproductive organs, which includes the uterus, ovaries, and fallopian tubes. It is related to an untreated or unresolved sexually transmitted infection of the woman’s reproductive organs and is one of the causes of infertility. If pelvic inflammatory disease (PID) is left untreated, one can develop an abscess in the pelvic reproductive area and potentially develop a generalised infection, which can be life-threatening.

Pelvic inflammatory disease (PID) occurs when any part of the female reproductive organ is inflamed.

How common is pelvic inflammatory disease (PID) in Singapore?

In Singapore, pelvic inflammatory disease is commonly seen in women in the age group of 15-24 years old, with a general incidence of approximately 10 in every 1000 women [1].

What are the symptoms of pelvic inflammatory disease (PID)?

You may not be aware of pelvic inflammatory disease symptoms in milder cases, as one can present without any symptoms. Symptoms suggestive of PID include:

If you are experiencing any of the above symptoms or you are concerned about developing PID, you are advised to see your doctor for further evaluation of your condition and seek prompt and appropriate treatment.

irregular period
Irregular periods are a common symptom of pelvic inflammatory disease.

What are the causes of pelvic inflammatory disease (PID)?

The cause of a person developing PID is commonly due to underlying sexually transmitted diseases (STDs) or reproductive organ infections that were left untreated.

Possible causes of pelvic inflammatory disease include [2-5]:

Speak to your doctor about ways to reduce the risk factors of developing PID, and consider STD screening if you are concerned about developing PID.

vaginal douching
Vaginal douching can cause pelvic inflammatory disease.

What is the association between PID and STDs?

STDs are known causes that can lead to PID if the infections are left untreated, as the bacteria can ascend from the vagina to the cervix and further up to the uterus or fallopian tube of the female’s reproductive organs [6].

STDs associated with PID include:

If you have been exposed to STDs/PID, speak to your doctor, consider STD testing, and seek treatment without further delay.

Is there a chance of acquiring PID without having any STDs?

Yes, a person can develop PID even without underlying STDs. Non-STD causes that can lead to PID include:

Please see a doctor if you are concerned about PID or experiencing symptoms that suggest PID.

If I don’t treat the STD, which part of my reproductive system can be affected by PID?

As the STD bacteria that are left untreated can ascend the female reproductive system, areas that can eventually develop inflammation or scarring in PID include:

How do I reduce the risk of acquiring PID?

You can reduce the risk of acquiring PID by:

When should I consider seeing a doctor for PID?

You should seek medical advice if you are presenting with PID symptoms or if you notice the following:

How is pelvic inflammatory disease diagnosed?

PID is diagnosed based on your clinical symptoms and findings from gynaecological tests and examination.

Depending on individual conditions, your doctor may offer vaginal and cervix swab tests for laboratory investigation of STD/bacterial infection. Your doctor may offer tests such as blood tests, urine tests, pregnancy tests, and an ultrasound of the pelvis region to screen further for PID. 

In more severe cases, you may be advised to seek medical attention in the hospital and consider a laparoscopy procedure to investigate further for PID.

pelvic ultrasound
A pelvic ultrasound can identify pelvic inflammatory disease (PID).

Can pelvic inflammatory disease (PID) be treated?

PID can be treated. However, the complications of PID, such as damage or scarring of the reproductive organ, may not be reversible with treatment. Treatment works to clear off the underlying infection(s) and avoid further irreversible complications from PID [9]. Your sexual partner(s) must also be treated to prevent re-infection of the condition.

In severe cases of PID, you may be admitted to the hospital for intravenous antibiotics treatment and monitoring.

What will happen if my PID is not treated?

Long term complication from PID includes:

When can I resume sexual intercourse if I have PID?

You can consider resuming your sexual life after completing your antibiotics and resolving your symptoms. Your partner is advised to get screened and tested before resuming a sexual lifestyle with you.

In conclusion

PID is a treatable condition if it is managed promptly and appropriately. Hence, do not allow the infection to brew longer and worsen; consider early STD screening and treatment!


  1. Women's Wellness Centre KK Women's and Children's Hospital. (2021). Pelvic Inflammatory Disease. Retrieved from HealthXchange.sg: https://www.healthxchange.sg/women/urology/pelvic-inflammatory-disease
  2. AMY CURRY, T. W. (2019). Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention. American Family Physician, 357-364.
  3. Roberta B. Ness, S. L. (2005). Douching, Pelvic Inflammatory Disease, and Incident Gonococcal and Chlamydial Genital Infection in a Cohort of High-Risk Women. American Journal of Epidemiology, 186-195.
  4. Ross, J. D. (2002). An update on pelvic inflammatory disease. BMJ Journals, 18-19.
  5. D Scholes, J. R. (1992). Current cigarette smoking and risk of acute pelvic inflammatory disease. American Journal of Public Health, 1352–1355.
  6. Lindsey K. Jennings, D. M. (2023). Pelvic Inflammatory Disease. Florida: StatPearls.
  7. PAILLIER-GONZALEZ, J. E., & FLOREZ-ARANGO, N. S.-M. (2021). Case report. Pelvic inflammatory disease as a complication of acute appendicitis. Iatreia, https://doi.org/10.17533/udea.iatreia.84.
  8. Jacques Ravel, I. M. (2021). Bacterial vaginosis and its association with infertility, endometritis, and pelvic inflammatory disease. American Journal of Obstetrics and Gynecology, 251-257.
  9. Centers for Disease Control and Prevention. (2021, July 22). Pelvic Inflammatory Disease (PID) Treatment and Care. Retrieved from Pelvic Inflammatory Disease: https://www.cdc.gov/std/pid/treatment.htm

Do you happen to know any female around you that is experiencing both physical and emotional lability symptoms that can be disruptive at certain times of the month? They may be suffering from PMDD, read on to find out more about this debilitating disorder.

What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS).

In PMDD, the symptoms occur in cycles, only during the second half of the menstrual cycle and may last until the first few days after your period begins. 
Contrary to PMS, PMDD is associated with a debilitating interference of normal routine life and personal relationship with others.

PMDD is a severe form of PMS that is debilitating and can interfere with normal daily activities.

What are the symptoms of PMDD?

Women with PMDD may experience the following symptoms: 

When do symptoms of PMDD begin?

PMDD symptoms tend to begin 7-10 days before you start your period and may continue for the first few days after your period commences.

What causes PMDD?

The actual reason for a woman to develop PMDD remains unknown. However, there are several factors that have been linked to the development of PMDD, such as: 

High levels of serotonin, a neurotransmitter which also acts as a hormone can help boost your mood, while low levels of serotonin has been linked to the development of PMDD and other issues.

How common is PMDD?

Studies have shown that while PMS is fairly common, affecting 75% of women with a regular menstrual cycle, PMDD is uncommon and affects only 3-8% of women who are already affected by PMS.  

Who is at risk of developing PMDD in Singapore?

You are more predisposed to PMDD if you have the following factors:

How does PMDD affect a woman’s life?

PMDD is extremely disruptive, affecting not only a woman’s day-to-day life but also affecting and disrupting her relationship with others. PMDD causes detrimental physical and emotional symptoms which go on to cause tensions and problems in all aspects of a woman’s life.

When should I see doctor if I suspect have PMDD?

PMDD can be treated so if you notice that you have cyclical symptoms suggestive of PMDD, and you are experiencing daily functional impairment with possible relationship breakdowns, make an appointment with us and we can help you through your symptoms.

medical treatment
Symptoms of PMDD can be treated by a medical professional.

How is PMDD diagnosed?

PMDD is diagnosed in the following ways:

What are the treatment options for PMDD in Singapore?

The management and treatment of PMDD are not easy as there is no single solution to the condition. Treatment usually requires a partnership discussion with your doctor, via motivation, patience, and trial and error. 

Treatment for PMDD usually involves a combination of various options that include both medical and non-medical approaches. 

Non-medical treatment options include:

Incorporate a healthy lifestyle to help reduce the intensity or severity of your PMDD symptoms.

Medical treatment options include: 

Your doctor wilL work together with you to come up with an individualised management plan for your symptoms and follow-up with you over the course of weeks to months to see your response to the treatment plan.

birth control pills
Birth control pills can help regulate the levels of oestrogen and progesterone in your body.

Is PMDD a psychiatric condition?

PMDD is a medical condition that can be associated with both physical symptoms and a range of mental health symptoms including depression, anxiety, irritability, or suicidal feelings. PMDD can coexist or be misdiagnosed with concurrent mood disorders. 

You are advised to speak to your doctor if you notice persistent, chronic abnormal mood symptoms or if you have feedback from your loved ones on possible mood issues.

What is the difference between PMDD and PMS?

PMDD is an extension of and a more severe form of PMS. In addition to the usual physical symptoms of PMS, PMDD has a negative effect on a person’s social aspect with debilitating interference of daily routine and interpersonal relationship. 

Is there a test for PMDD?

Unfortunately, there is no diagnostic test for PMDD. PMDD is diagnosed based on a detailed medical history and a clinical evaluation of your symptoms. Occasionally, your doctor may offer you blood tests to screen for other possible medical conditions (such as endocrine disorders) that may confound your symptoms. 

Frequently asked questions

At what age does PMDD usually begin?

PMDD can occur anytime as long as a woman is reproductively healthy, however, the average age of PMDD onset is 26 years.

Is PMDD the same as bipolar?

Both PMDD and bipolar disorder are cyclic disorders, and they may often present together at the same time. However, they are not the same as each other.

When is PMDD at its peak?

Symptoms of PMDD usually begin approximately 6 days before your period begins and are at its peak 2 days before your period starts.

Can PMDD be cured?

PMDD is treatable through a non-medical treatment, medical treatment, or a combination of both. Speak to your doctor who can help personalise a treatment plan for you.

What are irregular periods?

An average menstrual cycle lasts approximately 28 days, although most women have menstrual cycles that vary and can range from slightly longer to slightly shorter than the stipulated average.

Menstrual cycles are temperamental at times. While some women may notice the gap between the end of their last periods and the start of their next period constantly changing, others may have missing or infrequent menses. 

There are two types of irregular periods, these are:


Amenorrhoea, also known as the absence of menses and can be further categorised into:

Oligomenorrhoea, also known as infrequent irregular menses and is defined by fewer than 6-8 periods per year.

 irregular periods
Irregular or absent periods can be a sign of underlying medical conditions.

What are the symptoms of irregular periods?

Women with irregular periods may experience the following symptoms:

If you are experiencing any of the above symptoms, you are advised to consult your doctor to evaluate your symptoms further.

What causes irregular periods?

Irregular periods can be normal in some women. However, for others, there may be underlying medical conditions that require intervention/attention to re-establish a normal period cycle.

Below are some common medical causes of irregular or ceasing of periods: 

Be honest and open when sharing your medical history with your doctor. This will help him/her come to the most accurate diagnosis with regards to your irregular periods.

absent periods
Irregular periods can be regular again for some women if the underlying cause is treated.

When should I see a doctor for irregular periods? Should I be worried if I have irregular periods?

You are advised to seek medical attention if your period:

How are irregular periods diagnosed?

Irregular periods and the underlying cause(s) can be diagnosed with clinical history and physical examination which involves a full body examination including abdominal and pelvic examinations. 

Depending on your condition, you may be required to undergo the following:

For sexually active patients, a pregnancy test will be offered. Depending on individual cases, further investigations such as blood tests, hormonal tests, ultrasound of the pelvis, MRI of the brain, and genetic testing may also be advised or conducted. 

pap smear
Pap smears can be used to identify underlying medical reasons for irregular periods.

What are the treatment options for irregular periods?

The goal of treatment is to treat the underlying condition and restore fertility in women who are in the reproductive phase of their life. How can we make irregular periods regular? This depends on the cause of the irregular periods. 

Let’s take a look at some general treatment options for irregular periods:

Do speak to your doctor for further understanding on individual treatment and management of your irregular periods.

What is a healthy diet and lifestyle for irregular periods?

You are advised to consider moderate exercise; some women can restore a regular menstrual cycle with healthy moderate exercise. Exercises such as yoga, have also been clinically proven to alleviate premenstrual syndrome (PMS) symptoms as there is an increase in the production of endorphin and serotonin, commonly known as the ‘happy’ hormones.

In terms of diet, a healthy balanced diet, high in fibre, omega-3 fatty acids, calcium, and vitamin D is also important. Fatty meals high in saturated fats, salt, carbohydrates, and caffeine should be reduced or avoided.

You are encouraged to discuss your daily lifestyle when sharing your concerns regarding irregular periods with your doctor. 

healthy lifestyle
Healthy lifestyle choices can improve your life in more ways than one, from regulating your menstrual cycle to improving your overall wellbeing.

Can I get pregnant if I have irregular periods?

Some women with irregular periods may have difficulty in getting pregnant as they may not ovulate regularly. Hence, it is good practice to speak to your doctor if your menstrual cycle is abnormal.

Depending on individual medical circumstances, your doctor may advise hormonal medication or fertility treatment to facilitate the process of conceiving naturally.

Are irregular periods normal?

Some women may notice their period irregularity since young/puberty— this can be normal. Occasionally, period cycles may also become irregular due to stress, lifestyle changes, medical conditions, illnesses, vaccinations, etc.

You are encouraged to discuss your symptoms with your doctor so that he/she can come up with a concerted plan to screen for any underlying medical issues that may be the cause of your irregular periods and manage accordingly.

What is Polycystic Ovarian Syndrome?

In a healthy menstrual cycle, the reproductive hormones induce the ovaries to make the egg and release it every month. In PCOS, due to the imbalance of the hormones, the egg may not be developed, and even if it is developed, it may not be released during ovulation each month.

PCOS is a common condition that affects 10% of women of childbearing age. PCOS causes missed or irregular menstrual periods. Irregular periods in women can lead to:

What causes PCOS?

Hormonal imbalance of the reproductive system

High levels of androgen. Androgen is a male hormone that is responsible for the development of male traits, such as being more masculine, having more hair, acne, male-pattern baldness. In the reproductive organs, when the level of androgen is high in females, this can prevent the ovaries from releasing the egg during the menstrual cycle.

PCOS is associated with diabetes and insulin resistance. Insulin is a hormone that controls the carbohydrate and sugar in your body and turns them into energy. In insulin resistance circumstances, the body is not able to respond to insulin, leading to a high level of sugar in the body, which is termed diabetes mellitus.

Symptoms of PCOS include:

Irregular or absence of menstrual cycle

What are other health conditions associated with PCOS?

What do I expect during my consultation with my doctor?

Your doctor will take a relevant, thorough medical history, and a physical examination of your face, hair, chest back, abdomen, and pelvis. Other physical examinations include measuring your blood pressure, body mass index (BMI), and waist size. You will be offered hormonal blood tests and ultrasound of the pelvis to evaluate further your reproductive organs.

How is PCOS treated?

Although there is no cure, there are treatment options to manage PCOS. The goal of management is to manage your symptoms, restore and increase the chance of fertility in childbearing ladies, and manage risks of long term health issues such as diabetes and heart disease.

Leading a healthy lifestyle and eating a normal healthy balanced diet is crucial in PCOS ladies. A reduction of 5% of body weight has been shown to increase fertility chance and to restore spontaneous ovulation in some women.

In ladies who are not planning pregnancy, hormonal birth controls in the form of pills, patches, shot, vaginal rings, or intrauterine hormonal devices are used to regulate the menstrual cycle, reduce the risk of endometrial cancer, improves acne and reduce excessive hair in the face and body.

A medication known as metformin may be recommended in those with insulin resistance and diabetes. Interestingly metformin also lowers the androgen levels in ladies with PCOS, and aid in restoring ovulation.

Speak to your doctor for further advice, as every lady has different needs and concerns, and your treatment is likely individualized to yourself.

Can I still become pregnant if I have PCOS?

Yes. Although PCOS is a common cause of infertility in women, thankfully often, it is treatable. Your doctor can discuss ways to help you to ovulate and increase your chance of becoming pregnant.