Postpartum health issues: the most common explained
Mrs Pradnya Pisal, our consultant Gynaecologist, was featured in the Swindon Advertiser to talk about some of the most common postpartum health issues. To read the article, click here.
Mrs Pradnya Pisal, our consultant Gynaecologist, was featured in the Swindon Advertiser to talk about some of the most common postpartum health issues. To read the article, click here.
Our Consultant Gynaecologist, Mrs Pradnya Pisal, was published online on This is Wiltshire, to provide insight and expertise on some of the most common postpartum health issues.
To read the article, click here.
Our Consultant Gynaecologist, Mrs Pradnya Pisal, was featured in The Irish News to provide insight for an important feature focusing on some of the most common postpartum health issues. To read the article, click here.
Too often patients who attend a GP appointment over excruciatingly painful periods are met with the default response that painful menstruation is “just part of being a woman”. Yes period’s can be painful, but the truth is, if your monthly bleed is interfering with your day-to-day life or you are struggling with other uncomfortable symptoms, such as pain during sex and/or changable bowel habits, this needs further investigation.
My name is Amber and for the past 11 years I have been battling cripplingly painful periods.
Now aged 23, I’ve learnt that my painful symptoms, the countless trips to the GP, misdiagnoses and the struggle to get my pain taken seriously were all part of a collective experience. I was dealing with an invisible condition and my lengthy diagnostic experience was a textbook example amongst the 1 in 10 menstruators affected by endometriosis.
What is endometriosis and what are the symptoms?
Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus (the endometrium) is found outside of the uterus. This tissue attaches itself to other areas in the body, most commonly the ovaries, fallopian tubes and bowel. Each month this tissue swells and bleeds but unlike the lining of the womb, it has no exit point, which causes pain. The cause of endometriosis is currently unknown. Along with painful menstrual cramps, other endometriosis symptoms may include:
It’s important to note that people with endometriosis may not experience all of the listed symptoms. The extent of endometriosis also doesn’t necessarily correspond with the severity of pain. Some women with severe endometriosis that is widespread involving deep implants and adhesions, may not experience any pain. Whereas some women with minimal or mild endometriosis can experience chronic pain despite a smaller area being affected.
My experience
I started my period at the age of 12. Since then, searing pain that would resonate through my pelvis, lower back and down my legs was a routine occurrence for me every month. This would typically be accompanied by diarrhea, nausea, cold sweats, vomiting and passing out.
I dreaded it.
I dreaded the thought of my period coming. I dreaded the thought of the pain catching me off guard during class, waking me up in the middle of the night or causing me to cancel plans, all of which happened regularly. I knew that for 7-9 days each month my period would take over my day-to-day activities and I’d mentally prepare for what felt like an episode of labour. It wasn’t until I heard other girls at school say ‘I barely notice my period’ that it was clear something wasn’t right.
But getting my voice heard and my pain believed wasn’t plain sailing.
Searching for answers…
I first visited my GP about my painful periods around the age of 14. My pain was carelessly dismissed as “just part of being a woman”, that “all women experience period pain” and it was something I’d “just have to get used to”.
After several more trips to the GP during the course of my teens and a number of misdiagnoses later I insisted that further investigations were carried out. The GP suggested an ultrasound scan to see whether I had Fibroids, Polyps or Endometriosis. I had the scan, was told I had none of the said gynaecological abnormalities and there was no need for further investigations. I was simply “one of the unlucky ones”. Too shy to question the authority of a doctor as a pubescent teen, I accepted what I was told and went on trying to survive my periods each month.
What I didn’t realise at the time was an ultrasound scan is not a definitive diagnosis for endometriosis. While pelvic and transvaginal ultrasound scans can detect deep infiltrating endometriosis, large lesions or other abnormalities such as cysts, it cannot pick up milder forms of endometriosis.
It was in 2020 that things took a turn for the worst. By the end of the year my pain was not only present during my period but every day. Again I tried to express to a GP the pain I was in, but I was met by a lack of sensitivity and condescending attitude. It especially bewildered me that female practitioners had such a cold bedside manner when it came to discussing my menstrual issues. At this point I was exhausted and anxious about what was happening to my body. I was in my 20s and I felt like an old woman. I was mysteriously ill and riddled with pain. It hurt to move, to walk, and I was hopelessly wondering how my body was capable of inflicting so much pain on itself. I had to look for answers.
So I took to the internet to see if I could find anyone or anything that could shed light on my situation. Sure enough, I discovered a huge community on Instagram where people were documenting their arduous experiences finding a diagnosis for their chronic pain and were encouraging others to seek help from a specialist.
That’s when I booked a consultation with Mr Pisal. He immediately landed at the suspected diagnosis of endometriosis. With sensitivity and informative reassurance that things would improve, Mr Pisal’s expertise validated something I had been trying to get to the bottom of for years.
I felt relieved to find someone who finally understood. But I couldn’t help but regret that had I not been misinformed and unsympathetically cast off by my GP, maybe those 11 years of fighting my periods would have been different.
What could be done better to improve the diagnosis experience of endometriosis?
The diagnostic experience for those with endometriosis needs to be improved so they can access the support they need earlier. Endometriosis is known for being infamously difficult to diagnose. Laparoscopic surgery is the gold standard for diagnosing endometriosis, but accessing this can take years. According to a APPG report on endometriosis in 2020, it takes on average 8 years for a woman to receive an endometriosis diagnosis.
The answer to reducing diagnosis times seems twofold.
First, Endometriosis is an under recognised condition, not only amongst the public but also in healthcare. It seems logical that menstrual wellbeing and gynaecological conditions should be covered as part of the school curriculum in Relationships, Sex and Health Education lessons. People who menstruate need to be empowered by education so they can identify abnormalities and feel comfortable to seek help, instead of suffering in silence.
Additionally, despite endometriosis being named by the NHS as one of the top 20 most painful conditions, there is a clear stigma around the believability of pain. Guidelines from the National Institute for Health and Care (NICE) stress that healthcare professionals often fail to realise the importance of symptoms in identifying endometriosis and as a result women are left to feel like they are not being taken seriously, which adds to the emotional stress already caused by the condition. It also plays into the unhealthy and outdated ideology that women are hysterical or have a tendency to exaggerate. NICE quite rightly calls for doctors to be aware of the severity of the condition and to provide support for the long-term physical, psychological and social impacts.
Second, there needs to be an effective course of action for diagnosis, treatment and care. Despite there being NICE guidelines on endometriosis, these have not been implemented across the UK. If an efficient pathway is put in place this will not only reduce the diagnostic period and help people get access to treatment and support but would also save NHS resources. The APPG report on endometriosis found that 58% of patients visited the GP over 10 times, 21% visited doctors in hospital 10 times or more and 53% went to A&E – all of which could be reduced.
The power of intuition
To others looking to get to the bottom of their pelvic pain – don’t give up. If you suspect something isn’t right with your body, even if your GP is telling you everything is fine, take further advice.
Your gut instinct is rarely wrong and while you may not be a doctor, you are a specialist in knowing your body better than anybody else.
For more information, advice and support on endometriosis, visit the UK’s leading endometriosis charity website endometriosis-uk.org. If you have any questions about anything mentioned in the article and would like to contact Amber directly, please do so here.
Make an appointment
At London Gynaecology, we provide diagnosis of and see patients for the treatment of endometriosis. To make an appointment with Mr Pisal or another member of London Gynaecology team, please email [email protected] or call 0207 10 11 700 (24hrs).
To learn more about our endometriosis package, click here.
At London Gynaecology, we are proud to see and treat patients from the LGBTQ+ community who need our care.
As a private Gynaecology practice, we offer clinics in a discreet and charming location of the city of London and at the renowned Central London hospital, The Portland Hospital. Our consultants and wider team are dedicated to providing a tailored patient centric experience at every stage of your visit. The level of care will not be compromised.
Many of our consultants hold senior positions at their NHS Trust and have a wealth of experience and expertise seeing and treating patients, providing a patient led experience regardless of whether you are: A transgender woman, choose not to identify as a woman and those who identify as LGBTQ+.
To learn about our services and expertise, click here.
Our Consultant Gynaecologist, Mrs Pradnya Pisal, spoke with The Independent to provide insight for an important feature focusing on some of the most common postpartum health issues. To read the article, click here.
Our consultant Gynaecologist, Mr Pisal, talks to Marie Claire about the reasons why the pandemic has had an impact on women and their periods and shares helpful tips on how best to deal with missed periods.
To read the article, click here.
Following the birth of Zara and Mike Tindall’s third child, our consultant Gynaecologist, Miss Meg Wilson, spoke to Yahoo Style to clarify what Birth Before Arrival (BBA) means. To read the article, click here.
We sat down with Lucy Allen, Clinical Specialist Pelvic Health Physiotherapist to understand more about why women may find sex painful. Our consultants may refer patients to Lucy when they are experiencing pain during sex for further specialist care, if required. Here, Lucy discusses the common causes and misconceptions, what you can try at home and when you should seek medical help.
Sex should be a pleasurable experience, yet around 1 in 10 women in the UK will experience pain during sex. Dyspareunia or painful sex can include pain at the entrance to the vagina and/or deep inside the pelvis and is often described as a tearing sensation, stinging, burning, bruised, stabbing or aching pain.
The common causes of painful sex are:
There are many causes of painful sex that can lead to a tense or non-relaxing pelvic floor muscle. For many women the pelvic floor muscle tensing is a protective mechanism in response to trauma, infection or pain in other areas of the pelvis. However, in some cases the pelvic floor doesn’t regain its full range of movement or can become more sensitised which leads to pain during sex.
Are there any common misconceptions?
There is still a lack of awareness in the treatment and management options for women who experience painful sex, but there is help available!
Pelvic Health Physiotherapy can be very effective in helping women understand the cause of their symptoms and in reducing pain and dysfunction. It is not a case that painful sex is something you have to live with or put up with. In some scenarios we work in collaboration with psychologists and gynaecologists to ensure all causes of pain are addressed. For example, if scar tissue following childbirth was causing pain with sex then a pelvic health physiotherapist would work on helping mobilise the scar tissue, desensitise, whilst regaining pelvic floor movement, a psychologist would help to address any issues following a traumatic birth experience and/or sexual dysfunction and your gynaecologist would address pain relief, investigations to ensure there is no other underlying cause and for more invasive procedures if required such as a Fenton’s procedure.
You will find that most healthcare professionals work alongside each other to ensure that your care is optimised and that there is always someone who can help.
There are some thing you can you try at home to see if this helps ease symptoms:
When should someone seek medical help?
If sex has always been painful or it is now painful and the tips above haven’t helped I would recommend seeking the help of a gynaecologist and Pelvic Health Physiotherapist. Your GP can refer you via the NHS or privately and you can also self-refer to a private Pelvic Health Physiotherapist.
*If you experience any bleeding after sex then I would speak to your GP for further investigation.
Make an appointment
London Gynaecology is an established private gynaecology practice led by a team of consultant gynaecologists at our practice locations at The Portland Hospital and our brand new clinic at Austin Friars, City of London.
If you would like to make an appointment with one of our Consultants, please call 0207 10 11 700 or email [email protected],
To learn more about Lucy Allen, Clinical Specialist Pelvic Health Physiotherapist, click here
Many women have taken up cycling during the pandemic and perhaps will decide to continue cycling as a way of travelling into work when lockdown restrictions ease and as we return to the ‘new normal’.
Our consultant Gynaecologist, Mrs Pradnya Pisal, spoke with Cycling News to outline the various ways long hours cycling can affect our most delicate parts.
Diagnosing labial and vaginal conditions:
Chafing
The skin around the genital area and the groin/medium part of the thigh may experience chafing caused by a mixture of contact friction, sweat and the fabric of your cycling clothes. The superficial layer of the skin is abraded and causes that area to be sensitive and painful.
“If chafing is ignored, it can turn into open sores due to the damage of the top layer of the skin.
Skin sensitivity and numbness
“Sitting on a saddle for a long time can cause sensitivity or numbness of the labia and perineal area. The pressure on the skin affects the nerve endings, and this repeated pressure on the nerve endings [can cause tingling and sensitivity]. Over a period of time that sensitivity and tingling sensation will turn to numbness, so there is almost a loss of the superficial nerve endings in that area of the skin.”
Labial enlargement
Pressure on a woman’s vulva can cause the labia to become swollen and appear bigger. Some women already have asymmetrical or enlarged (hypertrophied) labia and this can exacerbate the issues listed above. I have come across women with enlarged labia who have sought labiaplasty (surgery to reduce the size of the labia) as the pressure causes intense pain during cycle rides so much so that they are unable to continue riding.
Vaginal irritation and infection (thrush and bacterial vaginosis)
Thrush is a very common vaginal infection, caused by an overgrowth of yeasts which live normally in the bowel and may be present in other parts of the body, such as the mouth, skin and vagina. Thrush occurs when the good bacteria in the vagina can’t keep the fungus under control, creating a suitable environment for the overgrowth of this fungus. When cycling, there is a lot of perspiration and so the sweat collects in that area of the skin and any stagnation of sweat over a surface is likely to result in growth of fungus. The advice is to not linger in your clothes after a bike ride and to wash them immediately, so not to allow the yeast to grow.
Urinary tract infections (UTI)
A UTI is an infection of your bladder, so you may feel the sudden urge to pee and experience pain or a stinging sensation when peeing. These usually are caused by bacteria entering the urinary tract. Using the right padded cycle shorts without underwear is important. Always wash the shorts immediately and use a fresh pair each time you ride a bike. Cycling shorts will get damp with sweat with little ventilation and rubbed up against your body is a breeding ground for bacteria. Also dehydration or going on long bike rides without emptying the bladder quick enough can cause this so ensure you drink plenty of water and empty the bladder without delaying too much, to help flush bacteria out and prevent urinary tract infections. This will help to avoid pressure symptoms but also prevent vaginal and urinary tract infections.
To continue reading the full article, click here.