6 Common Gynaecology Procedures & Surgeries

As part of your gynecological care, it may be necessary to perform a diagnostic or therapeutic procedure. These procedures can help identify the underlying cause of your symptoms and guide your treatment plan.Our procedures are typically performed in our private procedure room, providing a comfortable and discreet environment. The procedure will depend upon your presenting complaint and will only be performed if it is necessary to establish a diagnosis, or as part of treatment.

Where are our procedures performed?

We believe in open communication and transparency. Before any procedure, Associate Professor Kliman will explain the process in detail and obtain your informed consent. We prioritise your comfort and well-being, and will always provide appropriate pain relief when necessary. Our compassionate nursing staff will be present to assist you throughout the procedure.

Below is a list of procedures that Associate Professor Kliman can perform:

An ultrasound is a non-invasive imaging test that helps visualise the internal organs. Ultrasounds are performed as an aid to diagnosis. If you have had abnormal bleeding, we often need to visualise the actual lining of the uterus. If we suspect that there may be a pelvic mass present than a pelvic ultrasound is particularly helpful. Sometimes the ultrasound can be performed through your abdomen but on other occasions a vaginal ultrasound is required where a narrow ultrasound probe is gently inserted into the vagina with the aid of lubrication. This will only be performed with one of our nurses present. Sometimes a more sophisticated ultrasound machine is required and then you may need to be referred to an ultrasound group that specialises in gynaecological issues.

Implanon’s are plastic rods that can be inserted on the inside of your forearm under the skin. They continually secrete a progesterone hormone and are used for contraception. Side effects may occur and the commonest two side effects are irregular bleeding or mood changes. This may or may not be an appropriate contraception for you and will be discussed prior to insertion.

A colposcopy is the visualisation of your cervix or neck of the womb using a digital microscope. There are two reasons for having a colposcopy procedure which is a painless procedure.

• Because of you have had an abnormal cervical screening test (Pap smear) showing the HPV virus plus or minus abnormal cells.
• You have had symptoms which may suggest the possibility of abnormal cells such as bleeding following intercourse.

The cervix is visualised with a digital microscope after the insertion of a speculum device. A cervical screening test may need to be taken and the cervix is then painted with a 5% solution of vinegar which helps to show up any abnormal cells. If there is an area on your cervix which looks abnormal, it may need a small biopsy which is usually painless. Sometimes if a cervical polyp is present on the cervix it can be easily removed at the time of your examination also as a painless procedure.

Implanon’s are plastic rods that can be inserted on the inside of your forearm under the skin. They continually secrete a progesterone hormone and are used for contraception. Side effects may occur and the commonest two side effects are irregular bleeding or mood changes. This may or may not be an appropriate contraception for you and will be discussed prior to insertion.

A vulvoscopy procedure is performed again with the patient sitting in an examination chair with a nurse present. The vulval skin is visualised to exclude a vulval skin disorder including precancerous skin changes. Occasionally a skin biopsy is required and this will be a 1 mm punch biopsy performed after the area has been made completely numb using a strong local anaesthetic instilled with a 30 gauge fine needle.

Often during an examination, it may be necessary to take swab tests to exclude infection. These swab tests are taken using a cotton bud on a wooden stick and are completely painless. The swabs may either be analysed via a PCR test which is similar to a COVID test to diagnose particular bacteria or other infective agents or they may involve the laboratory visualising the specimen under a microscope and then culturing or growing any infective agents that are present. Occasionally we need to take a swab of the vulval skin to discern HPV virus of the vulva which is related to HPV virus of the cervix. This specimen is sent to The Royal Women’s Hospital laboratory and the result may take some weeks.

In January of 2018, the old Pap smears were superseded by tests to determine the presence or absence of the human papilloma virus. This is the virus that is associated with almost 100% of all cervical pre-cancers and cancers. A cervical screening test is a test where the laboratory only looks for the presence or absence of the HPV virus using a PCR test similar to a COVID test. A co-test is exactly the same procedure but rather than just looking for HPV virus, they also look for the presence or absence of abnormal cells on the cervix. This more extensive co-test is especially performed if HPV has already been diagnosed or if you have had symptoms especially bleeding following intercourse.

A Pipelle Endometrial Biopsy is a procedure used to collect a small sample of tissue from the lining of your uterus. It involves gently inserting a thin plastic tube through your cervix into your uterus. Once the tube reaches the top of your uterus, a small amount of tissue is carefully extracted.

This procedure is often recommended for women who are experiencing abnormal bleeding, especially those over the age of 40.

Hormone releasing IUDs such as Mirenas or Kyleenas may be inserted gently into the uterus also in the examination chair in the procedure room with a nurse present. It is often wise to take an anti-inflammatory medication one hour prior to your appointment to provide some underlying pain relief. Naprogesic or Nurofen are excellent examples. The procedure itself usually is a short sharp feeling within the cervix and we have Entonox available which is a very effective pain relieving gas for this procedure. The IUDs can either be progesterone releasing IUDs which are effective forms of contraception and are also particularly helpful treatment if you have heavy periods, pelvic pain or diagnosed endometriosis.

Non-hormone releasing IUDs may be inserted but these are used less often. This is because they tend to make your periods heavier and more uncomfortable where the hormone releasing IUDs actually treat painful or heavy periods. It may not be possible to insert an IUD in a patient without a general anaesthetic. This is because inserting an IUD is a blind procedure that is we cannot see exactly where the IUD is going on its insertion. Therefore if you have a weak point within the uterus such as a scar due to previous caesarean sections or if you have a very narrow cervix, especially if you have not had children vaginally previously then it may be wiser to have your IUD inserted under a general anaesthetic. This is something that can be discussed with you at your first appointment.

The pudendal nerves provide sensation to the vagina and vulval skin. In women who have vulvodynia or vulval pain often without a discernible cause, a nerve block may be an effective form of treatment. A pudendal nerve is present on each side of the vagina and travel around a bony point of your pelvis called the ischial spine. Therefore an injection of both local anaesthetic and a long acting steroid medication into the area where these nerves are present may result in an improvement in vulvodynia or vulval pain. The degree of pain relief and the duration of pain relief is often difficult to discern without trying the procedure. It is not particularly uncomfortable but it involves a needle being inserted through the vaginal skin on each side of the vagina roughly 5-6 cm in from the vaginal opening.

A pessary is a plastic Portex ring device which can be inserted into the vagina to hold up and support a prolapse. It is especially useful in seeing whether or not treating a prolapse results in symptom relief. It is also used in older women who have medical conditions and may not be fit for surgery. The pessary lies between the underside of the pubic bone and goes backwards to an area called the posterior fornix which is the space behind the cervix. The vaginal skin should be checked every 6 months to make sure that the pessary is still the right size and to ensure that there is no irritation or ulceration of your vaginal skin which is uncommon. If you have a pessary inserted it is important you phone if the pessary becomes uncomfortable, where you notice any abnormal discharge or bleeding or where you notice your prolapse symptoms have returned.

It is important to realise that if Associate Professor Kliman needs to perform a diagnostic or therapeutic procedure during your consultation it will be performed with your full consent. Consent always requires a detailed explanation of the procedure and how it will help with the diagnosis and management of your condition. There will always be a nurse present during your procedure and the procedure will always be carried out with appropriate pain relief. If after a procedure you are feeling weak, in pain or just uncomfortable you will be rested and provided with any medication that is required to improve your condition.