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!

Can'tchoose can you answer my question re who decides on mandatory training for gp's then and who advises them?

Anyone whose male GP refused to discuss gynae issues or examine them should definitely complain
When I started in my current practice a few of the male GPs suggested to patients they should book with me for the examination. Which meant I was receiving a grumpy patient who wouldn't have booked with a male gp if they had a problem with them examining them. It no longer happens and has even been included in the trainees handbook here that it is strictly forbidden but that I am happy to come in to help and supervise if they don't feel sufficiently confident. They can, of course, request a chaperone which is entirely reasonable...

I don't know, graphista, I remember the change coming in but can't remember who decreed it. I would assume Health Education England. The overwhelming majority of trainees will still rotate through (it was paeds, psych and o&g I think that were compulsory but now aren't). And most Med Ed depts ask for your past experience - I didn't do psych in my gp training as if already done a long stint in a previous role. Previously I would have had to repeat it, fairly pointlessly to be honest. This is the most common situation where this would apply I would think.

I can assure you it IS still happening my dd recently had just that experience - recurrent thrush issue but we're not sure it is thrush as she has a disability that also affects the mucous membranes.

As for "complain" I hope you're aware of how difficult some gp's make this and how it can result in patients facing great difficulty in being accepted into practices.

Certainly where I live (very small county) there is a big problem with

A not enough gp's anyway
B those that are here if a patient is seen as 'difficult' (and that includes justifiable complaints) they close ranks and those patients then find it very difficult to get accepted onto a practice anywhere in the county. We've had a few have to take it to higher authorities who've then enforced their access to gp.

I won't be surprised if you say "gp's don't blacklist patients" but it's absolutely a problem where I live and I've also friends in another county where in that part of the county there's a similar problem.

So patients DAREN'T complain.

Sorry - not buying that as a GP you DON'T KNOW who oversees GP training

It's also absolutely appalling that paeds and psych are no longer mandatory - I notice there's no male centred specialism this has happened to.

A lot of what youve said is very reassuring. Thank you.

graphista you are obviously distressed by these issues and I'm sorry if you've had bad experiences which have made you feel that way.
I meant it no longer happens in my surgery. I don't doubt it happens elsewhere, though it shouldn't.
I meant that I did not know which body was responsible for that specific decision - there are several different bodies involved in GP training. But as I said, it was most likely health education England - who oversee the vast majority of training for all specialties.
No male centered specialism has ever been included. Previously those I mentioned were compulsory and they others very varied. Now there are no compulsory rotations (apart from general practice itself) although, as I said, the vast majority of trainees will still rotate through them.
I hope your daughter gets her issues sorted as soon as possible.
I am trying to be helpful and provide an 'insiders' perspective but I think it is escalating your concerns not easing them so I will dip out now.

What’s the weirdest appointment you’ve had?

Problem is, there doesn't seem to be any way to effectively complain about GPs or any evaluation of their competence over a range of issues (women's health being one). Perhaps there is and I've missed it. But the GMC doesn't want to know (unless it makes the medical profession look bad and people have already heard about the incident) and the practice manager/other GPs close ranks.

If there was a GP giving this utterly useless advice, he/she could do so 100 times and not necessarily encounter any discipline or obligatory professional development. They are allowed to be ignorant about things that don't interest them (while taking every opportunity to do time wasting things that make money such as weigh every patient who passes through the door). That state of affairs is really bad for women.

A few years ago I had a lump on my cervix, (it's still there) it was biopsied and turned out to be endometriosis. Now I have a mirena fitted and have no pain or periods any more. They used to be painful and very heavy.
My question is, would I have endo in other places and not know?

I am due to have a TAH and BSO as a result of having a BRCA 2 mutation. I am unsure whether to have the Hysterectomy as the side effects worry me. Also reading the experiences of others it seems that some consultants are all for it and others very against it. Do you have any thoughts on this. It is driving me crazy.

My fertility consultant gynae literally wrote the book on endo (he authored an endometriosis textbook) and used to run an endo and fibroids clinic at a major London teaching hospital. He said the amount of women he saw who'd been suffering with very heavy, very painful periods for years and years, who'd been told by GPs that it was normal, and simply put on the pill, was staggering. He said with endo in particular that by the time they arrived in his clinic the endo had often progressed to such a degree the bowel would be all stuck together etc and infertility was often a key issue - and that if they'd been diagnosed and treated much earlier it very possibly wouldn't have progressed that severely and they might not have had to suffer for so long. He says it starts somewhere but people take years to end up seeing him, and then needed more drastic intervention as a result

Fuzzy - a fibroid with no symptoms isn’t a problem usually. But presume you had symptoms initially to trigger the scan that identified it? Tennis ball sized is a whopper though.

Would it indicate a problem to have cramping during exercise around the time I ovulate? It happens when I’ve been doing cardio exercise for about 25-30 mins each time and just as it gets to the stage where I think I’ll have to stop it goes away again.

I’ve just started TTC this year (age 31) and am worried there may be something wrong after 8 cycles. It seems an odd symptom to go to a doctor with!

Ellie/DontDrink - good examples of how every woman is different, and that some symptoms can bother one woman more than another.
Heavy bleeding that is NOT making you anaemia is fine as long as you are happy with that - inconvenience alone is sufficient reason to treat it though, and your GPS suggestions are spot on.
Painful periods are awful, and would advise you seek some treatment to reduce heaviness and pain (not just painkillers) or stop them.

Nanini - it’s unusual to still have such a large fibroid so long after the menopause, as they usually shrink, but don’t go away completely.
It sounds like it is giving you troublesome symptoms, and is likely to continue to cause PMB -which need to be investigated every time it happens, to exclude any other more serious causes.
Considering surgery (fibroids removal, hopefully via cervix) or hysterectomy would be options.

Oranges - normal as in it is a common perimenopausal change, but should ideally be investigated to exclude much less common and more serious causes
It should also be managed as is very disruptive to normal life, esp if periods also become irregular and woman becomes anaemic.

Smelly - all vulvas look different but broadly alike! No, I wouldn’t be able to identify the owner again.... all vaginas (internal) look much more similar.

TodaysFish - pretty unusual unless the uterus is overstimulated in labour, usually by induction. More common with a very thin uterine anterior wall, which should be picked up on scan.

Derelict - very much depends on size of cysts, if they need to be reomoved fro other tissues, how easy the surgery is.
Laparoscopic (keyhole) surgery avids the complications and pain of a large abdominal incision - but there can still be considerable internal tissue trauma, so not necessarily less painful post-op. You are usually out the same day or day after. Always a small risk may need to convert to open surgery and stay in longer, though rare. Make sure you can pee ok before going home and have decent pain relief, some help at home and a realistic time off work (1-4 week’s standard, poss more).
Hope all goes well.

Thanks Quince - if I'm 50 and have an ovarian cyst (simple - 6.5cm growing fast), is there any reason to only remove one ovary?

Victorian - glad you have had good experiences, and your problems sound to have been considerable.
I am doing the job I am paid for and which I love - I think everyone else in the profession should too, but sadly not the case.
Btw, a prolapsed cervix should’t mean you can’t have a Mirena fitted, but would recommend going to a contraceptive consultant for this.

hmmm - fairly uncommon, as usually the waters break spontaneously, or are broken by midwife/doctor during labour. Intact membranes would often stop the baby’s head descending properly.
LOTS of mythology about membranes and keeping them for good luck in the past.

Plums - couldn’t agree more! I am slightly shocked by how many women are asking me specific clinical advice on this thread, which implies they have not had their queries answered by their own GP or gynaecologist, don’t understand or, worse, don’t trust them.