25 May What to expect at your first gynaecologist appointment
You may be referred to see a gynaecologist by your local GP for a number of reasons. These include abnormal menstrual bleeding, fibroids, endometriosis, pelvic pain, abnormal pap test results, family planning, difficulty falling pregnant, prolapse, menopausal symptoms or concerns about malignancies. Your initial visit will involve assessment of your presenting problem through history taking, physical examination and arranging further tests. Tailored treatment options will then be discussed based on these assessments.
History taking involves your gynaecologist asking you about the nature of your symptoms – what, when, how long etc, menstrual history, pregnancy related history, past medical or gynaecological conditions and any other history that will assist them in making a diagnosis. Feeling comfortable and having a good rapport with your gynaecologist is essential as thorough history taking gives the gynaecologist a better grasp of your situation and enable them to help you more.
Physical examination generally involves a vaginal examination with a speculum so the cervix can be examined. Internal examination may also be performed to assess the uterus and pelvis. Pap test or swabs to check for infections can be done at the same time if indicated. This may be uncomfortable but should not be painful. It is absolutely important that you are in control of what is happening, so you can stop the examination if it is too painful.
Finally, your gynaecologist may arrange further tests to be done. This is generally in the form of pelvic ultrasound (preferably transvaginal) to assess the uterus, ovaries and other pelvic organs. The quality of the ultrasound scan is operator dependant, more thorough scans done by specialist gynaecological sonologists can be more helpful in reaching the right diagnosis. Bloods tests such as blood counts and hormonal levels may be arranged too.
Most diagnosis can be derived from history taking and physical examination. Initial treatment options will be discussed. These options will be individualised to you depending on your specific situations. The treatment can also be tailored further once results from investigations are back.
In general, treatment options can be conservative watch and wait approach, medical or surgical in nature. Medical treatments include non-hormonal or hormonal medications. Surgical treatments range from minor day procedures to major surgeries depending on the diagnosis. Many major gynaecological procedures can be performed through minimally invasive ‘key hole’ laparoscopic or robotic surgeries, reducing the risks of surgery and allowing quicker recovery.
Time should also be given for you to ask your gynaecologist questions, to ensure you completely understand the process of arriving at diagnosis and what it means for you. You also need to ask your gynaecologists the risks and benefits of each treatment options, including potential side effects. If surgery is recommended, the process, risks and recovery period of the surgery should be discussed. You should also ask if your gynaecologist is the best person to do this procedure for you.
While all surgery carries associated risks, gynaecologists performing high volume surgery have been shown to have lower complication rates. So do not hesitate to ask your gynaecologist how much of their work is gynaecology rather than obstetrics (maternity related), what areas of gynaecology form their main bulk and focus of work, how frequently they perform a particular type of surgery, and what type of complications have they previously encountered.
You should feel totally comfortable with your gynaecologist and the recommendations they make. Otherwise, please do not hesitate to get a referral for a second opinion. The relationship between you and your gynaecologist should be built on respect, trust and honesty.