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!

Hey,

Thank you for your wisdom.
I'm keen to know your view on ashermans syndrome and how you think it could be prevented or supported particularly through the NHS ?
Feels like many OBGYN don't know about it
X

If you had a gynae issue quince, would you let your colleagues examine you or would you prefer a different hospital?

How would you feel if you made a mistake or series of mistakes that was negligence and lead to a young woman university age getting cancer and losing her womb before she's had children?

(triggering myself)

How do you feel about other gynaes who have been involved prolifically (i.e. several occasions of negligence) in this?

Honestly, it gets to me a decade later. I know what I suffered and suffer, every single day. I saw them in court, some of them at least, they walk away because they are protected by NHS, even when they openly admit negligence. Not mistakes, negligence. Some seemed to car, some seemed to think nothing and stared right through me, even as it was clear the judge and everyone in the court was disgusted with them.

I of course have had to make my peace with an incredible amount of ongoing pain, difficulties and loss. I was never given the respect of acknowledgement (it took a Judge in the Hight Court to note negligence), concern for what I lost of went through or any concern as if I or my losses and pain matter.

I try not to think of these people, but I do wonder if they still think of me.

I spoke to one doctor who misread a colposcopy (exam of cervix for precancerous cells for the non gynaes), inexplicably. She seemed upset and actually looked at me in court. I followed her out and gave her a hug and told her it was ok and we would all be ok. She cried.

She was unusual however. No changes were made to the system and it was the opposite for me with others, they were awful, smug and agressive. That was devastation on top of devastation and it stays with me. I wonder f they remember me, wonder if I'm even still alive because it was very serious, wonder how I am because they know all parts of my life were destroyed and taken away, if they remember were part of doing to a young girl.

Bryan - hysterectomy a reasonab”e option but not compulsory. If you are going to have a tummy tuck anyway, there would be advantages to getting it done at the same time as another procedure. But these mainly relate to need for only 1 anaesthetic, and 1 incision, IF same suitable for both. This is unlikely, as many hysterectomies done laparoscopically these days.
Tummy tuck extremely unlikely to be done in NHS now, so logistically difficult to combine.
Increased risk of infection, scarring, bleeding with dual procedure?
It can’t hurt to ask but think unlikely.

Pooriver as above - Gynaecologist with interest in psychosexual medicine and/or vulval clinic. You are spit on that a poorly penis would be taken a lot more seriously.

Do you have a working relationship with women's health physios in continence clinics? If not - what would make that work better?

THANK YOU! For answering AND for understanding.

As an army brat and then army wife I saw a LOT of gp's in the 14 years from when I first had symptoms (from very first period) until dx. And the Dx happened almost by accident - and by a consultant gynae not a GP NOR thanks to a referral.

"Many reasons for this - GP training has changed in last 20 years+, O&G as a junior Doctor now not compulsory"

Can I please ask WHO decides that and who advises them? Because thats completely dismissing half the population! Can I also ask is urology still mandatory? I'm guessing yes.

Frankly I feel with things as they are we should be able to self refer, as we can for SO many other things.

I personally feel the BIGGEST problem with care at GP level is there's no incentive to find the CAUSE of a patient's symptoms, but instead too much emphasis on just treating symptoms (and hoping they'll go away and stop complaining!). Not only is this doing patients a disservice to the point of costing lives, it's short sighted and I think probably a false economy.

"I’m afraid this is indicative also of endemic sexism and ageism in medicine." Wholeheartedly agree.

Thanks so much for this thread OP. I would like to know if it's true that the latest wave of research shows that hrt can benefit perimenopausal women as much as, if not more than those in menopause? I think I'm in early peri (age 39, periods now 3weeks apart rather than 4, much worse pmt). I was wondering how you tell at what point hrt can benefit a woman? Do I just need to see a private gyn and have bloods? Thanks xx

A million thank you for this thread.

Snappedit - no problem.
I am extremely pro-vaginal birth, as a straightforward, term, spontaneous vaginal delivery is the safest option overall. The problem is that this is a retrospective diagnosis - not all vaginal births are straightforward, and you cannot predict which ones will or won’t (risk factors are meaningless in an individual basis). Some complications are life-threatening or catastrophic, but thankfully rare. Things we do to try and avoid these can cause more harm than good on an individual basis, but improve the outcome of a population.
eg: we induce by 14 days after due date, because rate of stillbirth goes up sharply at that stage if undelivered. Induction is more likely to end in intervention, so more women will end up with assisted deliveries or emergency sections than if not induced. But their babies have a higher chance of being alive!
Vaginal birth definitely not cheapest option due to need for emergency 24h care and intervention. Cheapest probably planned C/S for all, but no one would recommend that.
Yes, any vaginal birth has a more possible complications for baby than a C/S - distress, failure to progress, delivery problems (shoulder dystocia, assisted delivery). Better for their lungs though!

I’m so worried for my mum who is 62. She had a late menopause at 58/59 and says she regularly still gets a brownish smelly discharge but absolutely refuses to go to her GP again after having a scan last year which confirmed her uterus showed she was probably post menopausal.
Is this discharge harmless, or should I persuade her to go back again? (She never had HRT but had the Mirena until she was 58). Her mum, my grandma, had menopause at 56.

Fascinating thread, thank you for starting it.

My question: how would you teach girls/young women about their bodies, if you were to go into a school or university? Should women know 'the basics' at around age 11/12 then 'the remaining gory details' at 18?!

I thought i was quite knowledgeable about my undercarriage until A i had a baby, B my best friend was going through ivf and C a close friend had cervical cancer. All during the same year. It taught me a lot and i wish i had known sooner.

I'm mid-40s now, but if i could re-train i'd be a gynaecologist.

Would I be able to be sterilised I. 25 and I have had 4 children and definitely don't want anymore iv asked every midwife and health visitor what my chances are and they say slim to non as u have to be over 32

Monkey - if you mean is the uterus healed - then no reason to think not unless you have persistent pain or painful sex, signs of infection etc. No “test” for being healed, but it is a big op, especially if emergency C/S done at full dilatation.
Pregnancy changes your body, and most women find backache common afterwards.
If you mean cervix or vagina, then presume you have specific concerns or symptoms, which should be discussed with GP at minimum.

Screaming - see above for comments on GP training. Endometriosis can be difficult to diagnose as our tests are not definitive, and there is no “best” treatment. There are robust guidelines on options, though.

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?

Have you seen a women's physio and been evaluated for hypertonic pelvic floor / pelvic floor dysfunction?

For pelvic pain incl dyspareunia I can highly recommend 2 books

Healing Pelvic Pain - Amy Stein
A Headache In the Pelvis - Wise & Anderson (it says prostatitis in the title but it's for both male and female pelvic pain)

The self care advice is terrific

And I cannot recommend a decent women's physio enough

Thank you for this thread. Like Snappedit, I'm interested in the risks of C sections compared with vaginal births. I've had one EMCS and may have another. Why does a C section increase the risk of breathing difficulties? I tried to find info online, but all the info I found was about premature babies whose lungs weren't fully developed.

Also, in your opinion does IVF cause any problems for mother or baby? I had IVF at a private clinic and was on quite high doses of Gonal F (up to 350 units per day). My consultant seemed really nice, but I couldn't shake off the feeling that he was part-doctor, part-salesman (possibly me being paranoid).

Amaried - I am way out of date on the current management - but have never seen a uterine septum removed. I am not sure if this was traditionally not offered as lack of skilled surgeons, or whether no benefit has been demonstrated. Any uterine wall surgery carries a risk of bleeding, infection and subsequent weakening of uterus in pregnancy. Your sister’s history would suggest that the bicornuate uterus anatomy is likely to be related, however. Sorry can’t give more advice on this.

Very interesting thread.
I particularly appreciate your comments about GPs and their lack of training in this area. I visited my GP with urinary incontinence and a dragging feeling in my vagina which I feared was a minor prolapse. She could not think of a single physio to support me, even if I went private. All I got sent away with was a photocopied leaflet and a general pat on the shoulder "it is normal as you get older" "you shouldn't do strenuous exercise again" (I am early 40s FGS).
I ended up googling, finding a fantastic private women's physio on the same street (!) and receiving excellent advice (which incidentally was that if I had done the exercises in the leaflet I would have damaged myself more). I am now in much better shape.
I just feel that there is a general sense that women pissing themselves and having their innards falling out and never being able to have PIV sex without pain and not running or dancing ever again is seen as... normal. Which is fantastically depressing.

Thank you so much for coming on here and answering questions, this is the best thread ever!

I had a vaginal delivery 7 months ago after an induction. I had an epidural and pushed my DS out after 13 minutes, resulting in three second degree tears and 1.5 litres of blood loss.

At my debrief, it was explained that the tears occurred at the pressure points where I was pushing, if that makes sense, and that for my next pregnancy, I should book into the premature clinic straight away.

I was told that there may be a chance that my cervix might be too short to hold the pregnancy, and I may need stitches to hold to prevent the cervix from opening. They also said it would be uncertain how I might labour as well.

Should I try and go for an ELC for my next pregancy, in your opinion?

Many thanks!

My 18 yr old DD had a Mirina inserted at 15 under GA as she had very heavy periods and was extremely anaemic and it was impacting significantly on her wellbeing. She was also going to live remotely for two years She’s had two iron infusions and for the last 3 years has not had a period, her iron levels are normal and she has been able to compete at a high level athletically.
She is overseas and has just phoned to say she has a “flooding” period (first bleed in 3 yrs) and intense pelvic pain.
Is it possible the Mirina has moved ? Have you heard of intense pain from a Mirina ? Her gynaecologist is away until Monday ...she’s a 21 hour flight away ....not sure what to advise ...ie does she need an ultrasound to see what’s going on ?? Should she come home. No other symptoms eg signs of infection – thank you !

Peter - seen most things, I reckon. Not that a patient couldn’t come with something new, but more to try and reassure women that my job is to try and help them, which involves a full and relevant history and examination if required. Nothing would embarrass or disgust me. Sadly many women seem so by their own bodies, increasingly so.

ScreamingValenta - for ease see op's response to my question.

Pisses me off too.

mum - lots of fairly minor physical injuries (poor suturing of tears or epis) and some more major (eg: anal spincter injury). I think women are conditioned to expect that this is normal and untreatable. Unavoidable in most of cases, but all certainly treatable to an extent.

Killing, I would suggest you see your local sexual health clinic when you have symptoms, for examination and appropriate tests to confirm whether it is thrush or not (many women have BV, strophic vaginitis, skin condition or maybe an STI when they think they have thrush).
If positive, you will be able to access a clinic for recurrent thrush management.
May be related to perimenopause if you are in that age group 40+