If you are not currently planning a pregnancy and are sexually active, reliable contraception is important. There are many options and delivery systems to choose from, including barrier methods and hormonal methods, which may be short or long acting. At Women’s Health Melbourne we can facilitate a number of contraception methods, including:

Short Term

Barrier Methods:
– Condoms Imperative for Sexually Transmitted Infection (STI) prevention in new relationships
– Cervical diaphragm (rarely used)

Hormonal Methods:
– Combined Oral Contraceptive Pill (Estrogen & Progesterone formulations)
– Combined vaginal contraceptive ring (Estrogen & Progesterone formulations)
– Progesterone only mini-pill

Longer term

Non Hormonal Methods:
– Copper Intra Uterine Device (IUD)

Hormonal Methods:
– Implanon implant
– Mirena IUD
– Depot Provera

Permanent

– Tubal ligation
– Vasectomy (male)

Miscarriages are very common, affecting 1 in 5 clinical pregnancies. Most women who successfully have a baby will also experience one or more miscarriages in their reproductive lifetime. Miscarriage is a subject that is seldom spoken about, which means that many women going through a miscarriage can feel very isolated.

In most cases, having a miscarriage is not associated with any underlying reproductive disorder. A spontaneous and uncorrectable “mistake” in early fetal development (commonly caused by an uneven number of fetal chromosomes) is responsible.

Recurrent Miscarriage

• Three or more consecutive miscarriages may indicate an underlying problem. Some potential causes can include:

• Inherited chromosome imbalance in one or both parents

• Abnormalities of the uterus

• Autoimmune conditions such as Lupus or Anti-Phospholipid Syndrome

• Thyroid disease

• Blood coagulation disorders

Management of Miscarriage

When a miscarriage has been confirmed, a woman can be cared for in a variety of ways. From a medical perspective, these options are of equivalent benefit and the strategy chosen is based on a patient’s care preference.

Options include supporting a woman through a natural miscarriage or interventions to achieve resolution of symptoms more rapidly (such as Misoprostol/Mifepristone or surgical Dilatation & Curettage). Women with a Rhesus factor “negative” blood group are also advised to have an injection of Anti-D following a miscarriage.

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Laparoscopy

Laparoscopy refers to small incision pelvic surgery, where advanced gynaecological operations are performed using purpose designed miniature instruments, under the vision of a 5mm wide fibre-optic telescope.

During laparoscopic surgery, the anatomy and function of your ovaries, fallopian tubes and uterus are fully assessed. Endometriosis, pelvic adhesions, pelvic inflammatory disease, ovarian cysts, non-functioning fallopian tubes and some fibroids can be diagnosed and appropriately treated.

In women who require an uncomplicated hysterectomy, this may be performed by laparoscopy. Advantages of laparoscopy over “open” gynaecological surgery include:

• Smaller, less noticeable incisions (which are quicker to heal)

• Reduced post-operative pain

• Reduced time to achieve a full recovery from surgery

• Reduced length of time in hospital

Reduced risk of pelvic adhesion formation

Hysteroscopy

A diagnostic hysteroscopy refers to the inspection of the uterine cavity using a 5mm trans-cervical telescope, which allows diagnosis of any structural abnormalities of your womb. Some abnormalities (for example submucosal fibroids and uterine septae) can be effectively treated by an operative hysteroscopy.

An operative hysteroscopy is an advanced procedure using specialised instruments and thermal energy to remove abnormal tissue from within the uterine cavity. The aim of an operative hysteroscopy is to restore normal uterine anatomy and to improve fertility.

An Abnormal Cervical Screening Test requires respect and attention. A cervical screening test involves checking for cervical cancer (previously known as a Pap smear). Detecting and treating early cellular changes effectively prevents cervical cancer, which can save a woman from requiring a hysterectomy. The WHM Gynaecologists are expertly qualified in colposcopy (microscopic assessment of the cervix), monitoring and treatment of cervical abnormalities.

Pre-Treatment Information

What is colposcopy?

Colposcopy is a technique that performs a detailed examination of the cervix (entrance of the womb) using a variety of stains to identify abnormalities. A small biopsy of any suspected abnormal areas identified may be taken using a specially-designed biopsy forceps.

Cervical biopsy specimens are smaller in size than a quarter of a grain of rice, but they provide important cellular information that can be interpreted by a pathologist to assess your risk of developing cervical cancer.

Why have I been referred for colposcopy?

You have been referred for colposcopy because your practitioner suspects a possible abnormality of the cervix. This may be because:

A) You have been found to be infected by a high risk strain of the Human Papilloma Virus (HPV) on DNA analysis

B) You have had abnormal cells suspected on a routine cervical screening test

C) You have experienced abnormal vaginal bleeding, between menstrual periods or after sexual intercourse

Colposcopy is a way of better assessing your risk of developing cervical cancer. Pre-cancer changes can be detected at colposcopy and if confirmed, treatments can subsequently be arranged to prevent cancer development.

What is HPV? Is it sexually transmitted?

HPV is a family of viruses, with hundreds of strains of HPV in existence. Approximately 30 strains of HPV have been associated with an increased lifetime risk of a woman developing cancer of the cervix. Once contracted, HPV can persist for many years.

Australia changed the way we screen women for cervical cancer, now assessing HPV DNA status together with cellular changes. Previously, cervical cell changes were assessed in isolation (known as a pap smear).

Discovering the presence of an HPV infection on routine screening does not indicate a partner’s recent infidelity, and having HPV does not mean a woman will definitely develop cervical cancer; it is simply a recognised risk factor.

What is involved in colposcopy?

A colposcopy procedure takes 15 to 20 minutes to perform. An instrument called a speculum is inserted into the vagina so that the cervix may be visualised, focusing on the cervical transformation zone.

This is the area where the glandular cells lining the inner cervix transform into the outer squamous cell type of the external cervix, which is where HPV high-risk strains may cause a persistent infection. Chronic inflammation caused by HPV is a risk factor for a woman developing cervical cancer over many years.

Stains commonly applied at colposcopy include acetic acid (a gentle vinegar stain) and aqueous iodine. These stains help to highlight abnormal areas so that a target biopsy can be performed to accurately characterise cervical changes.

If a cervical biopsy is performed, bleeding may occur as the cervix has an extremely rich blood supply. Silver nitrate paste may be applied to the biopsy site to cauterise procedural bleeding. Healing is rapid, but intercourse and tampon use should be avoided for 24 hours after a cervical biopsy procedure. However no other subsequent precautions are necessary.

Will I require a follow up appointment?

It is important that you arrange and attend a follow-up appointment to discuss cervical biopsy results and to confirm an action plan for your ongoing cervical monitoring. An annual review may be recommended if lower risk concerns are present. If pre-cancer changes are confirmed, treatment to remove the abnormal cells may be recommended on the basis of your cervical biopsy assessment.

Like every area of the body, the appearance of the labia and external female genitalia greatly differ from woman to woman, which is healthy and normal. Occasionally, women may notice asymmetry or prominence of the labia which they feel self-conscious about, or women with prominent labia minora may suffer discomfort from friction and rubbing – specifically when wearing tight clothing.

Surgical measures to correct these issues should be conservative and are best performed in the hands of a highly skilled specialist gynaecologist. Our approach is to holistically assess your anatomical, functional and sexual issues and fully advise you of both the pros and cons of any proposed cosmetic gynaecological intervention such as labiaplasty.

Like all parts of our bodies, women’s labia come in all shapes and sizes. Labiaplasty is a cosmetic procedure that surgically reduces the outer folds of the female labia, which can help some women to boost their confidence and feel more comfortable. As a leading gynaecologist and IVF specialist, Dr Raelia Lew can expertly shape and refine women’s labial appearance, performing labiaplasty at various locations across Melbourne.

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