Everything you need to know about a Transvaginal Scan

Feeling anxious about an upcoming transvaginal scan appointment? 

Stylist Magazine writer Abbi Henderson recently underwent her first transvaginal scan.  Although the thought of the scan itself didn’t cause her much mental anguish (though, it very commonly can), She did have a lot of other, unanswered concerns. Did she need to do anything special – food and drink-wise – beforehand? What, exactly, would be picked up on the scan? And, were the treasure hunt successful, would she receive info on the whereabouts of the sneaky thread or even be able to have the IUD removed same-day? So she turned to our expert consultant gynaecologist Mrs Pradnya Pisal to provide the answers.

Can you give an outline of what actually happens at a transvaginal ultrasound? What’s the process from start to finish?

For an internal (vaginal) ultrasound scan, you will be advised to empty your bladder and then undress completely from the waist down. A hospital gown or sheet will be given to cover you. You will be asked to lie on your back on the ultrasound couch. A chaperone is always present for this scan. Your knees will be bent and your feet will be on movable feet rests. The knees will then be raised in a way that allows the scan to be performed easily. A thin elongated ultrasound probe is used for this procedure. It will be covered with a protective sheath and lubricating gel and then gently inserted into the vagina.

The ultrasound probe will need to be moved into different positions in order to visualize the uterus and ovaries clearly. Ultrasound scans are generally painless, although you may experience some discomfort as the probe is inserted into your body.

An ultrasound scan takes around 15-20 minutes. It will be carried out in the ultrasound department or in the consulting rooms of the clinic.

What is the ultrasound looking for? What info can it obtain (obviously, someone may be having one for many reasons but for those feeling anxious about it, can it locate cysts/endo tissue/cancers/irregularities/awkwardly positioned contraceptives, etc)?

An ultrasound scan is an investigation to create an image on a screen of the organ or body part being examined using sound waves. It is used to help in making a diagnosis so that appropriate treatment can be offered. It is carried out by medical doctors and specially trained health care professionals (sonographers). The scan is performed using an ultrasound probe that gives out high frequency ultrasound waves. These sound waves cannot be heard. The size and shape of the ultrasound probe depends on the part of the body being examined.

The internal (vaginal) ultrasound scan allows the probe to be placed inside the vagina so that it is closer to the pelvic organs being examined. This provides clearer pictures of the uterus, ovaries and abnormalities that may lie deep in the pelvis.

What happens after? Do patients receive results straight away or is there a wait? If there is a wait, is there anything that can be done for those with anxiety to make the wait less stressful for them?

The person performing the scan will usually inform you of the findings or arrange for you to see your doctor. If your scan is performed by a sonographer, if appropriate, they will tell you if any abnormality is detected.

You will be given a report immediately or the report will be emailed to you. For pregnancy scans, you will be given a copy of the images of your baby. Your consultant will explain the scan findings, make a diagnosis and then discuss further investigations and treatment options.

What if someone is allergic to latex?

If you’re having an internal (vaginal) scan and are allergic to latex, it’s important to let the sonographer or doctor carrying out the scan know this so they can use a latex-free probe cover.

 If someone has sexual trauma, how is that handled?

Please inform the clinic / person carrying out the scan of this. You can also ask to take a friend with you and request a female sonographer. You can also request a local anaesthetic gel to be used to make the scan less uncomfortable. If you think that you may not be able to go through a transvaginal scan, you can request a transabdominal scan (you will need a full bladder) or an MRI scan.

Why aren’t virgins allowed to have a transvaginal ultrasound?

A transvaginal scan involves insertion of a probe which can be uncomfortable and also not appropriate. Hence, a transabdominal scan is preferred.

Are there alternatives if someone absolutely doesn’t want to have a transvaginal ultrasound?

The three types of ultrasound scans commonly used in obstetrics and gynaecology are:
1. External abdominal ultrasound scan – the probe is moved over the skin
2. Internal (vaginal) ultrasound scan – the probe is inserted into the body (vagina)
3. HyCoSy or Aqua scan – this scan is performed to assess the uterine cavity and patency of fallopian tube

An external ultrasound scan is most often used to examine your unborn baby (after 10 weeks of pregnancy) or when an internal scan cannot be performed to examine the pelvic organs. A small handheld probe is placed on your skin and moved over the part of the body being examined. A lubricating gel is put on your skin to allow the probe to move smoothly. This also ensures there’s continuous contact between the probe and the skin. You shouldn’t feel anything other than the probe and gel on your skin (which is often cold). If you’re having a scan of your womb or pelvic area, you may have a full bladder that causes you a little discomfort.

In some cases, ultrasound scanning has no alternatives but an MRI or CT scan can be used instead or in addition to ultrasound scanning.

Anything else to know to make the experience less uncomfortable? Any specific questions to ask the gynae/info to disclose to them? Advice on what to wear/what to eat or drink before and after?

Before having some types of ultrasound scan, you may be asked to follow certain instructions to help improve the quality of the images produced. You may be advised to drink water and not go to the toilet until after the scan – this may be needed before a scan of your unborn baby or your pelvic area. You can eat as normal and you do not need to starve. There will be a toilet nearby to empty your bladder once the scan is complete. If you are using a tampon, this will need to be removed before a vaginal scan.

Patients can bring a friend or relative with if it makes them feel more comfortable.

Click here to view the full article.

Beverley Knight’s personal battle with fibroids

Did you know Beverly Knight suffered from fibroids and had to take a break from showbiz as she recovered?

Singer’s scary condition ‘I had no idea’!  Beverley Knight didn’t know what fibroid were when she was diagnosed. The NHS notes that fibroids are more common in women of African-Caribbean descent and a 2015 study highlighted that 80 per cent of Black women will suffer from fibroids, compared to 70 per cent of white women by age 50.

Beverley Knight is a recording artist and musical theatre actress. She is widely labelled as one of Britain’s greatest soul singers and is best known for her hit single “Greatest Day”. The singer endured a health scare and was forced to take time out.  Beverley Knight’s battle with mystery condition that affects 80 per cent of Black women.

The hitmaker, who now appears on TV each Saturday night on the judging panel of Starstruck, told Hello! at the time: “I have no idea why, I’m just glad that I got through it.” She added: “‘I’m a proud aunty and godmum, but having children of my own has never been part of the plan”.

Beverley Knight spoke candidly about her experience in 2017 to the Mirror recently.

Mr Narendra Pisal, consultant gynaecologist , says more awareness needs to be raised. “I don’t think there is much awareness of fibroids, even in the African-Caribbean community,” the expert, who has practised gynaecology in London for over 21 years, tells the Mirror. “I see women and they are often shocked. It does become a taboo, kept a secret, it is a private thing for a lot of women, they won’t talk about it. “The more awareness we increase, the better it will be.”

He has called for every woman at the age of 25 to have an ultrasound – which can pick up conditions like fibroids, endometriosis, and polycystic ovaries.

This is why fibroids can remain undetected, he says, until women start trying to have a baby and then go for a pregnancy scan, most commonly in their 30s. Click here to view the full article online.

Endometriosis Instagram Live Tonight

Save the Date Tonight Instagram Live Tuesday 21st March 7pm

Every March, Endometriosis Month takes place across the world, with the aim of increasing awareness and highlighting the symptoms of this debilitating condition that affects millions of women worldwide.

So tonight, Tuesday 21st March 7pm join us for an Instagram Live. Leading consultant Mr Narendra Pisal will be a guest presenter, joining Endometriosis Advocate Shivani Gadhia for an informative and educational session on Endometriosis. They will be discussing Shivani’s personal journey, the condition and treatment options for sufferers.

Engage with us live on Shivani’s Gadhia Instagram (@miss_shivv), tonight Tuesday 21st March at 7pm.

Shivani Gadhia, is on a mission calling an end to the stigma associated with Endometriosis. Her personal battle with endometriosis has been a challenging one. But she has learned many lessons along the way and hopes to help other women by sharing her story.

Menopause Symptoms

What menopause symptoms might I have?

No two women are the same when it comes to menopause symptoms. However, we do know that we have oestrogen receptors in every cell of our body so it is possible that the fluctuating levels of oestrogen can provoke a wide variety of menopause symptoms.

Not all women will experience all of these menopause symptoms, but common ones include:

• Hot flushes
• Night sweats
• Insomnia
• Low mood
• Panic attacks or anxiety
• Feeling tense or nervous
• Heart beating quickly or strongly
• Loss of feeling in hands and feet
• Breathing difficulties
• Vaginal dryness and itching with painful intercourse
• Wanting to pass urine often
• Hair loss
• Formication (a feeling of insects crawling on your skin)
• Crying spells
• Loss of interest in most things
• Irritability
• Feeling dizzy or faint
• Parts of the body feeling numb or tingling
• Joint pains and muscle aches
• Loss of interest in sex
• Muscle and joint pains
• Headaches including worsening migraines
• Poor concentration
• Feeling tired or lacking in energy
• Urinary urgency
• Hair and skin changes
• Dry eyes/dry mouth
• Weight gain

How much does a colposcopy cost?

The cost of a private colposcopy with one of our specialist Consultant Gynaecologists starts from £675 and includes a full consultation.

We understand that cost can be an important factor when considering private health services. We have a transparent approach to our fees and offer packages where possible to ensure clarity upfront whilst keeping our costs as low as possible.

Here at London Gynaecology, we see patients who are covered by private health insurance along with self-paying patients.

Who is a colposcopy for?

A colposcopy is for women who have:

• had an abnormal smear result and need further examination
• symptoms such as bleeding after sex, irregular bleeding or contact bleeding
• been referred by their GP for unusual appearance of the cervix

The examination is carried out by one of our specialist gynaecologist’s who is accredited by the British Society of Colposcopy and Cervical Pathology (BSCCP). A nurse will also be present and you will be given an option to see your cervix on the screen.

All of our colposcopy packages include the below as standard:

• 30 minuite consultation with a consultant gynaecologist
• Full history taking
• Colposcopy procedure
• Explanation of results
• Recommendation for any required tests (tests are always charged in addition to the appointment)
• Detailed written report emailed or posted to you and your GP
• Arrangement for prescription and onward referral if required
• Direct access for any urgent health concerns

This package is our consultation + colposcopy package and is priced at £675 (as priced at date of publication)

If you are a self-paying patient and are considering booking in for a package please discuss any queries with the practice secretary.

Make an appointment

If you would like to enquire about a colposcopy or learn more about any of our services please call 0207 10 11 700 or email our team on [email protected]

If you are unsure whether you need a colposcopy and therefore interested in a consultation, please visit our fees page for pricing.

London Gynaecology is proud to be rated of 4.9/5 overall by patients across Trustpilot, Google and Doctify.

Nutritionist shares food tips to manage endometriosis symptoms

Can certain foods help lessen the pain and other discomforts that women with endometriosis feel?

It’s Endometriosis Awareness Month and nutritionist Laura Southern shares how dietary support can help manage endometriosis symptoms and improve overall health. Nutritional therapy for endometriosis support is multidisciplinary.

There are some key areas of dietary focus:

• Reducing inflammation,
• Supporting nutrient deficiencies
• Ensuring optimal digestion
• Supporting liver detoxification.

1. Reducing inflammation

Endometriosis causes chronic inflammation in the body leading to pain and fatigue so it’s critical to try and reduce this. Studies have shown that inflammation-lowering diets reduce the risk of endometriosis (1) and endometrial pain (2). In order to reduce pro-inflammatory foods it’s important to switch from a high sugar, highly processed diet, to a minimally processed diet which focuses on ‘whole’ foods and natural ingredients.

A Mediterranean style diet with a focus on fresh produce and a mix on mono-unsaturated and poly-unsaturated fats has been linked to lower levels of inflammation. Many studies have shown a positive impact on intake of polyunsaturated fats (from nuts, seeds, oily fish) and inflammation. There have also been a couple of studies showing a positive impact on endometriosis- pain reduction by supplementing with omega 3 rich fish oils (3)(4)

Pro-inflammatory foods include high sugar and highly processed foods. There is conflicting evidence on whether animal fats have a negative impact on endometriosis however red meat is pro-inflammatory. It might be worth moving to an unprocessed vegetarian diet for one month to see if there is symptom relief

Any food intolerances such as dairy or gluten will increase inflammation in the body so it is useful to work with a nutritional therapist to see if an elimination diet can help.

2. Nutrient deficiencies

Many women with endometriosis have found to be low in key immune-supporting nutrients such as vitamin D, iron, B12. Deficiencies in these can easily be tested for by your GP and corrected with supplementation and/or diet. Iron and B12 are found in animal proteins and both harder to obtain from a vegan diet so supplementation should be considered then.

Vitamin D is manufactured through the skin via sunlight so those with darker skin, who spend more time indoors and live in Northern hemisphere might struggle to have adequate levels. Again, supplementation at 1000iu daily can be useful.

3. Supporting digestion

Many women with endometriosis will also experience digestive discomfort. It might be bloating, cramps, intermittent stools. Endometriosis is an oestrogen-dominant condition and excess and used oestrogen is excreted via stools.

Constipation can lead to excess oestrogen being recirculated, increasing more toxic forms of oestrogen in the body. It is therefore important to pass regular bowel movements (aiming for 1 -2 solid, well formed stools daily) to ensure excess oestrogen is excreted.

The gut microbiome is also critical to hormonal health, immunity and digestive health and so it is important to support it. Fibre is key here.

Again a diet rich in plant based foods, a wide variety of vegetables, pulses, nuts and seeds can be supportive. Hydration is also important. Focusing on drinking water rather than fizzy/sweetened drinks or too much caffeine and minimal alcohol.

4. Liver function

The liver plays a crucial role in hormone metabolism which can be compromised in women with endometriosis. In order to support the liver it’s important to eat a diet containing plenty of green leafy vegetables.

The cruciferous family (broccoli, kale, cabbage, cauliflower, Brussels) are particularly beneficial as they contain a substance called indole-3-carbinol which studies show supports oestrogen metabolism (5).

It is also important to reduce the burden on the liver by reducing alcohol, recreational drugs, caffeine and high levels of sugar.

For further advise and a personalised nutritional consultation book an appointment with our expert Laura Southern, it may help manage your symptoms.

1. https://www.scielo.br/j/ramb/a/FCFF8JMHW7YqL9RN6w38xPp
2. https://www.sciencedirect.com/science/article/abs/pii/S0301211522000781
3. https://academic.oup.com/ajcn/article/112/1/229/5846052
4. https://www.sciencedirect.com/science/article/abs/pii/S0301211513001735
5. https://academic.oup.com/jn/article/133/7/2470S/4688465?login=false

International Women’s Day 2023

Sex: Frisky (and Safe) After 50

Changing patterns of sexual behaviour amongst some demographics are being reflected for instance through increases in the levels of STIs diagnosed amongst those over 50, whilst practices such as chemsex and use of dating apps can also be associated with higher-risk behaviour.

Dated preconceptions regarding the sex lives of those aged 50 and over are slowly being challenged and overturned. Over 80% of people aged between 50 and 90 are sexually active these days, with two-thirds rating sex as a vital component of their relationship. Regardless of age, sex is important to one’s overall holistic health.

Miss Julie Bowring, consultant gynaecologist in sexual and reproductive health spoke to Sheerluxe on the rise of STI’s, symptoms to spot and top tips for treatment.

1. Is it true that STIs are on the rise in women over 50? If so, what are the latest stats? How has this changed in the last few years?

Prior to covid, it had been noted that the number of STIs in men and women over 50 was on the rise. Data published from Public Health England showed an increase in the total number of chlamydia infections in men and women between 45-64yrs. The effect of covid and lockdowns may mean the numbers have since decreased, but sexual health in people over the age of 50 remains an important issue.

2. What is behind this rise? Why are more women getting STIs, and which are the most common in this age group?

There are a number of reasons why this rise may be occurring. The majority of sexual health campaigns still target a younger demographic, older women may therefore be less aware about their own individual risk of an STI. During a medical consultation older women are perhaps less likely to discuss STIs with healthcare providers and likewise healthcare workers may assume incorrectly they are less sexually active avoiding the topic as a result. Compared to the current curriculum, there also would have been less focus on sexual education when they were in school.
One other major reason may be that women over 50 are less likely to use a condom if there is no risk of pregnancy.

Previous data from the US stated that the three most common STIs in adults over 50 included chlamydia, gonorrhoea and HIV.

3. What are some of the myths about STIs that persist in women 50+?

Hopefully the above answers this?

4. What are the symptoms to look out for – are some more obvious than others? Do STI symptoms change later in life?

Many men and women will often have no symptoms from STIs. All infections can exist without symptoms, but particularly chlamydia is often asymptomatic. This just highlights the importance of safe sex and routine checks when you enter a new relationship.

The symptoms, however small, to look out for are:
1. Any vaginal discharge that is not ‘normal’ for you, this can mean change in colour, amount, odour.
2. Vaginal or vulval irritation or soreness
3. Ulcers or blisters on the vulval area (outside)
4. Genital warts
5. Swollen lymph nodes in the groin
6. Pain on passing urine
7. Bleeding after sex
8. When infection spreads to the pelvis (PID: Pelvic Inflammatory Disease), women can get severe lower abdominal pain and temperature

Women presenting with the symptoms above may be misdiagnosed as symptoms can be attributed to an alternative diagnosis. Vaginal and urinary symptoms for example, may be considered to be due to the menopause rather than an STI. The opportunity to successfully treat an infection can be missed, increasing the risk of transmission and later complications.

5. When it comes to getting tested, where can you get this done? How can you find services local to you?

Sexual health testing can be carried out in a variety of settings. Most people will attend a sexual health clinic or their GP surgery. If you do not have symptoms and want to have a sexual health check for peace of mind, this can be carried out at home by ordering an online kit. This can be a good solution for people that might have embarked on a new relationship or simply want to check their sexual health.

6. If you suspect you have an STI, how soon after having unprotected sex should you get tested?

If you have symptoms or you are concerned about having an STI you should visit a sexual health clinic or your doctor to get tested. Some infections taken time to show up on sexual health screens. This means you may sometimes have to repeat a test if you have recently had unprotected sex with someone.

7. Treatment – what are your treatment options?

Infections are often treated by simple antibiotics. It is necessary to treat your partner as well as sexual contacts in the recent past. Sometimes, a “test of cure” is necessary to ensure that the infection has been satisfactorily treated.

Infections, if not diagnosed and treated promptly, can spread to the fallopian tubes and the pelvis in women. This can lead to what is known as Pelvic Inflammatory Disease (PID). This is often characterised by severe pelvic pain and raised temperature. Admission to the hospital and intravenous antibiotics are sometimes needed in severe cases.

PID can lead to blocked fallopian tubes and infertility. If the fallopian tubes are partially blocked or affected, there is also a risk of tubal ectopic pregnancy. PID can also lead to scar tissue and chronic pelvic pain which can be difficult to treat.

8. Does having one STI put you more at risk of catching another?

Having an STI may increase the risk of you becoming infected with HIV. This is because some STIs lead to inflammation and broken skin which increases the risk of HIV transmission.

9. What are your top tips for safer sex in your 50s? Do you have any insights to share with our readers?

There is still a risk of having an STI in your 50s, protecting yourself by using a condom will prevent the STIs such as chlamydia, gonorrhoea and HIV.

Sexual health tests can often be sent to you and carried out in the comfort of your own home, this is a great way to access testing if you are concerned about having an STI.

It can often be daunting talking about sex but healthcare professionals working in sexual health are trained to do this, do visit your sexual health service or doctor if you are worried about anything or have questions related to STIs.

Click here to view the full SheerLuxe article.

A regular sexual health check can be performed at any time for peace of mind. Why not book your sexual health appointment today.

Menopause and Migraines

What are migraines?

Migraines are severe and recurrent headaches which can have a significant impact on a person’s quality of life. They are often accompanied by other symptoms such as visual disturbances, nausea and vomiting, sensitivity to light and sound, irritability, fatigue and malaise.  

What how can menopause affect migraines?

From the early 40s, the menstrual cycle can become more erratic, with fluctuations in oestrogen levels, leading to more frequent migraines. As these fluctuations lessen in the run up to the menopause and beyond, some women may find that their migraine improves after the menopause. 

What are the options for migraine treatment during menopause?

Here are 7 possible treatments for migraine sufferers during the menopause.

• Hormone Replacement Therapy (HRT): Some menopausal women may benefit from HRT, which can help stabilise hormonal fluctuations and reduce the frequency and severity of migraines. If you have migraines with aura (changes to your vision) it is often advised to use oestrogen which is delivered through the skin, as there is no increased risk of blood clots when it is given this way. Your doctor will be able to discuss and individualised treatment approach with you.  
• Lifestyle Modifications: Lifestyle changes can play a crucial role in migraine management. This includes maintaining a regular sleep schedule, staying hydrated, managing stress, and avoiding trigger factors (for you) like certain foods, alcohol, and excessive caffeine. 
• Medications: Your healthcare provider may recommend migraine-specific medications, such as triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), or preventive medications like beta-blockers, calcium channel blockers, or antiepileptic drugs. The choice of medication depends on the frequency and severity of your migraines and of course, your preference.  
• Complementary Therapies: Some women find relief through complementary therapies like acupuncture, chiropractic care, or herbal supplements. Be sure to consult with a healthcare professional before trying these approaches. 
• Dietary Changes: Maintaining a healthy diet and identifying and avoiding trigger foods can be helpful. Common migraine triggers include aged cheeses, processed meats, and foods with artificial additives. Alcohol again can be a trigger for some.  
• Exercise: Regular physical activity can help reduce the frequency and severity of migraines. However, it’s essential to find an exercise routine that suits your individual needs and doesn’t trigger migraines. 
• Tracking Migraines: Keeping a migraine diary can help identify patterns and triggers, which can inform your treatment plan. 

Menopause: When to Stop Contraception

The decision of when to stop contraception during menopause can vary depending on your individual circumstances and preferences. Menopause is defined as the cessation of menstruation for 12 consecutive months and is technically one day in time. It is important to understand that pregnancy can still occur during the perimenopausal transition, as ovulation can be irregular.

• If you are over 50 and your periods have naturally stopped for 12 months or more, you can usually stop contraception. This only applies if you are not using additional hormonal medication.
• If you are under 50 you can stop using contraception if your periods have naturally stopped for 2 years. Again, this advice only applies if you are not taking additional hormones or using the Mirena coil.
• At the age of 55 you can usually stop using contraception as natural conception at this time is very rare.

If you are using the combined contraceptive pill and you have withdrawal bleeds these are occurring because of these hormones rather than your own cycle. Because these methods give an ‘artificial bleed’, you are not able to tell where you are in the menopause transition or if your periods have naturally stopped.

Some women using the progesterone only pill, progesterone implant or hormone-containing coil may not have regular bleeds which can make it difficult to know when the menopause happens.

If this is the case, your doctor can carry out a blood test to check your follicle stimulating hormone (FSH) level. This blood test can be useful in helping you work out when to stop using contraception. Speak to a doctor to arrange this, and for advice on how to interpret the results.  If you would like to discuss menopause or when to stop contraception with one of our menopause specialists, click here,