Attending your appointment with gynaecology - Newcastle Hospitals NHS Foundation Trust

What to expect from your visit

You have an appointment in one of our clinics. We offer gynaecology clinics in both general outpatients (on the ground floor of the New Victoria Wing) and the Women’s Health Unit (on the second floor of the New Victoria Wing, behind the food court).

Please check your letter to confirm where your appointment is.

What will happen at this appointment?

When you attend the department, the receptionist will welcome you and you will be shown to the waiting room.
For most clinics, you will next be invited to see one of our healthcare staff. They will measure your height and weight. This is used to calculate your BMI (body mass index) and is often helpful when discussing what treatments are suitable.
You will then be asked to return to the waiting room. This will be until of the doctors, specialist nurses or physician associates is ready to see you.
We are a teaching hospital, and you are likely to meet resident doctors as well as undergraduate student doctors and nurses. The team all work together with the consultant. Our team includes male and female staff.

Will there be any tests involved?

After we have taken your history, most women will be offered an examination. This may involve feeling your abdomen (tummy) or may involve a speculum (an internal vaginal) examination.

During a vaginal examination, you will be asked to remove the clothes on your lower half. You will be asked to sit on the bed covered with a sheet. A female member of the nursing team will act as a chaperone to help with the examination. They will provide support for you and also ensure that the clinician has everything that they need.

The examination might involve looking at the vulval skin on the outside as well as a speculum examination to look inside. A speculum is a small metal or plastic device that is gently put into the vagina to look at the cervix and check the vagina. You may be offered swabs to test for infection or a ‘smear’ (cervical screening test) at the same time if this is due.

You can decline any element of the assessment you feel uncomfortable with. All investigations are handled sensitively and are offered because they are clinically appropriate to explore your problem. A urine test may also be needed.

Some patients need a scan. Depending upon the type of scan needed, this can sometimes be offered in clinic. However, the majority of scans will be requested following your appointment You will be invited to attend on another day.

Sometimes it is possible for the hospital team to recognise that a particular scan or test will be useful to be completed ahead of time. If this is the case, we will work with your GP to ensure that this is completed, where possible, before you attend your appointment.

My smear is overdue, what shall I do?

We will ask about previous smear tests (cervical screening tests) as part of our assessment.

If we don’t, please remind us that you are overdue or are expected to have one in the next three months.

If this is the case, we can do the smear for you on the day in most cases. This involves a speculum that is inserted into the vagina to view the cervix. We will take a sweep of the cervix using a brush.

Are there any other tests I may be offered on the day?

In some cases where there is problematic vaginal bleeding in women over the age of 40, a biopsy of the womb lining (endometrium) may be offered. This can be done in two ways.

Hysteroscopy

For this, you will need to attend for an appointment on another day.

A hysteroscopy involves passing a small camera through the cervix (neck of the womb) to look at the endometrium (lining of the womb) to take biopsies (small samples of tissue).

It is typically done using a local anaesthetic injection to the cervix, with ‘gas and air’ to breathe.

Pipelle biopsy

The alternative is a quick test called a ‘pipelle’ biopsy. This can be done the same day in clinic and involves a speculum examination and a fine straw being passed through the cervix to take a small sample of fluid and cells.

This only takes a few seconds and can result in some cramping pain at the time. This is usually manageable by most women, but simple pain relief may be needed after this.

I have a vulval lump or skin condition, what will they do in clinic?

We will take your history and ask you about any other skin conditions that you may have. We might ask to see the affected skin on other parts of the body.

A vaginal examination will then be carried out. We will shine a light onto the vulva, and sometimes use a magnifying telescope (colposcope) to look in finer detail. Medical photography images may be taken and will be stored in the medical records if you give consent.

If we think it would be useful, we may offer a small biopsy. This would involve an injection of local anaesthetic into the skin followed by a small biopsy of the skin.

This is likely to take less than five minutes. A small stitch or patch is held onto the skin to stop any bleeding. We will give you information on aftercare before you go home.

Are there any treatments that I might be offered in clinic straight away?

Depending on the problem, your clinician will discuss all the options with you. They may recommend treatment with medications or surgery and will discuss these further during your appointment.

For people who have heavy menstrual bleeding, those needing hormone replacement therapy (HRT) or who need a treatment for certain types of cell changes of the endometrium, a hormonal coil is a good treatment. If you are happy and certain with your decision, then this can often be fitted straight away in clinic if you are suitable.

Intrauterine system (IUS)

An intrauterine system (IUS), known as a Mirena or Levosert, is a small T-shaped piece of smooth plastic, which is inserted into the uterus (womb). They have a hormone in the stem called levonorgestrel (a type of progestogen), which is gradually released. The hormone works directly on the lining of the womb to make it thinner. At the base of the IUS, there are threads attached, which are used to check the position of the IUS and remove it when it is no longer needed.

It is essential that an IUS is fitted when you are not pregnant. Most women have a fitting during or just after a period (unless there is a secure form of contraception such as a contraceptive implant, injection sterilisation or vasectomy). You should not have sex from your last period until the IUS is fitted if you have not been through the menopause.

Fitting an intrauterine system (IUS)

To fit the IUS, you will have a vaginal examination with a speculum. The IUS device will be passed through the cervix into the womb. Sometimes it is necessary to use a local anaesthetic injection so that the cervix can be held with an instrument to help move the IUS device through the cervix. It usually takes five to ten minutes in total to fit.

Most women find the procedure tolerable but, if it is too uncomfortable, you can ask for the procedure to be stopped at any time. You may have some discomfort during the procedure, and it may feel like you have period pain after the procedure. You may want to take some simple painkillers like paracetamol and/or ibuprofen, an hour before your appointment.

A further leaflet on the hormonal coil is available at your request before or during the appointment if you wish to know more and your clinician will run through it all before insertion if you wish to go ahead on the day.

Research

At the RVI, we have a large research team and often work with Newcastle University. All of our consultant team are actively involved in research and may discuss the possibility of you getting involved in research at any of our clinics.

Whilst we are very grateful for those who choose to participate, this is not essential and please feel free to decline. This will not affect your care.

For further information

Contact details

PALS (Patient Advice and Liaison Service) for help, advice and information about NHS services. You can contact them on freephone 0800 032 02 02, email [email protected]