GYNAECOLOGY

At Women’s Health Melbourne we understand that visiting a gynaecologist can feel intimidating or uncomfortable, which is why we champion values of dignity, compassion and respect.

Dr Raelia Lew and our team of caring practitioners are committed to ensuring that you feel at ease during your treatment, taking a proactive and professional yet gentle approach with every patient across a full range of general gynaecological services.

GYNAE ISSUES

  • Pelvic pain can be very distressing, and it can also be due to a variety of causes. This is why we place particular importance on fully investigating every patient’s circumstances to ensure that a correct diagnosis is achieved accurately and efficiently.

    Once the underlying cause of your pelvic pain has been diagnosed, a comprehensive treatment plan can be formulated and you may be referred to a W.H.M. Practitioner who is more specialised in the treatment based on your needs.

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  • A regular, 28-day menstrual cycle might be billed as the norm, but in reality it remains a dream for many women. Heavy, painful or irregular periods can occur, especially during adolescence and in the years prior to menopause. This can be due to a variety of conditions.

    Treatment options may include a referral for acupuncture, herbal medicine, diet and lifestyle modifications with one of our W.H.M. Allied Health Practitioners.

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  • Endometriosis is a condition where abnormal tissue outside of the uterine cavity reacts to the hormonal changes of the menstrual cycle. Endometriosis lesions are structurally similar to the endometrium in your womb.

    Active endometriosis is associated with inflammation and scarring. Lesions, nodules and endometriomas (endometriosis lined ovarian cysts, known as chocolate cysts) can cause anatomical damage to important pelvic organs, leading to impaired fertility. Inflammatory mediators of endometriosis in a woman’s pelvic environment can also have toxic effects on eggs and embryos.

    Endometriosis can cause a spectrum of pelvic pain syndromes, which are cyclical in nature. Pain tends to be worst in the days leading up to and during your menstrual period, but endometriosis can also cause pain associated with your bowel and bladder function and “deep“ pain with sexual intercourse.

    The gold standard treatment for endometriosis is surgical removal of abnormal tissue, however it is vital that a conservative surgical approach is taken in treatment for women seeking fertility. Extensive surgery to a woman’s ovaries can destroy normal surrounding ovarian cortex (the tissue containing her eggs). The Women’s Health Melbourne team are fertility experts that are highly skilled in minimally invasive laparoscopic gynaecological surgery, with a focus on simultaneously eradicating your endometriosis symptoms and maximising your fertility.

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  • Vaginismus is when involuntary contraction of overactive pelvic floor muscles cause sexual pain, inability to have penetrative sex or to be able to undertake vaginal examinations.

    Vaginismus can be secondary to underlying medical conditions such as vulvodynia or endometriosis, or can occur as a result of sexual trauma or abuse. Effective treatments exist, often involving a multidisciplinary team approach.

  • Libido or sex drive can vary with hormonal changes and life stages. Low or mismatched libido can be a cause of sexual and relationship concerns.

  • Natural fertility usually involves sexual intercourse. Sexual concerns for some couples create a barrier to getting pregnant.

    Examples include:

    • Vaginismus

    • Erectile dysfunction

    • Ejaculatory dysfunction

    • Low or mismatched libido

    • Sexual anxiety

    For some couples with sexual concerns, assisted reproductive technologies including IUI and IVF to achieve their goals of having a baby is the best immediate action while in the longer term we work on strategies to achieve enjoyable sex.

  • Fibroids are tumours of the uterine muscle. While usually benign, some fibroids can rarely develop into a cancer called leiomyosarcoma.

    Fibroids need to be surgically removed if they reduce the chance of a successful pregnancy. This depends on the size and location of fibroids, which can be subserous, intramural or submucous in classification.

  • Adenomyosis is a condition where the muscle of the uterus is diffusely infiltrated by glandular tissue, causing the uterus to become enlarged and the muscle thickened. Adenomyosis has typical ultrasound features including sun endometrial cysts and "Venetian blind" shadowing.

    Adenomyosis can be associated with infertility, including Fallopian tubal dysfunction due to peri-isthmal muscular hypertrophy. Adenomyosis can also be associated with heavy menstrual periods.

  • Anorgasmia is delayed, infrequent or absent orgasms, or significantly less-intense orgasms after sexual arousal and adequate sexual stimulation.

GYNAECOLOGICAL SERVICES

  • 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 bexpertly qualified in colposcopy (microscopic assessment of the cervix), monitoring and treatment of cervical abnormalities.

    Colposcopy: Pretreatment 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.

    In December 2017, Australia changed the way we screen women for cervical cancer, now for the first time 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 recognized risk factor.

    The area of interest is called 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. It is in this region that 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 strains help highlight abnormal areas so that a target biopsy can be performed to accurately characterize 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 cauterize procedural bleeding. Healing extremely is rapid. Intercourse and tampon use should be avoided for 24 hours after a cervical biopsy procedure. 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. 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.

    - 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.

  • 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 recognized 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.

    - What is labiaplasty?

    Labiaplasty is the surgical reduction of the outer folds of the female labia. It is also known as ‘labia majora surgery’, ‘labia minora surgery’, ‘labia reduction surgery’ and ‘labioplasty’.

    - Why would a woman choose to consider labiaplasty?

    As with the rest of our bodies, women’s labia come in a large range of genital appearances, which is healthy and normal. However some women have very large labial folds of tissue that cause discomfort, often prompting friction issues. Some women may also feel self-conscious, uncomfortable or be unable to wear tight clothing such as gym leggings or g-string underwear. Activities such as running, bike riding and horse riding may also cause great discomfort. At the extreme, very large labia can make sex uncomfortable and affect relationships.

    In recent decades, pubic hair fashion has changed. Women who choose to shave, prefer brazilian waxing, or laser hair removal may be more aware and concerned about their labial appearance and may wish to make subtle changes to achieve their own ideal. Some women have labia that appear very uneven from side-to-side and wish to achieve a more even appearance. For the right patients, labiaplasty can help women feel more feminine, more confident and much more comfortable.

    Are there health benefits to labiaplasty?

    Labiaplasty is a cosmetic procedure that is designed to help women feel happier about the way they look. While it does not directly convey health benefits or heighten sexual pleasure, some women experience improved comfort and sexual confidence, which can lead to an improved quality of life and self-esteem.

    In most cases there is not a medical indication for labiaplasty, which means that the procedure is not currently subsidised under Medicare. However, your consultation appointments with our Women’s Health Melbourne gynaecology team about labiaplasty are eligible for a Medicare rebate. To claim this rebate, a GP referral is required.

    - What does the labiaplasty operation entail?

    The procedure is performed in an operating theatre under a general anaesthetic. Dr Raelia Lew gently and subtly reduces the excess tissue around the inner and outer labial lips using diathermy energy (which minimises tissue inflammation). Her aim is to expertly reshape and refine the labial appearance. Most women can return to work within a week and sexual activity can resume after 3-4 weeks.

    - Why choose an expert gynaecologist for labiaplasty?

    Many doctors who perform labiaplasty are plastic surgeons or cosmetic surgeons who are often ‘self-taught’ in regards to female genital surgery. When considering treatment to the female genital area, we highly recommend choosing a doctor with formal training and expertise in genital surgery.

    Dr Raelia Lew has achieved advanced training in labial and vaginal repair and reconstruction. She has extensive experience in the repair of labial and vaginal tears from birth-related traumatic injury, successfully treating hundreds of women. She has translated this expansive skillset by applying principles and techniques from both gynaecology and plastic surgery to achieve the best cosmetic outcomes for her patients.

    As a female gynaecologist, Dr Raelia Lew is also easy to talk to about the slightly uncomfortable subject of labiaplasty, making her patients feel at ease and secure.

    - What can I expect at my first consultation?

    At your first consultation, Dr Lew will assess you holistically to understand the issues that are important to you. You can speak with her about all aspects of your gynaecological health, or even concerning your future fertility.

    You will also have a genital examination where you can show Dr Lew what aspects of your labial appearance you would like to enhance. She will counsel you about the risks of labiaplasty surgery and about what she believes can be achieved in your particular case, encouraging the best possible outcome.

    - What is the cost of labiaplasty?

    The cost of your initial gynaecological consultation with Dr Lew will be $305. If you do decide to proceed with labiaplasty surgery, we will provide a surgical quote but the hospital and anaesthetist will provide their quotes separately. As an indication, labia minora reduction begins at around $7900 (for surgeon, hospital and anaesthetist fees combined).

    - What are the risks of labiaplasty?

    All surgical procedures carry inherent risk. Possible complications of labiaplasty may include the following:

    • Risks associated with a general anaesthetic

    • Risk of post-operative infection or blood clot

    • Risk of bruising and swelling (haematoma)

    • Risk of excessive bleeding

    • Risk of a slower recovery than anticipated

    • Risk of scarring/dissatisfaction with your cosmetic outcome

    Fortunately, in the case of labiaplasty these risks are rare. The skin of the labia is moist, flexible and tends to heal well and very quickly. Infection is most unlikely as the procedure is performed under sterile conditions and you will be given preventative antibiotics during the operation.

    - What can I expect during my post-operative “down time”?

    You will have your procedure as a day case and will be discharged to go home about two hours later. During the first few days you will use a labial cool pack to reduce swelling and use regular pain relief medications.

    Your initial scar should heal within 1 week and you will see Dr Lew after 1-2 weeks postoperatively for review (but also earlier if you need). Your dissolvable stitches will fall out in between 1 and 4 weeks, and you may choose to resume your sex life at 3-4 weeks.

    Once the swelling has gone down (up to 6 weeks), the final cosmetic outcome can be assessed. Contact us or visit our Women’s Health Melbourne clinic to book your labiaplasty consultation with our team.

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