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Gynecologists Finally Debunked Vulvas

No two vulvas are the same. There’s no standard! Vulvas can be all kinds of shapes and sizes

Cosmopolitan Magazine invited Miss Julie Bowring, consultant gynaecologist in Sexual and Reproductive Health at London Gynaecology to shed light on that everyone has a unique and different type of vulva!  There are no set number of vulva types. Each vagina is unique and specific to every person. So there’s not necessarily a “normal” vagina shape or standard way your vagina should look. “You know the saying, ‘No two snowflakes are exactly alike?’ Well, the expression could just as easily refer to the vulva and vagina,”

Get ready to learn all about the vulva as we answer the question ‘what is the vulva?’, bust misconceptions and uncover the truths about the vulva we wish everyone knew as much as Julie.

The vulva and the labia vary hugely in size and appearance for woman to woman. They also undergo a lot of physiological changes from being a young girl to having children and after the menopause. It is common to have asymmetry in the body and also in the vulva.

There is no right shape or size of labia and it can change during your various life stages. Having a longer labia that sticks out is not abnormal and women should be reassured by this. In very few women, there are genuine symptoms arising from the elongated or enlarged labia and these women should be managed in a multidisciplinary manner before surgery is considered.

Vulvas are incredible unique and they vary just like all our bodily characteristic – so from the labial size to the shape.

MYTH : Hair-free vulvas are cleaner

No this is a common misconception. Pubic hair has several purposes one of which is to catch bacteria and other potential harmful organisms.

MYTH: Vulvas are light pink

No. Vulvas vary in colour just as your skin tone varies. However, if you notice a new area of skin that has changed in colour, please do see your GP.

MYTH: Labia are small, tidy and tucked away

The vulva has two folds of skin either side which is the labia majora and minora – they are designed to stick out, how far will vary and they do not have to be tucked away out of sight.

MYTH : Healthy vulvas are smooth

No this is not true. The vulva skin has a number of reasons why it might not be smooth for instance sweat glands and hair follicles may cause the skin to appear slightly bumpy. But, if you are worried about a new lump or raised area please see your GP or gynaecologist.

MYTH: Discharge is a sign of an unclean, smelly vagina

No this is not the case. Normal physiological vaginal discharge that is not itchy or irritant is good as it cleanses the vagina and reduces friction. Smelly discharge can be a sign of infection such as bacterial vaginosis or candida infection. Best way to get rid of the smell is to start appropriate treatment after seeing a doctor.

We offer a comprehensive service for women with vulva problems so if you have any concerns book your consultation today click here.

Symptoms of gynaecological cancer you shouldn’t ignore.

September is Gynaecological Cancer Awareness Month (GCAM), so time for us to shine a spotlight on it.

September is Gynaecological Cancer Awareness Month and womens gynaecological organs include womb, cervix, fallopian tube/ovary, vagina and vulva. ⁠

Every year, more than 21,000 women in the UK are diagnosed with a gynaecological cancer – however circa. 95% of women with symptoms will not have a gynaecological cancer. This means 60 people receive this life-changing news each and every day. Although the likelihood of having a gynaecological cancer diagnosis is low, it is crucial to recognise symptoms and to understand what is normal for you.

Womens Health recently invited Mr Narendra Pisal and Mr Saurabh Phadnis, our consultant gynaecologists here at London Gynaecology, to discuss about the symptoms and ‘red flags’ you should never ignore when it comes to your vulva.

Symptoms of gynaecological cancer you shouldn’t ignore

Abnormal bleeding/discharge

Any type of abnormal bleeding should be investigated, but bleeding between periods, bleeding after intercourse or post-menopausal bleeding could be a sign of cervical or uterine cancer and can occur with other gynaecological cancers as well. These symptoms should be investigated without delay.

Lumps, bumps & ulcers

Vulval cancers often present as lumps and bumps or ulcers which are easily felt without searching, so you may feel something unusual whilst going to the toilet or during daily activities such as walking and sitting. If your lump is persistent and won’t go away it’s time to get it checked out.

Persistent itching

Persistent itching ‘down below’ could be a sign of thrush, but without the accompanying symptoms could be a pre-cancerous sign of vulval cancers. This may also present as tenderness of the vulva, pain or burning sensation.

Abdominal bloating / distention

We all have our days of feeling bloated, especially at certain times during our cycle, but if you feel constantly bloated or have tummy distention (where the tummy is visibly bigger) then this may be a sign of ovarian cancer. Some women with these symptoms describe that they can’t fit into their jeans or trousers, but they haven’t noticed any weight gain, in fact there may be weight loss.

New onset of abdominal pain

As women we are all used to a bit of tummy pain, but after the age of 45, a new onset of abdominal pain could be a sign of ovarian cancer and medical attention should be sought. Before the age of 45, abdominal pain is more likely to be an infection, or other gynaecological issue such as endometriosis, which also needs a GP assessment.

Other gynaecological symptoms you shouldn’t ignore

Whilst the following symptoms may not indicate cancer, these symptoms can sometimes be significant and — though they aren’t necessarily cause for major concern — are worth seeking early advice on.

Sudden onset of lower abdominal pain

In young women, acute and severe lower abdominal pain can have many causes. They can include important ones such as an ectopic pregnancy (tubal pregnancy) and ovarian cyst complications. Always do a pregnancy test to rule out an ectopic pregnancy and see your doctor for an assessment.

Heavy and painful periods

Heavy or painful periods can sometimes be caused by conditions such as fibroids and endometriosis. Whilst these conditions are not life-threatening, they can affect the quality of life in a major way. Seeking medical attention and early diagnosis can help with planning an appropriate treatment pathway.

Urinary frequency and stinging

An increase in the need to urinate, and stinging when doing, so can indicate a bladder infection and can be easily ruled out or treated. But these symptoms can sometimes indicate a pelvic mass such as a fibroid uterus or an ovarian cyst.

Urinary leakage or incontinence

Urinary leakage or incontinence is a common symptom in women and as many as 40% of women suffer from it particularly after childbirth and menopause. Simple measures such as physiotherapy with pelvic floor exercises can make a huge difference.

Pain during sex

Pain during intercourse can indicate conditions such as endometriosis, and if persistent, you should seek medical attention.

Acute onset of vulval blisters and sores (ulceration)

Sores, yellowish copious vaginal discharge, pelvic pain and bleeding after intercourse can sometimes indicate a sexually transmitted infection. It is always a good idea to get a sexual health check ticked off before embarking on a new relationship.

Symptoms of menopause

Symptoms of menopause such as hot flushes, night sweats, poor quality of sleep, anxiety and mood swings can affect your work and life in a major way. Hormone replacement therapy can be useful and there are also other nutritional and non-medical ways of helping these symptoms.

How long can you have cervical cancer without knowing?

Cervical cancer is a very rare consequence of a common viral infection known as human papilloma virus (HPV). 80% of men and women get HPV infection at some stage in their life and most would shake it off through their own immunity. HPV can be acquired through sex, but can also be transmitted by intimate genital contact.

The time interval between getting the HPV infection and development of cervical cancer is approximately 15 years. This gives plenty of time for prevention through smear tests. If women undergo routine and regular smears, HPV infection and precancerous lesions can be easily detected and treated, thus effectively preventing cancer.

The biggest risk factor for cervical cancer is not having a smear test and remaining unaware of the development of the pre-cancer.

It is therefore important that women see their GP, gynaecologist or practice nurse if they have any of the symptoms mentioned above. Book an appointment today if you have any concerns click here.

Birth control, headaches, and migraine: What’s the link?

What’s the link between birth control and headaches?

No birth control method is perfect, and each type has its risks. Each body is different and may react to forms of birth control differently. We explore the link between birth control and headaches or migraines.

What exactly is a migraine with aura, for readers who are unfamiliar with the term?

About one in three people with a migraine have migraines with aura. The auras usually happen before a headache.

Auras usually start happening gradually over about five minutes and last for up to an hour.

Auras are most commonly to do with your sight. Your speech can also be affected. Some people feel disoriented or confused, or can faint, although this is rare.

The common aura symptoms related to your sight include:
• blind spots
• seeing coloured spots or lines
• seeing flashing or flickering lights
• seeing zig zag patterns
• temporary blindness

Other aura symptoms can include:
• numbness or tingling sensation like pins and needles in parts of your body
• muscle weakness
• feeling dizzy or off balance

What’s the link between birth control and migraines with aura? Is there a specific type of birth control that affects it?

If you have migraine with aura, you’re about twice as likely to have an ischaemic stroke (a type of stroke caused by a blockage in an artery that supplies blood to the brain) in your lifetime, compared to those without migraine. However, the overall risk linked to migraine is still very low, and you are far more likely to have a stroke because of other risk factors like smoking and high blood pressure.

The combined oral contraceptive pill (‘the pill’), the contraceptive vaginal ring (‘the ring’) and the contraceptive patch (‘the patch’) contain the hormone oestrogen. They are all called ‘combined hormonal contraceptives’. Taking oestrogen causes you to have a slightly increased risk of having a stroke (compared with the normal risk).

Taking combined hormonal contraception therefore further increases the risk of a stroke in women who have migraine with aura. Because of this, women who have migraine with aura are not usually given combined hormonal contraceptions.

If you have migraine without aura you should be able to take combined hormonal contraception, unless you have other risk factors like smoking or being overweight.

Does this mean that birth control could increase risk of stroke, bearing in mind migraines with aura can increase risk of ischemic stroke?

The risk of having a stroke is low even if you have migraine with aura and take combined hormonal contraception and is likely to be even lower if you do not smoke or have high blood pressure. However, as the risk is directly related to the oestrogen in the combined hormonal contraceptives, it can be avoided by using non-oestrogen methods of contraception.
The World Health Organization have made recommendations to ensure safe prescribing of combined hormonal contraceptives by identifying women at risk of stroke and, where the risks outweigh the benefit of the method, offering alternative contraception.

A history of aura at any time, even if it occurred during childhood, is felt to be an unacceptable risk factor for the development of a stroke and so women with this should not use combined hormonal contraceptives for contraception.

Can people continue to take birth control if they experience migraines with aura, e.g. if they’re taking it for health reasons? If yes, how can the severity of migraine with aura (and any potential risk of stroke) be mitigated — if at all?

Women who have migraine with aura are not usually given combined hormonal contraceptions. There are a number of other methods of contraception available, for example, the progestogen-only pill (POP), the progestogen injection, intrauterine contraceptive devices (IUCDs) or the intrauterine system (IUS), and barrier methods that are usually suitable.

What forms of contraception are safest, for someone experiencing migraine with aura?

As above


Do you have anything further to add on the topic of the link between birth control and migraine with aura/risk of stroke that I haven’t asked?

In some women with migraine who take the combined pill or use the combined patch, migraine attacks can be triggered by the drop in the blood level of oestrogen during the pill-free or patch-free interval. So long as these migraine attacks are without aura AND you were already known to have migraine without aura before starting the pill or the patch, there is usually no need to stop the pill or the patch.
If these migraine attacks are without aura but are troublesome and not easily treated with pain killers, then options include:

Tri-cycling your pill. This means taking the pill continuously for three packets (nine weeks) without any breaks, followed by a seven-day pill-free interval. This keeps the level of oestrogen constant whilst you take the three packets. By doing this you have fewer withdrawal bleeds and therefore fewer migraine attacks.


A change to a different method of contraception.

Dr Shivani Dattani, can assist to determine the best method of birth control for you.  So click here to book your appointment today.

Extended Opening Hours + Same Day Appointments

We recognise that sometimes it is not easy to see us during working hours. With professionals who demand healthcare that fits around their availability and struggle to make appointments in the more normal 9-5 environment, our London City clinic now offer extended early morning appointments.

Austin Friars, London City will be offering extended opening hours on a Wednesday from 07.45 am and Thursday from 7.30 am, which will be a combination of pre-bookable and on the day, face to face, telephone & virtual consultations.

In the City of London, our ultra-modern clinic, is in the historic Austin Friars Square near Liverpool St Station.

Monday 08:30 – 19:30
Tuesday 08:30 – 19:30
Wednesday 07:45 – 19.30
Thursday 07:30 – 19:30
Friday 08:30 – 18:00
Saturday 08:30 – 13:00


As part of our extensive services, we offer a Nurse-led clinic with Clinical Nurse Specialist Jennifer every Monday from 8:30am – 1pm at our location in the City of London. The services include cervical screening, HPV vaccination and Pre and Post Op consultations.

For the simplest way to book an appointment and the latest clinic and appointment availability please check our online booking tool link

First HRT, now a Tampon shortage! What will be next…?

A number of news outlets are reporting that tampons are in short supply, You wouldn’t think that tampons would be a hot commodity, but apparently they’re flying off the shelves, if they’re even getting onto the shelves.  These shortages are caused by raw material shortage of cotton.

Until shortages ease, plan ahead and be flexible about which brand you buy.  So with tampons scarce from the shelves, there are period product alternatives that can help.  There are a growing number of feminine hygiene alternatives to tampons such as menstrual cups, menstrual discs, period underwear, disposable pads and reusable cloth pads. 

Over the past year or so, organic menstruation products have been steadily rising in widespread popularity, spurred on by ambitions to things better by the environment and by women. Consultant Gynaecologist Meg Wilson contributes to an article on organic menstrual products. Read it here  

Menstrual cups are ideal for people who want to make a switch to a more sustainable period product. Menstrual cups have quickly become a popular alternative to tampons and pads. Mr Narendra Pisal, a consultant gynaecologist at London Gynaecology shares his expert view on the use of menstural cups read more here

The Menopause in the Work Place

Handling menopause in the work place.

The menopause can have a huge impact on our functioning at work. It’s important that employers create and support a positive and open environment for women going through the menopause to help maintain their confidence and happiness at work and to prevent women feeling like they need to hide why they may be struggling at work.

Will my employer have a menopause policy?

If you are struggling with menopausal symptoms at work, it is worth finding out if there is a menopause policy at your workplace. A menopause policy is useful as it helps people within the organisation including managers, supervisors and team leaders to understand what the menopause is and how it can affect people. The policy may also help to identify who is a point of contact for queries related to the menopause and what support is available to staff affected by it.

There are simple changes at work that can make a huge difference to menopausal symptoms, these include:

Is there a menopause or wellbeing champion at work who could help people affected by the menopause? The champion could be a point of contact if you need advice, or someone to initially talk to if you are not comfortable talking to managers.

Menopause at Work

Consider setting up a support network for staff affected by the menopause in your workplace as you will not be alone. Often sharing common experiences can be really helpful.

Is there an option for psychological support through work? We know that the menopause can have a real impact on mood and self-confidence and often women may benefit from counselling or talking therapies.

Worried about the menopause?

Start by booking a Menopause Consultation for specialist advice from our menopause experts today. Packages Include Consultation & Testing. Packages Starting From £540.  Or book to see our GP Dr Shivani Dattani for a menopause consultation.  Click here to find our more.

Join our team: Sonographer (part time)

London Gynaecology is a leading private Gynaecology Practice, based at two locations: The Portland Hospital, one of London’s leading private hospitals, and our new clinic in the heart of the City of London.

We are looking for an experienced Sonographer, with a special interest in Obstetrics and Gynaecology, who will promote our ethos to provide expert advice and care and a first-class patient experience.

The position is based at our City of London clinic on Mondays and Saturdays.

Duties and responsibilities include:


Qualifications and Skills:


Interested applicants should email their CV and cover letter to Snehal Babar:  [email protected] Subject line: Sonographer: job opportunity.

Unfortunately, we will only be able to contact successful candidates – but we thank you for applying and for your interest.

Mr Pisal Runs Paris Marathon for DEC Ukraine Humanitarian Appeal

This year Mr Pisal is running the Paris Marathon on 3rd April (his 21st marathon) in aid of supporting the people of Ukraine by running in support of the British Red Cross Society DEC (Disasters Emergency Committee) Ukraine Humanitarian Appeal.

Mr Pisal says “Like everyone, I have been immensely saddened by the news of the war in Ukraine and I recognise that it is more important now than ever before that access to healthcare and basic life essentials continues for the people affected.”

The DEC Ukraine Humanitarian Appeal run by The British Red Cross Society are providing much needed support to reach the people who are in urgent need.  This support includes providing food, first aid, clean water and medicines as well as supporting hospitals and healthcare facilities and much more.

“My patients, colleagues and friends have been long-time supporters of my fundraising and their words of support and donations are forever humbling.  I appreciate there are many fundraising efforts already underway for Ukraine at the moment, and I am extremely grateful for any donations you may wish to make via my marathon”

If you wish to support, please click here to visit the JustGiving page.

Thank you for your support
Narendra Pisal

International Women’s Day Offer

Women are very important to us at London Gynaecology, from providing healthcare services to women in clinic to sharing valuable and easy to read healthcare information online, our purpose is dedicated making women’s lives better.

To celebrate International Women’s Day, we are offering services that are delivered by our 2 key female clinicians at discounted prices for one day only.

On Tuesday 8th March; our nurse-led smear service (primary HPV screen) with our lovely Clinical Nurse Specialist Jennifer Byrne is available for £100 and our scanning services led by Sonographer Edel Bulman are half price.

Both of these services are delivered in our brand new and state of the art clinic at 15 Austin Friars, London EC2N 2HE.

To access the prices please click here to book an appointment. Please note these prices are only available on Tuesday 8th March.

Mr Pisal’s last clinic in the NHS after 21 years

Today marks Consultant Gynaecologist, Mr Pisal’s final day at his NHS Trust, The Whittington Hospital where he has practiced in the department of gynaecology oncology for 21 years. During this time Mr Pisal has experienced first-hand a lot of support, love, success and happiness from colleagues and patients alike, for which he is most grateful.

Mr Pisal will continue working at the Trust as an Honorary Consultant to share surgical expertise and provide support in addition to training.

At London Gynaecology, we are very proud of Mr Pisal’s long-standing service to the NHS.