Gynaecological assessments
Gynaecological assessment
Gynaecological problems can affect women of all ages. It can be quite variable and requires careful assessment including, history taking and examination. Examination will include use of a speculum to visualise the vagina and the cervix. It also involves an examination to feel the internal organs. It will be done in a sensitive manner and utmost care will be taken to maintain your dignity. Please click on the link below to understand the process further.
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Ultrasound Scanning
A gynaecological scan is performed to evaluate for any possible gynaecological problems. It is done using a probe placed on the lower part of the tummy to see the structures in the pelvis though the tummy wall (transabdominal scan). It is also performed using a probe placed in the vagina (transvaginal scan). As the probe is closer to the gynaecological organs, any pathology is better appreciated by the transvaginal probe. I can perform scans at the same setting as the consultation and will incur additional cost. Please speak to Lucy, my secretary about this prior to the consultation.
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Period problems
Heavy and Irregular periods
The average menstrual cycle (periods) is around 28 days and some women get it a bit earlier or a bit later. The bleeding usually lasts less than a week. Irregular or heavy periods are not a sign of a problem, but can be seen around the time of puberty or later on in life. It is reasonable to get it checked by your GP or with a gynaecologist. A gynaecological assessment, blood tests, ultrasound scan, biopsy and a camera test (hysteroscopy) are sometimes performed to evaluate further.
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Hysteroscopy
Hysteroscopy is a camera test of the inside of the womb. A small tube with a camera and a light source is passed though the vagina and the neck of the womb (cervix), into the womb, to evaluate the inside (cavity) of the womb. It is relatively a simple procedure that can be performed without anaesthesia (outpatient clinic) or under anaesthesia (general anaesthesia as a day case procedure).
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Medicated coil (Intrauterine system)
A medicated coil is a T-shaped hormonal coil that is placed in side the womb (intrauterine device or system). It releases a hormone called progesterone. The coil is an effective contraception. Due to the hormone contained in the coil, it is also beneficial in women with period problems. There are various brand available in the market and you can find more information on the links below. Please do clarify any doubts you may have on the type of coil suitable for you at your consultation.
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Mirena further reading (Ext link)
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Levosert Further reading (Ext link)
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Jaydess Further reading (Ext link)
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Endometrial ablation
Endometrial ablation is a procedure to burn the inner lining of the womb (endometrium). The aim of the procedure is to ​reduce the amount of bleeding with periods. In some women it may stop the periods completely. This is not a contraceptive and you will need to use a contraceptive method. The procedure is performed when a women does not wish to consider pregnancy in the future. The most common method used in the UK utilises radio frequency waves (generated by a computer) to burn the inner lining of the womb (Novasure).
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Hysterectomy
A surgical procedure to remove the womb (uterus) is called a hysterectomy. The procedure is performed for various reasons including period problems, when all simpler procedures have failed. The procedure can be performed though the vagina (vaginal hysterectomy) or though a cut in the tummy (abdominal hysterectomy). It can also be performed through keyhole surgery (laparoscopic hysterectomy). Occasionally only the womb is removed, leaving the neck of the womb (cervix) behind (Subtotal hysterectomy). Your surgeon may also suggest removal of both the fallopian tubes (bilateral salpingectomy). Removal of the ovaries (oophorectomy) are discussed on an individual basis and you will need to discuss with your surgeon on the risks and benefits of saving the ovaries.
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Problems of the cervix
Cervical ectropion (Erosion)
A cervical ectropion is a common condition​ of the neck of the womb (cervix). The cells from the inside of the cervical canal is seen on the outside giving it a 'raw' or red appearance. Hormonal changes, including use of the the hormonal pill is usually associated with an ectropion. An ectropion may cause abnormal bleeding or vaginal discharge. Most women do not need any treatment, but if symptoms persists, treatment options may be discussed with you.
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Cervical Polyp
A cervical polyp is a projecting growth (like a skin tag) from the neck of the womb (cervix). Cervical polyps are quite common and are usually non-cancerous. Most women do not have any symptoms, but may have excessive vaginal discharge or abnormal vaginal bleeding.
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Cervical smear test
A smear test is a test to check the neck of the womb (cervix). A sample is taken from the cervix using a soft brush and is checked for a virus called Human Papilloma Virus (HPV). High risk HPV viruses which are associated with cancer of the cervix are tested. Cells may also checked for any abnormal changes. In the UK, regular smear tests are offered to women between 25 and 64 years of age. An instrument (speculum) is gently passed in to the vagina and opened to visualise the cervix. A soft plastic brush is then used to collect the sample from the cervix. It can be uncomfortable, but should not hurt. It is a screening test to prevent cancer and it important that every women who is offered the test should have it.
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Colposcopy
Colposcopy is a procedure to look at the cervix in detail. An instrument (speculum) is gently introduced in to the vagina and opened to visualise the cervix (like when having the smear test). The doctor (Colposcopist) then uses a magnifying glass with light (colposcope) to look at the cervix and the vagina in detail. It is often performed when the smear tests finds any abnormalities or if there is any other abnormalities on the cervix, including abnormal bleeding. A vinegary solution or iodine may be used on the cervix to analyse it further. A biopsy may be taken or you may be offered a removal of the abnormal cells.
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Vulval Skin conditions
The Vulva
The skin and the area around the vaginal opening is called the vulva. The vaginal opening is covered by the outer lips are called the labia majora (covered by hair) and the inner lips are called the labia minora (hair free). The skin covering the pubic bone with the fatty tissue is called the Mons Pubis. The anatomy can confusing and you can always discuss it during the consultation. Occasionally a mirror can be used during the consultation to explain the findings and the terms and you can always request it.
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Skin problems (Vulval skin conditions)
The skin and the area around the vaginal opening is called the vulva. It is important to look after this delicate part of the body. There are various conditions that can develop in this area. Soreness, itching, pain, change in the skin including bleeding and ulcers can develop in this area. These symptoms could represent a skin condition specific to this area or a generalised medical problem. Various skin conditions include Lichen sclerosis, Lichen planus, Thrush, Precancerous conditions (Vulval Intraepithelial Neoplasia or VIN) or cancer.
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Care of the vulval skin
The vulval skin needs specific care, especially if you have skin conditions.
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Lichen Sclerosis
Lichen sclerosis is a common skin condition of the vulva. The skin can look white and scarred and you may have itching, pain and soreness.
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Lichen Planus
Linchen Planus is another condition of the vulva which causes a rash or purplish areas on the vulva. It can cause soreness abd itching. It can affect other parts of the body like the mouth.
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VIN (Vulval Intraepithelial Neoplasia)
Vulval Intraepithelial Neoplasia or VIN is when precancerous cells are present in the skin of the vulva. It is important to understand that this is not cancer and can be treated. This can develop in to cancer over years and will need to be monitored.
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Vulval cancer
The vulval skin can rarely be affected by cancer. Any persistent itchy or sore area could be a sign of cancer and will need further testing to rule out cancer.
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Vulvodynia
Pain, burning sensation or soreness of the vulva in the absence of any obvious skin condition is described as vulvodynia. The symptoms may be continuous or can be triggered by touching or intercourse. Previously described as vestibulitis, the condition can be challenging to treat.
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Other gynaecological problems
Ovarian cysts
Ovarian cysts are fluid filled sacs that develop in the ovary. They are very common in women before menopause and disappear naturally, without any treatment. Most ovarian cysts are non cancerous, but some may be cancerous. Ovarian cysts may cause severe pain when they burst (rupture), bleed or twist (torsion). If they grow big, they can press on the surrounding structures and cause symptoms, including a feeling of a lump in the tummy. A gynaecological assessment including an ultrasound scan may be needed to diagnose an ovarian cyst. Based on various factors, including your symptoms, age and choice, you may be advised to observe the cyst or have it surgically removed.
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Laparoscopic (keyhole) surgery
Laparoscopic or keyhole surgery is a minimally invasive surgery, which allows the surgeon to perform surgical procedures inside the tummy without the need of large cuts. A laparoscopy (camera) is usually inserted through a small cut in your belly button. Further smaller cuts are made on the tummy to pass instruments to perform the surgery. Carbon dioxide gas is used to create a bubble inside the tummy to pass the instruments and perform the procedure safely. As the procedure is done without the use of a big cut, the recovery is generally quicker. Various procedures including a hysterectomy, removal of ovarian cysts, etc can be performed laparoscopically.
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Intrauterine device(Coil) - Insertion and removal
An intrauterine device or a coil is a T-shaped device inserted into the cavity of the womb (uterus). It can be non-hormonal (copper containing) or hormonal (contains a hormone called progesterone). They are effective contraceptive devices. The hormonal coil has the added benefit of reducing the bleeding with periods are also called intrauterine systems (IUS). I offer both insertion and removal of these coils.
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