I’m a consultant gynaecologist - AMA

[quince2figs]

I have worked in a variety of settings - hospital obstetrics and gynaecology incl labour ward, PMS and menopause, currently community contraception and unplanned pregnancy services, NHS and non. Ask away!

[Graphista]

Finally an ama I can get on board with!

Do you get very frustrated that women are repeatedly fobbed off by GP's re gynae issues, meaning:

By the time women reach you those conditions can be worse and more advanced/harder to treat?

By the time women reach you they're so stressed from this they're pissed off desperate, less trusting of drs generally?

That you're the one left picking up the pieces of eg cancer symptoms long being ignored?

What do you think can & should be done to stop this happening?

Most of the gynaes I've had contact with have been great, once I finally got to see them! Except one who insisted they'd never heard of endo - I requested a new gynaecologist in that case.

[Snappedit]

Is it true that many doctors, (or their wives) particularly from your specialism, opt to deliver their own babies by Caesarean section?

[Quantumblue]

What do you think all women should know about their health?

[questioninghhmm]

What would you say to someone who had previously had an emergency c section and knew they could only give birth via c section in future - who is now shitting themselves at the prospect of it?

[Quantumblue]

What's your view on HRT? My gp won't prescribe it.

[Tinseltower]

Are you ever surprised by how well or not somebody is manicured down there, or their personal hygiene?

[MeganChips]

I have fibroids and Adenomyosis, confirmed by both private and NHS scans. The consultant refused to treat me and said all that was wrong with me was a bit of scar tissue and to get a Mirena.

Apparently I now have a Mirena jammed in the wrong place against a very large fibroid.

If he refuses to treat me again can I demand to see someone else?

[Deux]

Would it be totally mad to consider keyhole hysterectomy purely for convenience sake? I am perimenopausal, on HRT 6 weekly bleed schedule. I love the oestrogen but find the progesterone/bleed side of things a pita. I can’t help thinking that if I didn’t have my uterus then I’d only have to use oestrogen and all would be kushty.

Have you ever had such requests? What would you say to a private patient who suggested such a thing?

Thanks.

[LeeMiller]

I'm pregnant with my first, and the statistics on doctors choosing CS scare me! Obviously each case is different, but do you have any general recommendations for pregnancy, birth and the postpartum period - e.g. do weight gain, keegals, perineal massage, postpartum pelvic floor exercises etc make much of a difference?

[kaytee87]

Is it normal to no longer be able to orgasm after childbirth? (2 years later!)
Is it normal for sex still to be uncomfortable 2 years after giving birth?
Is there a risk of an episiotomy scar tearing badly with a second vaginal birth? (first was 8lb12oz and rotational forceps, would expect a second baby to be on the large side too as DH was 9lb10oz at birth)

[Sunshiness]

I know in other countries women have regular gynae check-ups (like you'd have dentist check ups), here (UK) they only see them following a referral when there is a specific problem. Which do you think is right and why?

[FilledSoda]

Steroid cream made my lichen sclerosus worse, after reading a specialist forum i requested vagifem which actually worked for years in making episodes less severe. It appears to have stopped having the same effect now. Should I just start hrt?
There really is no cure and no hope is there?

[Ihopeyourcakeisshit]

What made you specialise in this branch of medicine?

[Namethatchange]

At what point did you think, ooh I'd really like to be a gynae?
How do you eat lunch minutes after digging around an intimate area?
What sort of things do you discuss with your partner about work of an evening?
Do you and your colleagues have codes for its not very pleasant down there?
I've always wanted to ask these but it never seems to be the right time

[Snappedit]

Op please come back I’ve always wanted to know the answer to my question about cs as it seems to be said a lot on threads on here.
I doubt any gynae would answer it in real life outside of their personal friendship circle and i don’t know any gynaes to ask!

[halfwitpicker]

Are you male or female?

[quince2figs]

Hi graphista - great question! This is one of my main worries about current state of women’s health in the UK.
Yes, I am incredibly frustrated by a large number of GPS who seem either very ill-informed, out of date clinically, or worse seem not to care that a woman has a treatable condition that is impacting on her life greatly.
This leads to needless delay in treating at an early stage, which of course is vital with female cancers, but also with things like heavy painful periods, for instance.
(There are many great GPs too, mind you, but I sadly feel that those who have adequate knowledge and treat or refer appropriately seem to be in the minority).
Many reasons for this - GP training has changed in last 20 years+, O&G as a junior Doctor now not compulsory, very few train in sexual health, and much of contraception/all smears has been devolved to practice nurses - who are now often very junior and have no specific training in women’s health. Menopause/PMS has extremely low priority.

You’re right, it seems for most women they have to be incredibly persistent and knowledgeable to access a Gynaecologist in secondary care, repeatedly fobbed off .... I’m afraid this is indicative also of endemic sexism and ageism in medicine.

Commissioning has split up women’s health to different providers, most of whom try to prove it's the other provider’s responsibility, ie: budget.

[quince2figs]

Better training needed for primary care to manage the majority of women’s health issues. Different commissioning, so that community gynaecologists are not just restricted to providing contraception, but can provide clinic based, cost effective investigations and management. Less dismissal of “women’s problems” as minor and unimportant.

[quince2figs]

Snappedit - yes, more likely to have C/S than general population. Sometimes for avoidance of sequelae (urinary incontinence/prolapse), more for reduction of risk to baby. There is no getting away from the simple fact that vaginal delivery is significantly more risky for the baby than a planned C/S (but safer for the mother). Some for medical indications, as for any other woman.

I had 2 very post-dates vaginal deliveries, btw!

[BryanAdamsLeftAnkle]

I have adenomyosis and have been offered a hysterectomy. Have previously had cervical cancer removed. So removal of cervix would make it easier for me. I also had 2 c sections after big babies. Well 8lb and 8lb 15 babies who both sat oddly and my bump was huge. I'm left with a massive apron.

Can I request that be removed at same time as hysterectomy or do I need to just get over it. I'm losing weight but had apron at a size 10. I'm too embarrassed to ask but hey I'm not face to face with you... So would I be unreasonable to discuss it?

[Pooriver]

I've had dyspareunia for years. It's getting worse, I've tried steroid creams and clinical psychology. Is there anything else to be tried?

I reckon it's a low priority. I could buy viagra over the counter if I had a penis.

[quince2figs]

Quantumblue - I would love all women to have the knowledge of how their body works at all stages of life, that they have control over whether and when they want to be pregnant, and the option of not being.
These changes should be normalised instead of medicalised, but acknowledged that we are lucky to be able to access (free - albeit often difficult - see above!) help to ease troublesome symptoms.
That pregnancy, vaginal delivery, and breastfeeding were less feared than they have become in the UK.

[quince2figs]

questioninghhmm - that a planned C/S is generally a thousand times more positive experience than an emergency one during often a long labour, induction, etc. Very few indications where you MUST have a planned C/S, often negotiable depends on your wishes as long as you are fully informed of relevant risks and benefits. Sometimes no alternative, eg: placenta praevia etc.

[quince2figs]

Quantumblue - I am extremely pro-HRT, esp since reaching that age myself.

British Menopause Society guidance supports almost all women to be safe to have it. Print out guidance for your GP!!! Or ask for referral to nearest menopause specialist (BMS website). Sadly v common as many GPS out of date on this.

[quince2figs]

Tinseltower - I honestly don’t even notice whether someone has removed hair/pierced/is bleeding at all.
Nice if a wash has been had recently - that’s all! Dirty or smelly feet are worse as they are either side of my head if someone is in stirrups...