Which symptom brings you here?
Most of what we treat is common, treatable, and rarely needs surgery — but it is also the kind of thing women put up with for years before asking. Find your symptom below for a straight answer on what it usually is, what helps first, and when it is worth seeing a doctor.
I leak a little urine when I cough, sneeze, laugh or lift
It is common, but it is not normal, and it is not something you have to accept with age. This is stress urinary incontinence — the pelvic floor no longer closes the urethra firmly when pressure rises in the abdomen. Most women improve substantially without surgery, using correct pelvic floor training over about three months.
Usually driven by: childbirth, menopause, weight gain, chronic cough, constipation, heavy lifting.
See a doctor if you need a pad every day, if leaking is getting worse, if it burns or contains blood, or if three months of correct training has changed nothing.
Read the full guide to urinary incontinence treatment →I wake up two or three times a night to pee
Waking more than once a night to pass urine is called nocturia, and it is not an inevitable part of ageing. In women it is usually an overactive bladder muscle, a pelvic floor weakened by childbirth, falling oestrogen around menopause, or fluid that pools in your legs during the day returning to the bloodstream once you lie flat — which makes the kidneys produce more urine overnight.
Try first: no drinks two hours before bed, no caffeine after early afternoon, legs elevated 30 minutes in the evening, empty the bladder fully before sleep.
See a doctor if you wake twice or more every night, if urgency outruns you and you leak, if your ankles swell, or if urination burns or contains blood.
Read more about nocturia in women →I need the toilet constantly, and sometimes I cannot hold it
Passing urine more than eight times a day, or feeling a sudden urge you struggle to defer, suggests an overactive bladder. It is a muscle behaviour problem rather than a plumbing one, which is why bladder retraining and pelvic floor work help most women within six to twelve weeks — and why going "just in case" makes it worse by teaching the bladder to hold less.
Often worsened by: caffeine, fizzy drinks, alcohol, pre-emptive toilet trips, low oestrogen.
See a doctor if the urge causes leaking before you arrive, if urination burns or contains blood, or if it is disrupting sleep or work.
Read more about overactive bladder →I feel heaviness, dragging, or a bulge — worse by the evening
A dragging heaviness that worsens as the day goes on, or the sense of something coming down, usually indicates pelvic organ prolapse — weakened support allowing the bladder, uterus or bowel to descend. It is far more common than most women realise, and mild to moderate prolapse is often managed without surgery.
It can also affect: how completely you empty your bladder or bowel, and comfort during sex.
See a doctor if you can feel or see a bulge, if you cannot empty fully, or if it interferes with daily activity — assessment is straightforward and determines which treatments are appropriate.
Read the full guide to prolapse treatment →Since giving birth, I do not feel like myself down there
Pregnancy and delivery stretch the pelvic floor and vaginal tissue, and while some recovery happens naturally over the first six months, it is often incomplete. Laxity, reduced sensation, leaking and a changed shape are all treatable, and starting earlier generally gives a better result than waiting years.
A six-week postpartum check should include a pelvic floor assessment — many do not, so it is worth asking for one specifically.
See a doctor if leaking persists past three months, if sex is painful, if you feel a bulge, or if you simply want to know whether what you are feeling is expected.
Read about postpartum vaginal recovery options →Dryness, burning, or sex has become painful since menopause
Yes, this is treatable, and it rarely resolves on its own. Falling oestrogen thins the vaginal lining and reduces natural lubrication — a condition called genitourinary syndrome of menopause. Treatment starts with regular vaginal moisturisers used consistently rather than only before sex, and where that is not enough there are low-dose local options and non-hormonal energy-based treatments.
It commonly comes with: urinary urgency and recurrent infections, because the same tissue lines the urethra.
See a doctor for any bleeding after sex, any bleeding after menopause, worsening pain, or burning on urination.
Read the full guide to vaginal dryness and menopause →Or read about MonaLisa Touch, a non-hormonal option →
Rubbing, chafing or discomfort from the labia in clothing or exercise
Labia vary enormously in size and shape, and almost all of that variation is normal. But when the tissue is large enough to catch, chafe or become sore during cycling, running or in fitted clothing, that is a functional complaint rather than a cosmetic one, and it is treatable. Discomfort, not appearance, is the reason to have it assessed.
It can also cause: irritation, recurrent soreness, and discomfort during sex.
See a doctor if it is persistently sore, if the skin breaks or becomes irritated, if it interferes with exercise or sex, or if you notice a change in colour, texture or a lump.
Read about aesthetic gynecology and labiaplasty →I keep getting vaginal infections — they clear and come back
Four or more episodes a year counts as recurrent infection, and the most common reason is repeat-treating without ever confirming the organism. Thrush, bacterial vaginosis and trichomonas need completely different treatment, so the first step is a swab to identify which one it actually is. Antiseptic washes and douching make recurrence more likely, not less, by destroying the protective bacteria.
Bangkok's heat and humidity genuinely contribute — as do tight non-breathable underwear and repeated antibiotic courses.
See a doctor if it recurs more than four times a year, if there is blood in the discharge, if you have pelvic pain or fever, or if treatment is not working.
Read about recurrent urinary and vaginal infections →My periods are very heavy, with large clots
Get it checked if you change a pad or tampon every one to two hours, pass clots larger than a ten baht coin, or bleed for more than eight days. That is heavy menstrual bleeding, and it is not something to endure. Common causes are fibroids, adenomyosis, polyps, thyroid problems and perimenopausal hormone shifts — most treated medically rather than surgically.
Bring a record of one or two cycles — when you bled and how heavily. It shortens the diagnosis more than any single test.
See a doctor sooner for dizziness, breathlessness or exhaustion (these suggest anaemia), bleeding between periods or after sex, or any bleeding after menopause.
Read about heavy, painful periods →Bladder pain or burning, but tests keep coming back clear
Persistent bladder pain, pressure or burning with repeatedly negative urine cultures may be interstitial cystitis, also called painful bladder syndrome. It is frequently mistaken for recurrent urinary infection and treated with repeated antibiotics that do not help. It is a diagnosis of pattern rather than a single test, so a proper history matters more than another culture.
Symptoms often flare with: certain foods, stress, and around the menstrual cycle.
See a doctor if you have had several courses of antibiotics without lasting improvement, or if pain is affecting sleep or daily life.
Read about painful bladder syndrome →A gap or bulge down the middle of my tummy after birth
A visible ridge or gap along the midline when you sit up is diastasis recti — the abdominal muscles separating during pregnancy. It is very common and often improves with the right rehabilitation, but ordinary sit-ups and crunches typically make it worse rather than better.
It frequently coexists with pelvic floor weakness, so the two are best assessed together rather than separately.
See a doctor before starting core exercise after birth, if the gap is not closing by around three months, or if you also have leaking or back pain.
Read about abdominal separation after birth →My C-section or episiotomy scar is tight, numb or uncomfortable
Scar tissue that feels tight, numb, itchy or tethered is common and does not have to be permanent. Scars remain treatable long after they have healed — often years later. Discomfort during sex from an episiotomy or perineal scar is a specific, treatable problem rather than something to accept.
Numbness above a C-section scar is normal and usually improves; a pulling or tethered sensation is what responds best to treatment.
See a doctor if the scar is painful, if it pulls when you move, if sex is uncomfortable because of it, or if it becomes red, hot or starts discharging.
Read about C-section and episiotomy scar recovery →I have been doing Kegels for months and nothing has changed
The most common reason is that they are being done incorrectly. Most women squeeze the abdomen, buttocks or thighs instead of the pelvic floor. A correct contraction feels like stopping the flow of urine and lifting inward, while the belly and buttocks stay still and you keep breathing normally. Place a hand on your abdomen and hold for five seconds — if the belly hardens or the buttocks lift, the wrong muscles are working.
A schedule that works: hold 5 seconds, rest 5, ten repetitions, three times a day, plus a quick squeeze just before you cough, sneeze or lift. Never practise while urinating.
See a doctor if you cannot feel the muscle move at all — some women need assessment and stimulation before exercises will do anything, and that is a specific clinical finding rather than a failure of effort.
Read about pelvic floor strengthening without surgery →Not sure which one is you?
That is a normal reason to book. Describe what you are noticing in a message and we will tell you whether it is worth being seen — and what an appointment would involve.
This page is general information about common conditions, not a diagnosis. Symptoms overlap heavily — leaking, urgency, prolapse and dryness frequently occur together and are best assessed as a whole. Consultations are in English or Thai; for other languages, mention it when you message us. THE FIT CLINIC — 8th Floor, EM Tower, EMSPHERE, BTS Phrom Phong, Bangkok. Open daily 10:00–19:00.