If you have a vagina, you know things can ebb and flow (sometimes confusingly) in your lower region. Maybe you wake up with heinous cramps and wonder if your period is en route — or perhaps you just feel a little wonky, and you wonder if stress, a new prescription, or something else entirely is to blame.
It’s tempting to keep these kinds of symptoms private and assume they’ll pass, but you might want to flag them to a gynaecologist, says Monica Avila, a gynaecological oncologist in the Gynecologic Oncology Program at Moffitt Cancer Centre in Florida. That’s because, in some cases, serious underlying diseases, like cervical cancer, can be at play.
This condition – caused almost entirely by human papillomavirus (HPV) – was once the number one cancer-related killer of people who have a cervix. But thanks to smear tests (which can detect it) and the HPV vaccine (which can usually prevent it), cases have dropped dramatically. Still, the vaccine doesn’t shield against every single strain, and not everyone has had the jabs. Plus, in the early stages, a lot of people with cervical cancer don’t feel or see any symptoms at all, Dr. Avila notes.
“Cervical cancer can be kind of insidious,” Dr. Avila explains. Once the signs become noticeable, you might associate them “with simply having a period – you might think a little spotting or heavy bleeding is normal.” Whether you’re at risk or not, experts recommend flagging these six (sometimes subtle) cervical cancer symptoms to your GP.
1. Pain or bleeding during or after sex
After Aisha McClellan, 39, bled after sex for about 10 minutes back in 2016, she didn’t think much of it at first. But when it happened again a second and third time, McClellan went to a local clinic for help – and was initially tested for STIs.
Her results came back negative, but the nurse practitioner assumed *some* kind of infection was at play and prescribed her antibiotics. Despite finishing the course of her meds, the bleeding didn’t stop for McClellan, and she became abnormally fatigued and her lower back ached. That worried McClellan, so she went back to the clinic and asked for a pelvic exam. “They said my cervix looked angry and inflamed,” she recalls.
After receiving a closer examination (and biopsy) from another clinic, McClellan was diagnosed with stage IIB cervical cancer – meaning cancer had spread from her cervix to nearby tissue.
Bleeding can happen during sex because although a penis, finger, or toy can’t necessarily reach the cervix, it can bump it a little – and jostle around precancerous or cancerous cells (or tumours, in McClellan’s case), Dr Avila says. “A lot of times, women will have some vaginal bleeding, usually after sexual intercourse, or they’ll have a lot of pain during intercourse,” she explains. (Again, though, you can have early-stage cervical cancer and not have any issues with sex – it can take a while for those symptoms to develop.)
As Dr Diana Pearre, a gynecologic oncologist at the Providence Saint Joseph Medical Centre in Burbank, California, says it’s really difficult to tell cervical-cancer-related bleeding and pain from sex apart from other things, like vaginal dryness or even uterine fibroids. But importantly, “bleeding after intercourse should not be happening all the time,” she explains.
“There are a lot of benign reasons it could be happening, but it’s something to report to your doctor – especially if it’s something you’re experiencing all of a sudden.”
2. A wonky menstrual cycle
If you get a period, it can look and feel different from month to month – sometimes it’s short and light, or drawn-out and heavy. But as Dr. Avila notes, when your flow is off, your body might be prodding you to listen up. According to Dr. Pearre, it’s typically one of the most tell-tale signs of the disease.
If you’re bleeding after menopause, between periods, or a lot – soaking through your pad or tampon every one to two hours or your period is lasting longer than seven days – it can sometimes signal cervical cancer.
Dr. Avila says it’s important to look out for any strange bleeding patterns, particularly if you’re skipping periods and then running through pads all of a sudden. She says people who had heavy bleeding and were eventually diagnosed with cervical cancer came to her office and just assumed a change in their diet or taking a new supplement was to blame. “I hear it all the time,” she stresses. “If there’s any abnormal bleeding, it’s important to come in [for an exam].”
3. Unpleasant vaginal discharge
Your vagina cleans itself by releasing discharge – AKA that mucusy fluid that piles on your underwear throughout the day. Yours might have a slight odour that’s more fragrant during certain parts of your menstrual cycle or even after a workout. But if the smell is particularly bothersome to you, cervical cancer could potentially be one reason to have on your radar – particularly if it’s happening alongside a wonky period, per Dr. Avila.
According to Dr. Pearre, when a person with late-stage cervical cancer has discharge, you won’t *not* be able to notice the odour. “It’s very foul-smelling,” she notes.
Though Dr Pearre says that some STIs, like trichomoniasis and gonorrhoea, can present with similar smells, cervical cancer discharge odour is usually worse, Dr Avila says. “That tumour is trying to get bigger and bigger, and there’s a lot of dead tissue that’s there, and that’s what we smell with those kinds of cancers,” she notes. Though its smell is often the most defining characteristic, the discharge might be watery, pink, pale, yellowish, brown, or mixed with blood, per Dr. Pearre.
4. Bowel and bladder issues
Similar to how having sex might affect the cervix (and cause pain and bleeding), cancerous cells or tumours can push up against other surrounding stuff too – and that includes your bladder and bowel. “I see a lot of patients [with cervical cancer] who either need to pee very frequently or have issues starting the stream,” Dr. Avila says. Alternatively, she says people who ultimately get diagnosed with cervical cancer complain about constipation or that they have to really strain to go. “I’ll have patients say, ‘Oh, I thought I was just constipated and straining too much, or I thought I had a meal that went bad.’” (There could also be blood in your poop or urine, per the National Cancer Institute.)
5. Pain and swelling in various parts of your body
As cervical cancer progresses, you might develop pain in your pelvis, back, belly, or legs. For McClellan, her lower back aches felt similar to period-related cramps.
You might also see some swelling in your legs – AKA lymphedema, which happens when something affects your lymphatic system and fluids build up in a certain part of the body. “The lymphedema starts to set in because the cancer is growing so wide that it’s kind of blocking the blood supply to and from your legs,” Dr. Avila explains.
However, Dr. Pearre notes that this type of leg swelling and pain usually happens at a really late stage of the disease, so it might also be paired with some of the other symptoms mentioned above (foul-smelling discharge, painful sex, weird periods). “It’s very common for women, especially after childbirth or in pregnancy, to have this type of pain,” she points out. “But if they have that, in addition to other symptoms like abnormal bleeding, it definitely warrants at least a pelvic exam.”
6. An abnormal smear test
Okay, this one isn’t necessarily a symptom of cervical cancer. But you can have precancerous changes – which are fully treatable early on – that can stay asymptomatic for long periods.
A visit to the gynaecologist is often the only way a person will know they are developing cancer, both Dr. Pearre and Dr. Avila stress.
If a doc wants to take a closer look, they might order more tests (say, a colposcopy, a procedure during which they use a lighted, magnifying tool to closely examine the vagina, vulva, and cervix). “The big part is following up,” Dr. Avila adds. “It’s not just getting the smear test and receiving an abnormal result – it’s making sure you take care of whatever’s going on.”
However, if you are diagnosed with cervical cancer, don’t lose hope. “In the last five years, we’ve got much better at improving our treatment strategies; we’ve seen a lot of FDA approvals of new types of drugs, immunotherapies, and targeted therapies,” Dr. Pearre says.
The bottom line: If you’re dealing with frustrating symptoms in your lower region, don’t just assume it’ll pass – both Dr. Pearre and Dr. Avila say they see too many people waiting (unnecessarily) in pain, regardless of whatever gynecological issue they’re dealing with. Your doctor might be able to fix it immediately, or they’ll put you on a direct path toward feeling better. Either way, it’s important to speak up.
This article was first published on SELF.
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