The screening programme: What the changes mean for women

Consultant Gynaecologist & Gynaecological Oncologist Mr Saurabh Phadnis is featured in Metro, to share insight into the the new screening programme following the changes made in 2019 when Primary HPV (Human Papillomavirus) screening was implemented in the UK.  Mr Phadnis provides key information following a cancer survivor’s story and reveals how this change will affect women and the unusual symptoms that should always be checked  by your GP or Gynaecologist. To read the article, click here

Fish in pregnancy: what is safe to eat & what is best avoided

The advice surrounding oily fish in pregnancy can be rather confusing. Laura Southern, our nutritional therapist, clarifies what oily fish is safe to eat while pregnant and what is best to be avoided altogether.

Oily fish, such as salmon, mackerel, anchovies, sardines, herring and trout contain high levels of omega 3 fats. These are essential for helping develop baby’s brain, however certain oily fish are very toxic and should be avoided.

Due to sea pollution, fish farmed from the sea is usually contaminated with mercury and PCBs. The larger the fish, the higher up the food chain it is, which means the toxicity levels are much higher than smaller fish.

What is safe to eat during pregnancy and what should you avoid?

• Marlin and swordfish are best avoided during pregnancy.
• Tuna, also a large fish, and has a high mercury content and should only be consumed a maximum of once a fortnight.
• Canned tuna is generally a smaller tuna species and is canned without the fish oils meaning it’s safe to consume during pregnancy, however it does not provide the omega 3 benefits.
• Smaller oily fish, such are sardines, anchovies and mackerel are ‘safe’ & it’s recommended they’re consumed 2 -3 times a week.
• During pregnancy fish should always be thoroughly cooked as raw fish can harbour parasites which can infect the mother. If raw fish is frozen before consuming, then this will kill the parasite. For this reason, sushi is safe to eat, only if you can be sure the restaurant uses frozen fish. If not, then don’t eat it.
• Smoked fish, for example smoked salmon, is safe to eat during pregnancy, but treat it as an oily fish – so consume maximum 3 times a week.

Make an appointment

If you would like to learn more about pregnancy nutrition with Laura Southern, or if would like to book a consultation with any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]

Genital warts: causes, treatment options & how to reduce your risk

Genital warts is one of the most common STI in the UK in men and women however with HPV vaccination, the incidence is rapidly declining. Miss Julie Bowring MRCOG MFSRH, our consultant gynaecologist reveals more about genital warts from what causes them to how they’re treated and how to reduce your risk…

What causes genital warts?

Genital warts are caused by low risk subtypes of Human Papilloma Virus (HPV). This is a very common sexually transmitted virus that can affect the lower genital area in men and women. The virus can be passed on easily by having vaginal or anal sex, but also from close skin-to-skin contact with someone who already has HPV.

There are several different strains of HPV, some strains cause a person to develop lumps on the genital skin or inside the vagina or anus, these are known as genital warts or condylomas. The commonest strains linked to genital warts are 6 and 11.

It is important to note that HPV strains causing warts are low risk strains and do not cause cancer.

How are genital warts treated?

There are treatments that can be offered to help warts go away. Treatments currently offered include creams that you can apply yourself, freezing (cryotherapy) often performed by a nurse or doctor using liquid nitrogen. If the warts are very large or persistent, laser surgery might be performed to remove them. Often, treatment is not needed and the warts will disappear spontaneously through your own immunity.

How can I reduce my risk?

Whilst condoms are advised for preventing sexually transmitted infections, they won’t always stop HPV passing from person to person as close skin contact is all that’s needed to spread HPV.  The (HPV) vaccine GARDASIL-9, protects against HPV subtypes 6&11 and thus reduces the risk of getting genital warts by 90%.

Talking about genital warts can be difficult and many people worry about passing it on to their partners. Having a sexual health check for both partners is advisable before starting a new relationship.

If you think you may have genital warts, please speak with your local sexual health clinic or gynaecologist.

Make an appointment

If you would like to book a consultation with Miss Julie Bowring or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]

The fight against cervical cancer and HPV in the pandemic

Professor Albert Singer, co-founder and trustee of the British Society for Colposcopy and Cervical Pathology and a founding member of the British Gynaecological Cancer Society, discusses in depth the fight against cervical cancer and HPV in the current coronavirus pandemic.

Professor Albert Singer says, “With the present pandemic it is said that life will never be the same again, and this will apply to many things in our present life.  For those concerned with eliminating cervical cancer, the effect of the Pandemic are extremely worrying. With resources being diverted to the COVID-19 response and social distancing, we face scarce supplies of the HPV vaccine; challenges of reduced or delayed screening for women; and the issue of cervical cancer plummeting down governments’ agenda. We must act now to mitigate the impact this pandemic could have on our fight against cervical cancer.”

You can read the full article on Professor Singer’s blog here 

Cycling associated genital problems & how to avoid them

Many of us have taken up cycling during the coronavirus pandemic. Fear of overcrowding on public transport & with less people travelling in to work, it has made cycling on normally busy roads far more pleasant and enjoyable with lots of us travelling further afield and exploring new areas.

But whether it’s cycling for transport, trying to keep fit or just keeping up with the kids, the act of cycling causes problems for both men and women with regard to their genitalia.  For female cyclists, the commonest problems are; chaffing, saddle sores, skin sensitivity and numbness, labial enlargement, vaginal irritation and infection (thrush and bacterial vaginosis), skin infections and urinary tract infections.

Sounds rather unpleasant, but rather than getting off the bike, Mrs Pradnya Pisal reveals the simple things that can be done to avoid these problems.

Ensuring your bike is fitted for YOU: before you even get on a bike, spending time making sure it is fitted correctly for your frame is one of the most important things you can do as this will prevent most problems.

The height and type of the seat is most important as the pressure needs to be distributed and transferred on to the ischial tuberosities (the ‘sit bones’ that takes the majority of the weight when sitting) rather than the labia.  And don’t forget the handlebars as you should not have to stretch too far forwards to reach them; sitting in a more upright position will also reduce pressure on the labia.

These simple adjustments will prevent pressure sores on the labia, skin sensitivity and loss of sensation and also enlargement of the labia.

Wear the right clothing:  In fact in cycling, what not to wear is just as important as what to wear; use the right padded cycle shorts but skip your underwear.  Always wash the shorts immediately and use a fresh pair each time you ride a bike. The padding will help to avoid pressure symptoms but also prevent vaginal and urinary tract infections through the washing.

Lubricate:  Use Vaseline or chamois cream to provide lubrication to the labia, groin and inner thighs to prevent chaffing and saddle sores.

Hydrate:  Drink plenty of water and empty the bladder without delaying too much. As well as the obvious hydration benefits this will prevent urinary tract infections.

Treat:  Use of a local antibiotic cream will prevent infections of the skin and labial sores.

Probiotics:  Taking regular probiotics can help to prevent vaginal infections and cranberry supplements (this is controversial) to prevent urinary tract infections

Some women already have asymmetrical or enlarged (hypertrophied) labia and this can be a problem as the skin problems are likely to be exacerbated in women. I have come across women with enlarged labia who have sought labioplasty (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.

There are some reports that cycling can affect women’s sex life. In fact cycling like any other sport releases endorphins and elevates mood and hence is likely to improve sex life. But the problems mentioned above may indirectly make women want to avoid sex when they are suffering with symptoms down below.

Most importantly, cycling is an enjoyable low impact way to stay fit and healthy – enjoy getting on your bike!

Make an appointment

If you would like to book a consultation with Mrs Pradnya Pisal or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]

Covid-19 Service Update

We are now able to see all patients who request an appointment, including routine screening.

If you wish to book an appointment, please contact us on 0207 101 1700.  Our normal consultation charges will apply, see here.

For patients who cannot get to our clinic at this time we are offering video consultations and telephone consultations .  Please see our our page on video consultations.

In order to keep our team and patients safe and well and comply with government advice, alongside the hospital we have introduced a number of measures in order to minimise risk during your visit.  You can read more about this here.

Coronavirus: Patient information

We are aware that guidelines regarding coronavirus is changing daily and as a consequence, our advice to patients will continually reflect these changes.

Following government advice, it has been decide to stop all non-urgent appointments at The Portland Hospital as of the evening of Friday 20th March.

If you wish to book an appointment, we are offering consultations over the telephone where practicable.

If you have an existing appointment, our admin team will be in touch shortly to rearrange.

Ovarian Cancer: What you need to be aware of

Amid times of uncertainty that Coronavirus/Covid-19 brings, it is important that we continue to highlight the conditions and illnesses that affect women every day.

March is Ovarian Cancer Awareness Month and to gain more understanding of this type of cancer which affects approximately 7,500 women in the UK every year, Consultant Gynaecologist and Gynaecological Oncologist Mr Saurabh Phadnis answers your most commonly asked questions.

What is Ovarian Cancer?

Ovarian cancer is when abnormal cells from the ovary grow in an uncontrolled way.

The ovaries are a pair of small organs located low in the tummy. Connected to the womb, the ovaries store a woman’s supply of eggs.  It is believed that most cases of ovarian cancer arise from the fallopian tube,  hence the term “tubo-ovarian cancer”.

What are the symptoms?

B – Bloating that doesn’t come and go

E – Eating difficulty and feeling full more quickly

A – Abdominal and pelvic pain that you feel most days

T – Toilet changes in urination or bowel habits

If you have any of these symptoms that are persistent you should seek immediate medical help with your GP

Can it be prevented?

There is not a screening programme for ovarian cancer. 10-15% of tubo-ovarian cancer is genetically linked. If you are found to be carrying a gene that predisposes you to ovarian cancer, you may be offered risk reducing surgery to remove ovaries at an appropriate age.

How common is it?

Approximately 7,500 women are diagnosed with ovarian cancer in the United Kingdom each year. It is the 6^th most common cancer in women.

Who is most affected/more at risk?

Ovarian cancer is more common with older age and your risk increases if you have any of the following:

• Inherited genes that increase the risk of ovarian cancer include faulty versions of BRCA1 and BRCA2
• Women who have had breast cancer in the past
• Using hormone replacement after menopause
• Smoking, exposure to asbestos and radiation
• Certain medical conditions such as endometriosis and diabetes have an increased risk as does being overweight

If there is a family history of this type of cancer, does this make a person more at risk?

Yes, approximately 10-15% of ovarian cancer is linked to faulty genes. A fault in genes such as BRCA1, BRCA2, RAD51C, RAD51D and BRIP-1 are known to be linked with ovarian cancer.

Does advanced stage 3 and 4 mean there is no cure?

Not at all. About 25% of patients with advanced stage ovarian cancer are cured. With advances in treatment, many patients (35%) are living longer than 10 years. In approximately 66% patients the cancer comes back within 2 years.

What is the treatment?

The treatment of ovarian cancer is a combination of surgery and chemotherapy. Even in advanced stage it is possible to offer surgery initially (also called primary cytoreduction surgery) to removes all sites of cancer followed by 6 cycles of chemotherapy. The aim of surgery is to not leave any cancer behind that is visible to the naked eye. If this is not achievable, then 3 cycles of chemotherapy are given initially followed by surgery (also called interval cytoreduction surgery) and then another 3 cycles of chemotherapy.

What is the survival rate?

The survival rate depends on the stage of cancer. More than 75% of women are alive at year 1, where are overall survival is 35% at the end of 5 years.

What can a patient expect during a consultation?

A consultation will include history taking, examination and relevant investigation such as an ultrasound scan of the pelvis. Occasionally further investigations such as examination under anaesthesia are necessary for diagnosis or planning treatment.

Make an appointment

We are currently only able to offer telephone consultations (virtual/video appointments) where appropriate, with Mr Saurabh Phadnis or any other member of the London Gynaecology team. Please call 020 3820 0040 or email [email protected] to find out more.

Please note: If you have symptoms such as; abnormal smear, abnormal bleeding, pelvic pain, abdominal mass or pain or bleeding in early pregnancy, please call us as we may be able to see you in the clinic on a case by case basis. We will need to assess your suitability before an appointment is made.

Read Mr Saurabh Phadnis’s latest patient reviews

Cycling, UTIs and the Vulva

You can read the full blog featured in City Women & Co here

Make an appointment

If you would like to book a consultation with Mrs Pradnya Pisal, or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]

Read Mrs Pradnya Pisal’s latest patient reviews

Gynaecological Cancers: What you need to know

As today marks World Cancer Day, Consultant Gynaecologist and Gynaecological Oncologist Mr Saurabh Phadnis discusses the different types of gynaecological cancers, from how to recognise the early signs and symptoms to who is most at risk and how common they are amongst women.

What are the different types of gynaecological cancers? – How common are they?

Gynaecological organs include womb, cervix, fallopian tube/ovary, vagina and vulva. Cancer can arise from any of these organs.

Cancer of womb is the most common with 9,300 new cases every year, ovarian or fallopian tubal cancer 7,500 cases, cervix cancer 3,000 new cases. Whereas vulval and vaginal cancers are rare with 1,300 and 250 new cases every year respectively.

What are the early signs and symptoms?

The red flag symptoms of gynaecological cancers are:

• Unusual vaginal bleeding (bleeding after menopause, bleeding in between periods, bleeding after sexual intercourse
• Unusual vaginal discharge
• Abdominal bloating, pain, change in bowel or urinary habits
• Unusual swelling or ulcer on the vulva
• Weight loss or loss of appetite

Who is most at risk of developing a gynaecological cancer?

Some gynaecological cancers may be hereditary i.e. linked to faulty genes. Genetic testing is available to determine an individual’s risk.

• A faulty gene linked with Lynch Syndrome is associated with a lifetime risk of about 40-60% for developing womb cancer.
• Some other risk factors for womb cancer include obesity, diabetes, use of estrogen alone as hormone replacement and medication such as tamoxifen used in maintenance treatment of breast cancer.
• 10-15% of ovarian cancers are related to faulty genes such as BRCA1 and BRCA2.
• Presence of HPV infection is associated with cancer of cervix and vagina and may be associated with some cancers arising from the vulva.

I have some of the above symptoms and I’m worried. What should I do?

If you have symptoms, you should seek appropriate medical advice. Either visit your GP or you can make an appointment at London Gynaecology.

What is the survival rate?

Survival rate depend on the stage of cancer. For example, stage 1 cancer of uterus has the best survival rate of 99% at 5 years whereas stage 3 and 4 ovarian cancer 40% at 5 years.

What can I expect from a consultation?

A consultation will include history taking, examination and relevant investigation such as ultrasound scan of pelvis. Occasionally further investigations such as examination under anaesthesia are necessary for diagnosis or planning treatment.

Make an appointment:

If you have any concerns and would like to book a consultation with Mr Saurabh Phadnis or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]

To learn more about Mr Saurabh Phadnis, visit his profile here

View Mr Saurabh Phadnis’s latest patient reviews