Can you get a urinary tract or yeast infection from the toilet? We asked doctors to debunk women's health myths

Sexual health is still seen as a taboo subject among women in Singapore. Not talking about it means that women are losing out on important education, and possibly, medical help.

KK Women’s and Children’s Hospital (KKH) conducted two studies in 2024 which revealed unmet sexual health needs in women of reproductive age. The first study involved 787 women, aged between 21 and 45 years, and found that 57 per cent were not aware of symptoms of female sexual health issues.

Also, even though 94 per cent agreed that awareness and education on female sexual health issues are important, only 43 per cent would seek medical help if they experienced such issues.

The second study, among 477 healthcare professionals who treat women of reproductive age, produced some shocking statistics – 81 per cent were unaware of available screening tools. And only 10 to 12 per cent felt confident or very confident in diagnosing or managing sexual health issues.

In March, the KKH-led Maternal and Child Health Research Institute launched Singapore’s first set of Guidelines on Sexual Health for Women of Reproductive Age, for healthcare professionals. These provide a comprehensive framework covering screening, assessment, education and management across all stages of reproductive health.

For example, a screening tool doctors would use could be The Female Sexual Function Index-6, a questionnaire which assesses female sexual function across six domains, including arousal, lubrication, satisfaction and pain.

“Sexual health during a woman’s reproductive years affects overall health now and in the future,” said KKH’s Dr Tan Tse Yeun, senior consultant at the department of reproductive medicine. “Specifically, it influences women’s function, well-being, relationships and ability to have children.”

MYTH #1: IF YOU’RE NOT SEXUALLY ACTIVE, YOU DON’T NEED TO SEE A GYNAECOLOGIST

A visit to the gynaecologist is not just about screening for sexually-transmitted diseases or monitoring your pregnancy or reproductive health.

“Gynaecological care is important throughout a woman’s life journey,” said Dr Tan, who is also co-chairperson of the guidelines’ work group at KKH. “During your teenage years, we help manage period problems and irregular cycles. In your twenties and thirties, we monitor reproductive health and address conditions like polycystic ovarian syndrome or endometriosis.

“During your forties and fifties, we help manage perimenopause and menopause symptoms,” she added. “Whether a woman is sexually active or not, these health needs remain relevant.”

Dr Charu Narayanan, family physician at International Medical Clinic, explained that all women, even if they’re not sexually active, should consider having a checkup with their primary care provider to address any concerns relating to their menstrual cycle, reproductive and sexual health and contraception, if required.

A visit to a gynaecologist might be necessary in some situations, regardless of whether women are sexually active.

“It’s commonplace for women to complain of heavy or painful periods, irregular cycles, abnormal bleeding or unusual vaginal discharge,” Dr Charu said. “There may be no underlying cause but there are conditions affecting the uterus and ovaries, namely fibroids, ovarian cysts and endometriosis, which can only be detected on scanning by a gynaecologist.”

If these conditions are detected early, treatment can alleviate symptoms, prevent other complications or possible impact on fertility, said Dr Charu.

MYTH #2: YOU CAN GET UTI OR YEAST INFECTIONS FROM A TOILET SEAT

This one is easy to dispel – urinary tract infections (UTIs) and yeast infections are not transmitted through toilet seats.

Dr Cassandra Cheong, associate consultant at KKH’s department of obstetrics and gynaecology, explained that UTIs can occur when bacteria, typically from the digestive tract, enter the urinary tract. And vaginal yeast infections are caused by an overgrowth of naturally-occurring fungi in warm, moist environments, often triggered by factors like antibiotics use, hormonal changes or poorly-controlled diabetes.

Dr Charu said that women in the reproductive age group can get UTI after intercourse; prevention includes hydrating well and emptying the bladder after sex. Women of menopausal age also suffer from UTI and vaginal oestrogen can be effective in avoiding it.

Having a UTI or yeast infection can affect your sexual health, though. Both can cause discomfort or pain during intercourse, which may lead couples to avoid sexual activity. And while neither condition is sexually transmitted, sexual activity can increase the risk of UTI in women, said Dr Cheong.

MYTH #3: THERE ARE ALWAYS SYMPTOMS IF YOU HAVE A SEXUALLY-TRANSMITTED INFECTION

In early stages of the disease, common sexually-transmitted infections (STIs) such as chlamydia, gonorrhoea, trichomoniasis, genital herpes, human papillomavirus (HPV), syphilis and HIV may not produce noticeable symptoms, said Dr Charu.

“Later on, clear or coloured vaginal discharge, abnormal bleeding patterns, burning urination, pelvic pain and, ultimately, infertility due to spread of the infection to the uterus and fallopian tubes, is noted with chlamydia, gonorrhoea and trichomoniasis infections,” she added.

Dr Cheong told CNA Women that most of the cases seen in the hospital’s STI Clinic are detected through screening patients who show no symptoms. However, these patients are “at risk”, such as those with an infected partner or who have multiple sexual partners, or are pregnant teenagers.

“Therefore, it is possible to contract STI from people who appear well and may not know they have an infection,” she added.

MYTH #4: SEXUALLY TRANSMITTED INFECTIONS AFFECT ONLY YOUR SEXUAL HEALTH AND FERTILITY

Not true, said Dr Cheong. She pointed out that STIs can affect your entire body. Some may even have long-term implications, which makes early detection and treatment crucial.

“For example, syphilis may cause heart, brain and eye problems, and HIV may cause weakened immunity and an increased risk of certain cancers,” she said.

Dr Charu noted that gonorrhoea can produce serious eye infections that can lead to blindness, as well as spread to the heart, joints and brain.

Chlamydia can also cause serious eye infections, as well as joint inflammation. And untreated chlamydia during pregnancy can cause serious pneumonia in the baby and also infect the baby’s eyes.  

MYTH #5: YOUR SEXUAL PROBLEMS ARE "ALL IN YOUR HEAD"

Sometimes, not being able to have sex isn’t because you’re mentally too caught up with life or just not in the mood. It could be a genuine problem, so don’t dismiss it.

Dr Tan explained that female sexual dysfunction can be due to biological, psychological, socio-cultural factors or a combination of them.

“Conservative social upbringing and religious or cultural influences can also shape views on intimacy and sexuality,” said Dr Tan. “These may give rise to anxiety about sexual intimacy, aversion to sexual relations and even female sexual dysfunction.”

She added that female sexual problems can be caused by certain conditions, such as chronic medical conditions, pregnancy, major pelvic or vagina surgeries and past negative sexual experiences.

Dr Charu said that pain during intercourse can occur with an inability to relax the pelvic floor. A pelvic floor physiotherapist and a gynaecologist can guide treatment.

MYTH #6: YOU JUST HAVE TO LIVE WITH IT IF YOUR LIBIDO DOESN’T MATCH YOUR PARTNER’S

If you and your partner have mismatched libidos, Dr Charu’s advice is to see a doctor to properly explore your medical history. The doctor will check for physical causes (vascular and neurological), mental health as well as certain medications, such as antidepressants, which can affect libido.

Low oestrogen and testosterone levels around perimenopause and its accompanying mental changes can impact sexual function too. Effective treatment includes psychosexual counselling and, in some cases, menopause hormone therapy (MHT; formerly called hormone replacement therapy) which can improve mood, libido and sleep quality.

Dr Tan recommended open and honest communication about each partner’s needs and expectations.

“Couples can consult healthcare professionals about underlying factors affecting desire levels, discussing solutions to explore, such as adjusting timing of intimate activities when energy levels are high or when activities or stress levels are low, to discussing the frequency and type of intimacy the couple prefers,” said Dr Tan.

MYTH #7: SEX WILL STOP BEING ENJOYABLE AFTER MENOPAUSE

The lack of lubrication, having a low mood and a reduced ability to orgasm can make sex difficult in menopause, but there are ways to manage it.

Dr Charu recommended using vaginal oestrogen, available as pessaries and creams, which helps relieve painful intercourse, improve sensation and libido. It can also help reduce recurrent urinary tract infections, something that many women suffer from after menopause.

Dr Tan stressed the importance of focusing on overall intimacy – taking time for foreplay, exploring different ways to be physically intimate and having open conversations with your partner.

“Every couple’s goals are different, and orgasms are not the only measure of satisfying intimacy,” said Dr Tan. “Orgasms might feel different or take longer to achieve with age but this does not mean couples cannot maintain a fulfilling intimate relationship.”