Tips to make your smear test more comfortable

This week marks Cervical Screening Awareness Week (15-21st June) and it is extremely important to attend your regular cervical screening when due. By not missing your appointment, it helps to save approximately 5,000 lives a year. Pre pandemic, out of the 5 million invitations sent every year, 25% of people do not attend. It is estimated that 1 in 8 of those who would have attended their smear, delayed their appointment amidst the COVID-19 pandemic and during the lockdowns.

Here we have outlined some tips to make your smear test more comfortable:

Listen to music or watch TV: Take your headphones and your phone and get prepared to zone out & don’t worry, if you do forget your headphones ask the nurse if she minds you watching or listening anyway.⁠
Paracetamol: Take a dose of paracetamol 30 minutes before your smear which will take some of the discomfort away.⁠
Equipment: Ask, if available, for the nurse to use a plastic speculum or a small speculum. Plastic is often warmer than metal and it’s clear so it’s easier for the nurse to see the cervix and a smaller speculum is more comfortable. If you have Vaginismus, ask for a smaller speculum or you could ask to insert the speculum yourself
Count from 1 to 100: Paula Radcliffe used to use this strategy towards the end of her marathon and many patients have found it useful – often it is done well before you get to 50.⁠
Retroverted uterus: Try having the smear with your fists behind your lower back, adjust position on the couch for comfort
Menopause: you may benefit from vaginal oestrogen for two weeks prior to the appointment.
Too little lubricant used during exam: you can ask for some more lubricant.

Make an appointment ⁠
If your smear test is overdue, please don’t delay, book it today with your GP or gynaecologist. At London Gynaecology, we are seeing patients for routine cervical screening along with colposcopy procedures. Please do not hesitate to contact us for appointments and enquiries on 020 7101 1700. or by emailing [email protected]

LGBTQ+: What we’re doing to ensure our services are inclusive to all

At London Gynaecology, we are committed to offering excellent healthcare to all our patients regardless of how they identify or their sexual orientation. We are aware of significant health inequalities and specific barriers to services and support experienced by lesbian/gay, bisexual, transgender, queer and questioning and the LGBTQ+ community. This can occur directly through lack of knowledge and understanding and indirectly through marginalisation and social isolation.

It is well known that people within the LGBTQ+ community may have concerns that they aren’t immediately comfortable talking about or are not aware of and this can lead to poorer health outcomes. We also acknowledge that this diverse population also includes people from different ethnicities, faith groups and with disabilities.

A safe and reassuring environment from two practice locations

We offer a safe and reassuring environment; you will be treated with the dignity and respect you deserve at every stage of the patient pathway. We will consider individual patients’ needs when making any decisions about investigations and treatment. We offer urgent and on the day appointments and have access to experienced and expert health care professionals; patients have the option to see either a male or female gynaecologist.

Confidentiality

At London Gynaecology, we treat all information with utmost confidence. We acknowledge people from the LGBTQ+ community may wish to be able to disclose and openly discuss their sexual orientation and not have it recorded in their notes, which is acceptable. Please discuss this at the beginning of your consultation.

Inclusive language

We aim to use inclusive language with all patients – e.g. using correct pronouns and salutations, and not assuming the gender of partner(s). Our staff will endeavour to avoid making assumptions or asking questions that may be deemed inappropriate.

Discrimination

London Gynaecology provides equality of services and care to everyone, regardless of people’s age, disability, gender, gender identity, race, religion or belief or sexual orientation.

We will seek and prevent discrimination of LGBTQ+ patients at our clinics and we have zero tolerance for racist or homophobic language. We will encourage patients to report it if they encounter poor treatment so we that we can make any necessary improvements in our practices. Should you wish to provide feedback, please raise it immediately at the point of service or contact us directly at [email protected], detailing your experience. We are committed to listening carefully and responding to complaints and feedback, acknowledging and rectify any mistakes, and so that we can make our service excellent for all.

What are some of the common health care issues experienced by LGBTQ+ people?

Sexually transmitted infections:

Sexual relationship between two women is not without some risks and some women who now identify as lesbian or bisexual may have had sex with a man at some point in their life. This puts them at the risk of sexually transmitted infections (STIs). STI’s can be transmitted via blood or vaginal fluids transferred during sex or even contact alone (such as herpes). The only way is to ensure that both partners have been fully tested and have had no other sexual contact (with women or men) since.

For more information about safe sex, please click here:

Bacterial vaginosis and thrush:

Bacterial vaginosis (BV) occurs when there is a change in vaginal acidity which causes overgrowth of mixed vaginal bacteria. BV can be triggered by the use of perfumed soaps/bubble bath and vaginal douching.
Thrush is caused by an overgrowth of yeast called candida.

These infections can be transmitted between women through touching and sharing sex toys (without using condoms).

HPV, genital warts and cervical cancer:

Lower participation in regular screening may increase risk of genital warts and cervical cancer. These conditions are caused by persistence of HPV infection which can be sexually acquired via skin contact such as rubbing vulvas together. Smear (HPV) testing is essential for all people with a cervix. Some queer people may be unaware they still need smears even if they don’t sleep with someone with a penis. Smears are important to transmen with cervices.

Other health risks that have been reported to be increased in people from LGBTQ+ groups:

Depression, stress and anxiety
Smoking, recreational drug use, alcohol with hazardous drinking patterns and weight issues can have effect on the liver and with possible impact on cardiovascular health
Increased suicide risk
Increased risk of injury by domestic abuse
Asthma
Musculoskeletal issues
Long term neurological problems
Increased incidence of some types of cancer: mesothelioma, oro-pharyngeal cancer, stomach cancer and endometrial cancer

We have listed links to further information that you may found useful:

Stonewall: Stonewall is the UK’s largest campaigning and lobbying group on LGB issues. Website: www.stonewall.org.uk Telephone: 0800 502 020

The Lesbian and Gay Foundation (LGF) provide a wide range of support services to lesbian, gay and bisexual people.

Website: lgbt.foundation/how-we-can-help-you Telephone: 0845 3 30 30 30

MindOut: LGBTQ Mental health Service

https://mindout.org.uk/resources/ Telephone: 01273 234839

The Gender Trust: It is the UK’s largest charity for people with gender identity issues.

Website: www.gendertrust.org.uk Telephone: 0845 231 0505

FFLAG Families and Friends of Lesbians and Gays (FFLAG) is a national voluntary organisation supporting the parents and families of LGB people.

Website: www.fflag.org.uk Telephone: 0845 652 0311

NHS England: Menu of evidence-based interventions and approaches for addressing and reducing health inequalities

What is a Mucus Plug?

What is a ‘Mucus Plug’, and what should you do when you lose it during pregnancy? Mr Pisal, our consultant gynaecologist spoke to Women’s Health magazine to answer questions on mucus plugs, that you may not be aware of. To read the article, click here.

Work for us: Administrative Assistant

Our COO is looking for an administrative assistant to help her with her duties. This includes (but definitely not limited to), arranging meetings (co-ordinating diaries), minute writing, document editing and formatting, Excel manipulation (vlookup, pivot, concatenate level skills), filing, PowerPoint presentation work, organising/working with IT and other suppliers / helping stay on top of projects.

We are a busy women’s health practice, we as passionate about creating the best experience for patients as possible, and that results in having a very busy COO who is driving new change as well as dealing with day to day management of the business. This is a great role, working very closely with Emma, and is based at Portland Hospital and possibly our clinic in Austin Friars.

This would suit a dynamic individual who enjoys getting on with the job, ticking off a big task list and multitasking.

It’s a temporary position for a few months, but could lead to longer term employment. The successful candidate would need to have a basic DBS check.

Interested applicants should send their cv and covering email to [email protected]

Application deadline Tuesday 1st June.

Covid vaccine: the discussion around menstrual changes

Ahead of your covid vaccine appointment, you may have heard or read about some of the possible side affects you may experience such as fever, headache or more commonly a painful arm for a day or two after being vaccinated. There will be no mention of ‘changes to menstrual cycle’.

However, some women are sharing their personal stories on social media often related to how they have suddenly experienced ‘heavier-than-normal periods’ after having the COVID-19 vaccine. This discussion was first started by two doctors from the US on Twitter in February 2021, Dr Kate Clancy and Dr Katherine Lee.

Dr Kate Clancy, a medical anthropologist, shared her experience about her own unusually heavy period following the Moderna vaccine, and received dozens of similar messages in response. Her former colleague Dr Katharine Lee launched a survey documenting people’s experiences.

At present, there is not any evidence to report whether the vaccine is linked to menstrual changes, as this has not yet been studied.

Mr Narendra Pisal, our consultant gynaecologist reveals: “In our experience at London Gynaecology, these menstrual changes are transient and usually resolve within 3 cycles. This risk is far outweighed by the benefit of protection against the potentially serious COVID infection and we strongly recommend the vaccine for all women.”

Dr Victoria Male, a reproductive immunologist at Imperial College London told the BBC in the article ‘Covid vaccine: Period changes could be a short-term side effect.’ that, ‘Some post-menopausal women, and people taking hormones which stop their periods, have reported bleeding.’ Therefore, according to the article, Dr Male is inclined to suspect there may be a physical reaction occurring.

Make an appointment:

If you experience any bleeding that is unusual for you, we advise you to contact your GP, or gynaecologist. At London Gynaecology, we have a team of consultants who see patients at two convenient locations; The Portland Hospital in Central London and our new location within Austin Friars in the City of London. To book a consultation please email our team on [email protected] or call 0207 10 11 700 (24hrs).

Vaginal discharge: the 7 types

Our Consultant Gynaecologist, Mr Pisal, was featured in Women’s Health online to discuss the different types of vaginal discharge, to help people understand what is normal and when to seek medical advice. To read the article, click here.

Vaginal discharge – what is normal?

Our Consultant Gynaecologist, Mr Pisal, was featured on Yahoo to discuss the various types of vaginal discharge, to help women understand what is normal and when to seek medical advice. To read the article, click here.

Infection control: hand cleaning techniques

To ensure we are maintaining the highest levels of infection control, we ask that you are aware of the guidance regarding handwashing. One of the easiest ways to protect yourself and others from illnesses such as food poisoning and flu and COVID-19 is by washing your hands. By doing so, it removes dirt, viruses, and bacteria and therefore stops the spread of viruses to other people and on to objects. We encourage patients to view the guidance regarding handwashing techniques and best practice prior to your appointment.

The handwashing guidance is by the NHS National Safety Agency and has been adapted from the World Health Organisation on hand hygiene and care.

View handwashing guidance

Adenomyosis: symptoms and diagnosis

What are the symptoms of Adenomyosis?

The symptoms of adenomyosis, a common yet under-recognised condition characterised by an enlarged uterus due to infiltration of the uterine lining into the muscle wall, may vary, and in fact, many women may not display any symptoms at all.

Here we highlight the symptoms of adenomyosis which can cause severe period pain and cramps and may include:

Typically heavy and painful periods;
A lump felt in the lower abdomen (as the uterus may become so enlarged);
Urinary frequency and constipation – caused by pressure on the bladder and bowel due to having an enlarged uterus.

April is Adenomyosis Awareness Month and it is important we shine a light on a condition that many women live with, without ever having a diagnosis. A lot of women with adenomyosis have such bad periods that they have to put their life on hold during their time of the month. It affects their work and quality of life significantly. It can lead to anaemia due to heavy bleeding and lead to extreme tiredness and also affect performance at work and sports.

During menstruation, the adenomyotic tissue swells up in addition to the uterine lining and bleeds within the uterine wall which can lead to severe period pain, cramps and heavy periods.

There are many other causes of heavy and painful periods such as fibroids and endometriosis which are more commonly known. In fact, both fibroids and endometriosis often coexist with adenomyosis. Adenomyosis is also known as ‘internal’ endometriosis as the uterine lining grows inside the uterine wall whereas it grows outside the uterus with endometriosis.

How is adenomyosis diagnosed?

This condition can be difficult to diagnose as the symptoms are common and affect a lot of women. A large proportion of women have heavy and painful periods and accept the symptoms as ‘normal for me’. Women don’t often know how heavy or painful their periods are supposed to be.

The condition is often diagnosed on an ultrasound or MRI scan where an enlarged uterus is seen with one wall of the uterus thicker than the other.

You can call your periods heavy, if you are passing lots of clots or having to constantly use double protection, changing protection more frequently than every four hours or if your periods are making you anemic.

What are the treatment options available?

Adenomyosis can be a difficult condition to treat. To make the periods less painful, supportive treatment is often the first line of management with medication (painkillers and antispasmodic medication such as Mefenamic Acid) and to reduce the bleeding (Tranexamic Acid). Sometimes taking the minipill or the contraceptive pill back to back can also stop the periods and hence help with the symptoms. Mirena intrauterine device is also helpful in reducing the symptoms significantly. The condition also improves during and after pregnancy and after menopause.

Uterine artery embolisation (UAE) is a treatment usually reserved for fibroids but is also very effective for treating adenomyosis. The uterine blood supply is blocked by an interventional procedure carried out through the groin blood vessels. Hysterectomy is often reserved for extreme cases where the symptoms are resistant to other forms of treatment and the family is complete.

Make an appointment:

At London Gynaecology, our consultants provide diagnosis of and see patients for the treatment of adenomyosis at our practice locations at The Portland Hospital and at our new opening in the City of London. To book a consultation please email our team on [email protected] or call 0207 10 11 700 (24hrs).

To learn more about our adenomyosis package, click here.

Ms Michelle Swer joins our team

We are delighted to announce that Ms Michelle Swer, consultant Gynaecologist, has joined the London Gynaecology team and will be seeing patients at our locations at The Portland Hospital and our new opening in The City of London.

Ms Swer is a highly experienced consultant Gynaecologist and holds the post for Care Group Lead for Gynaecology at her NHS Trust and is also part of the Abnormal Invasive Placenta Regional Service. She trained for Obstetrics and Gynaecology at a number of reputable London hospitals and her expertise is in early pregnancy and gynae scanning after having completed two years as Clinical Research Fellow at UCL.

Ms Swer has publications and book chapters in both early pregnancy and obstetrics and feels privileged in being able to help women through all aspects of their reproductive life. Her main interests lie in ambulatory gynaecology including scanning and outpatient hysteroscopy, early pregnancy and menopause, Ms Swer also speaks Italian.

If you would like to learn more about Ms Swer, visit our team page. For appointments and enquires, call our team on 0207 101 1700 or email, [email protected].