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Cervical Screening

What is cervical cancer?

Cervical cancer is an abnormal growth of cells in the cervix. If left untreated, it can grow and spread in the body, causing symptoms such as abnormal vaginal bleeding or discharge.

There are two main types of cervical cancer. The most common type arises in the squamous cells of the cervix, accounting for about 80% of all cases. Adenocarcinoma arises from the glandular cells (cells that produce a secretion), and accounts for about 20% of cases. There are some other very rare types that are not easily detected by cervical screening.

Nearly all cases of cervical cancer are caused by a persistent HPV infection.

Can cervical cancer be prevented?

Girls can be protected against the most common types of HPV (16 and 18) that cause cervical cancer by having HPV vaccination while at school.
Women can be screened using the Cervical Screening Test for the presence of HPV infection in cervical cells.
If detected, treatment for cervical cell abnormalities is simple and successful.
A repeat test in one year to see if the infection is persistent may be required or further investigation by colposcopy. This is the examination of the cervix using a colposcope, which gives a magnified view of the cervix. It is usually performed by a specialist gynaecologist and can detect abnormalities that may require treatment.
If a woman has a colposcopy and a cervical abnormality is confirmed, then treatment will be recommended.

Who should have a Cervical Screening Test?

Any woman, aged between 25 and 74, who has ever been sexually active, including same-sex relationships, even if they have received HPV vaccination.

Colposcopy

What is a colposcopy?

A colposcopy is a procedure that uses a special microscope (a colposcope) to look at the cervix (opening to the uterus or womb), vaginal and vulval area. The colposcope is like a pair of binoculars mounted on a stand and connected to a powerful light. It magnifies the tissue and enables the doctor to see any abnormal cell changes that cannot be seen with the naked eye. The procedure takes approximately 10 to 15 minutes. Our colposcope is connected to a television monitor, if you like, you can watch the procedure as it happens. If you do not wish to do this, please tell the doctor or nurse. Colposcopy images of the cervix will be saved to your records for future reference.

Why have a colposcopy?

A colposcopy is usually done when a woman has an abnormal Cervical Screening Test (Pap Smear). However, you should remember that most abnormal Cervical Screening Tests are not cancer.

What happens during the procedure?

You lie on an examination bed like you do for a Pap smear. Your legs will be on supports to allow better vision of the cervix. A speculum is inserted into your vagina. The doctor looks through the colposcope. The colposcope does not go into your vagina but is positioned between your legs to allow the doctor to examine the cervix. Another smear may be taken. Your cervix is then dabbed with dilute acetic acid (vinegar). This will help to identify any abnormal cells. Most women do not find this painful although it may sting. A brown dye (iodine) may then be used to outline the changes. When abnormal areas are identified, the doctor may take one or two small biopsies (samples of tissue from the surface of the cervix) which are sent to pathology for further investigation. The biopsy may cause mild discomfort or menstrual-type cramp.

What happens after the procedure?

Following a biopsy some light bleeding may occur. Spotting sometimes lasts for several days. Use panty liners if necessary. During this time DO NOT use tampons. Abstain from sexual intercourse for a week to allow healing of the biopsy site.

Contact our Rooms (9389 5000) or your GP if:

you have any heavy bleeding,
offensive discharge, or
are concerned.

The biopsy results and a plan of management will be discussed with you over the phone by our Nurse within 2-3 weeks. The pathology result will be forwarded to your GP. If further treatment is required, you will be informed at this stage and an appointment will be made.

Chronic Pelvic Pain

Chronic pelvic pain, in general, is persistent pain experienced in the pelvic area (below the belly button) lasting six months or longer.

Chronic pelvic pain is different for every person. It can be caused by disorders of the female reproductive tract (gynecologic), or the digestive system, urinary system, or irritation in the muscles and nerves in the pelvis.

In some cases, this condition is related to ‘centralised pain’, when the central nervous system has heightened reaction to certain triggers, and the person experiences more pain than would normally be expected.

Chronic pelvic pain develops over several years. The pain may come and go, but remains in a certain area of the lower abdomen. The most common early complaint is ‘cyclical’ pain experienced from ovulation to menstrual period during an individual’s reproductive years. Pain can persist long after the menstrual cycle has finished. Eventually pain is experienced all of the time and associated with ‘non-cyclical’ events such as urinating and bowel motion) and sexual intercourse.

Chronic pelvic pain can be associated with other chronic conditions, such as irritable bowel syndrome, premenstrual mood disorder and migraine headaches.

Contraception

When choosing a method of contraception it is important to consider the following:

Your individual needs and circumstances
How effective they are at preventing pregnancy
Possible side effects and risks
Cost and availability
Protection against sexually transmitted infections
Can it be reversed so pregnancy is possible?

Endometrial Ablation

Endometrial ablation is a surgical procedure that removes the inside layer (the endometrium) or lining of the uterus. The endometrium is the part that sheds each month as a period (menstruation ). The endometrium consists of 2 parts:

A deep part (called the basalis)
A superficial part (called the superficialis)

Each month a thickening of cells occurs to produce the superficial part. In a usual menstrual cycle, where pregnancy does not occur and without any hormone treatments (such as the oral contraceptive pill), the superficial part is shed and menstruation occurs. The deep part is always present and does not shed to allow the process to be repeated in the following month.

Endometriosis

Endometriosis is a chronic inflammatory condition that can affect women of reproductive age. It occurs when endometrial-like tissue (similar to the tissue that lines the uterus (womb)) exists in other parts of the body – most commonly in the pelvis.

During the reproductive cycle, the tissue that lines the uterus (endometrium) thickens in response to release of hormones to prepare to enable a fertilized egg to implant to begin a pregnancy. If this does not happen the lining breaks down and is shed, and a menstrual period occurs.

Endometriosis deposits outside the uterus behave in a similar way during the cycle and so cause pain during a period. The breakdown of the lining involves inflammation, and can be painful.

Endometriosis is:

common – at least 1 in 10 females have endometriosis
an oestrogen dependent condition – endometriosis responds to the hormone oestrogen. Oestrogen is produced by the ovary throughout the ‘reproductive years’, i.e. from the time you start having periods (puberty) to the time your ovaries no longer release hormones (menopause)
a long-term (chronic) condition – endometriosis rarely goes away without treatment before the menopause. People with endometriosis may require long-term healthcare support.

Heavy Menstrual Bleeding

Normal Periods

A woman normally loses between 30 and 40ml of blood with her period (six to eight teaspoonfuls) each month but there is much variability. Bleeding can last up to eight days, but bleeding for five days is average.

Heavy Menstrual Bleeding

There are medical definitions of heavy menstrual bleeding, but the only practical definition is when there is excessive menstrual blood loss that interferes with the physical, emotional, social and material quality of life. Monthly periods are an individual experience and women who have always had heavy periods will consider this normal. However if you believe that your periods are either unusually heavy, prolonged or both, there are many different treatment options available to you.

Hysterectomy

Hysterectomy is an operation where the uterus (womb) is removed.

There are different types of hysterectomy, and during the operation other organs – such as the ovaries or fallopian tubes – might also be removed

A ‘total hysterectomy’ means that the uterus and the cervix (neck of the uterus) are removed – this is the most common type of hysterectomy. A ‘subtotal’ hysterectomy means that the uterus is removed, but the cervix is not – this is a less common operation.

At the time of hysterectomy, one or both of the ovaries might be removed. It is also common for one or both of the fallopian tubes to be removed. It is important that you are clear about the type of hysterectomy that might be performed, and whether the ovaries or fallopian tubes are to be removed as well.

The type of hysterectomy and whether the ovaries or fallopian tubes are removed will depend on your personal circumstances and will be discussed with you by your gynaecologist before your operation.

Hysteroscopy

A hysteroscopy is a procedure used to examine the inside of the uterus (womb).

It is carried out using a narrow telescope, called the hysteroscope, which is inserted through the cervix (opening of the womb) into the uterus. The hysteroscope is connected to a light and camera, which sends images to a monitor so that your gynaecologist is able to see inside the uterus.

As the hysteroscope is passed into your uterus through the vagina and cervix, no cut needs to be made in your skin.

Why is a hysteroscopy performed?

To diagnose certain problems, your gynaecologist will need to look directly at the inside of your uterus.

Common reasons for having a hysteroscopy include abnormal bleeding, fibroids, polyps or difficulty getting pregnant. You should have a clear understanding why you are having this surgery, if not, please ask your doctor.

Laparoscopy

Laparoscopy is commonly called ‘keyhole surgery’. It is a procedure in which a surgical telescope and video camera is passed through a small cut ‘keyhole’ in the abdomen, usually in the umbilicus (belly button).

Carbon dioxide gas is used to gently inflate your abdomen during laparoscopy to enable your gynaecologist to see your pelvic organs. This allows your gynaecologist to look at, and operate on, the organs of the pelvis and abdomen. Instruments can be passed through one or more other small cuts in the wall of the abdomen.

The cuts are usually about a centimetre long so the gynaecologist can perform operations without the need for a large cut.

Laparoscopy and keyhole surgical techniques give patients a number of important advantages:

more rapid recovery
reduced pain
smaller scars

Menopause

Menopause is often referred to as the ‘change of life’ because it marks the end of a woman’s reproductive life. Menopause literally means that a woman has had her last (or final) menstrual period.

Most women become menopausal between the ages of 45 and 60 with the average age for Australian and New Zealand women being 51 years.

Each woman will experience her menopause in her own way. Many will have only minor discomfort but others will experience a range of troubling symptoms. These symptoms are commonly short lived but, for some women, will persist for over a decade.

Knowledge of the menopause and the symptoms is important to help you decide how best to manage your symptoms and maximise your quality of life.

Pelvic Floor Exercises

The pelvic floor is the hammock of muscles and tissue that lie across your pelvis and support your bladder

Daily pelvic floor strengthening exercises make a difference and can prevent future problems.

Q&As about women’s pelvic floor health

What is pelvic floor dysfunction?

Pelvic floor dysfunction or disorders is the collective term used to describe urinary and faecal incontinence, pelvic organ prolapse, and sexual dysfunction in women.

What is the pelvic floor?

The pelvic floor is the hammock of muscles and tissue that lie across the pelvis between the pubic bone at the front and the sacrum or tail bone at the back, that supports your bladder

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a bulge or lump in the vagina, which may affect your quality of life. Symptoms may include a heavy, dragging feeling or lump in the vagina, bladder or bowel problems and discomfort with sexual intercourse.

It is difficult to know exactly how many women are affected by prolapse since many do not go to their doctor about it. However, it does appear to be very common, especially in older women. Half of women over 50 will have some symptoms of POP and by the age of 80 more than one in ten will have had surgery for prolapse.

Stress Urinary Incontinence

Stress urinary incontinence (SUI) is when you leak urine or wet yourself with activity.

Women with this condition leak urine when they laugh, cough, sneeze, exercise or do anything that puts pressure on their bladder. This is caused by a weakness in structures that support the bladder neck and urethra, which means it cannot keep fully closed during exertion, allowing urine to escape.

SUI is extremely common. Often called “light bladder leakage”, it can affect up to 1 in 3 women. Some women find it burdensome and embarrassing, resulting in a negative impact on their quality of life and preventing them from seeking medical help and the range of simple, effective treatments available.

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