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!

I've noticed since my first child's birth to do an internal examination during induction for my second, doctors found it very difficult and had to go ' up and turn the corner' which became a bit like giving directions in a taxi while having checks!

Now 8 months post birth, if I use a tampon it almost 'clicks' into place to the right. This can be really uncomfortable but not overly painful most of the time.

Is this just 'one of those things' after having a baby or something worth discussing with my doctor?

As a rape survivor who can't go through internal examinations (even in dire medical circumstances) I've encountered a lot of impatience and frustration from obs and gynae professionals. How much training do you have into the after effects of sexual violence, do you commonly encounter women with extreme fear of being touched and do you think intiatives like My Body Back should be widely available?

Would you tell a 20 year old woman that some women just get pain during sex, and she'll have to get used to it? And that her symptoms definitely aren't vulval vestibulitis, even though they all match except one?

(This was 15 years ago, I wish I'd complained. Thankfully after two years of being ignored I moved and found a fantastic gynae who treated me.)

Thank you Quince, I didn’t know about the backache which I have also had

Thanks so much @quince2figs . If laparoscopy isn't great at diagnosing endometriosis, what alternatives are there?

Why is repair of my multiple dehissed labial tears sustained in childbirth considered 'cosmetic' and therefore not worthy of the NHS's efforts nor coverable on private health insurance?

I look like someone has sliced me up with a stanley knife and it is uncomfortable to ride a bike or sit on a stool

What is your opinion on the fact that second degree tears diagnosis and repair after birth is often done by midwifes and not doctors?

Anecdotally you see a lot of complaints from women whose tears were badly repaired causing them problems and sometimes needing resuturing - which also probably many women who needed don’t get.

Perineum is quite complicated area with lots of nerves and muscle tissue and it is also cosmetically sensitive. When you have a relatively minor cut on your face you are seen by a cosmetic surgeon in the A&E who advises on repair. Do you feel that such difference in treatment for the vaginal area is justified or do you feel it is based in misogynism?

I understand that there is the issue of the cost, but again can’t feel thjnkkng what would happen if we were dealing with penises...

I wanted to add that personally getting a tear repaired badly was my biggest concern before giving birth. Just because second degree tears are so common so it is almost unavoidable. I ended up giving births by elc’s for different reasons.

Since it is an AMA thread I wonder if you would trust a random midwife to repair your own tears :) and if you had any tears after giving birth, who sutured them ;)

Great thread O.P. Do you think it should be standard procedure for women to have a GA when having a hysteroscopy? I had one with very little LA and found it horrific. I've since read that there's a campaign to have GA as standard.

Why do so many GPs know so little about peri meopause and HRT.

@S0upertrooper

Yes this is the campaign:

www.hysteroscopyaction.org.uk

I had two hysteroscopies (privately, as medical insurance covered surgery for miscarriages) and both were done under full GA

Can't imagine having a diagnostic hysto, let alone a surgical one, done under LA!

How often do you come across a spontaneous massive acute fetomaternal haemorrhage and have you ever known a woman experience it more than once?

Id like to know your thoughts about Perimenopause and Menopause and when/how to seek treatment too.

I find it incredible how little information there is about this. I felt well pretty well prepared for mentruatuon, pregnancy, childbirth, from a myriad of sources. But for menopause, i literally havent got a clue what to expect, what is normal, what warrants HRT or how to get it.

Do you have any advice for junior doctors/medical students looking to go into obs and gynae? Would you choose to go into the specialty if you were just starting out now?

Oh, amazing thread, thank you!

I'm not in the UK so I see a gynae once or twice a year as routine, she also did all my pre- and post-natal care.

She's otherwise great, but completely uninterested in finding a solution to one issue, so perhaps you've seen it before.

I gave birth to my son 2 years ago. Labour was induced, birth was difficult, traumatic, and completely unmedicated,and ended with a ventouse delivery after my boy got stuck. My body has slowly recovered (though I have stress incontinence and haemorrhoids, but have Physio booked for my pelvic floor, which I hope will help) but on the sex front: I have orgasms more easily than before (for a year or so afterwards even very regularly in my sleep) but they are PAINFUL. So much so that it puts me off having them. They are really intense and as soon as they're over i am left with very bad cramping which feels exactly like post-labour pains. It only lasts a minute or two but it's excruciating.

Do you have any idea a)why this is happening and b) what if anything I can do about it?

I was hoping it'd resolve on its own as my body healed post-birth but 2 years down the line and it has not done so yet.

MyGreyCat, maybe you will be interested in this review of MFH, in addition to OPs answer.
It says there that it is most often a non recurring event and there is also some suggestion of what tests can be done in future pregnancies, but basically it is hard to predict or identify and they claim the best way is tracking fetal movements.
I am not a doctor, so hopefully op will be able to give more info. I just thought it might be helpful.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3653511/#!po=1.04167
www.ncbi.nlm.nih.gov/pmc/articles/PMC3653511/#!po=1.04167

Thank you so much , I'll have a hat with my GP.
Really appreciate the advice

Thank you @user1495362060 and that is kind of you to provide the links. I’ve had a few discussions with consultants at my hospital, and spoken to Tommy’s as well, and I also the information in the post mortem results but always interested to hear other consultants’ viewpoints as knowledge and experience of it occurring seems to vary massively.

Thank you re my horrendous periods.
I've made a Drs appointment to hopefully get a referral.

After the mefanamic acid didn't agree with me I just put up with the pain, but that was about 2 years ago. I've decided it really is time to try and get some relief. Shouldn't have to suffer if something can be done. But it looks like there's not much that can be done for endo or adenomyosis, however I would find it reassuring to be able to label it as 'period pains' does not convey the agony at all.

I am 43 and am now bleeding/spotting for 2 weeks a month - and getting worse clots and floods. My GP is the area FP specialist, said she can feel no lumps and advises a Mirena.

Is this standard, and as I can't tolerate any other hormonal contraception (family clot/heart attach risk for combined plus breakdown/migraines with aura on PGT only) am I likely to also react to Mirena (tried jab - implant made me suicidal - mini pill)?

Why do you think hyperemesis gravidarum is not very understood? From my experience drs say its unknown what causes it or how to stop it. Just to mask the symptoms. Any advice on it??

Would you be concerned about irregular periods 10 years after starting them? I was always told they were supposed to regulate after around 2 years of having them, but that hasn't happened for me. Is this something to worry about, or completely normal?

As a GP I've found this an interesting read!
I think you're being a smidge unfair to us if im honest. While there is definitely room for improvement it's a bit amis not to mention how woefully inadequate and inefficient the secondary care services are, too. Without the appropriate funding patients are being let down universally really!
I'd love to refer more often to gynae but we are under CONSTANT pressure not to refer anyone anywhere (not just gynae). We already have a nine month waiting list when we do refer.
Someone up thread said they thought urology would be a required part of training - it isn't and as far as I know never has been. Most GP trainees will still do o&g rotations (I did - though I wasn't allowed to actually do or learn anything, the registrars just used us as paperwork monkeys ) but recently they've said we don't HAVE to - mostly to allow for more service provision and to push more GPs through training as there's such a shortage.

I think you're being a smidge unfair to us if im honest.

I don't. Have you seen the statistics? Ten years from presenting with endometriosis symptoms to surgery? Read the threads on here?

GPs are terrible about not taking responsibility.

I agree. I get that they're very hampered by the system and stretched for resources but many (most?) GPs are not providing adequate care for women ime. i cant even get an appointment at mine, never mind ask about the menopause. They are so, so hard to access that I only go if its something urgent, like an infection. The whole process of getting an appointment is so difficult ans fraught (queue up, take time off work, be on hold for an hour, queue up at 8 again, kids late for school, ferocious and stressed receptionists, explain to work why late, hang around for hours etc etc) that i wpuld never feel it was worth trying to get an appointment to discuss my gynaecological issues. Hence why so many women suffer in silence.