Clinical Gynaecology Services
Colposcopy including biopsy
Referral for this is usually made after an abnormal pap smear. From a patient’s point of view, the actual examination is not a lot different to having a regular pap smear. You’ll be ushered into a separate room to change in privacy and then made comfortable on the custom built, motorised colposcopy couch. For distraction purposes, there is a TV playing music DVD’s on the ceiling. Gently and deftly, the same speculum used for taking a standard pap smear is inserted, and then the cervix is bathed in medical grade vinegar. This will then show up any abnormal areas on the cervix, which will be visible to Dr. Kiesey-Calding through the colposcope. This is a high quality magnification instrument. Depending on what is seen, Dr. Kiesey-Calding may suggest a biopsy of the cervix – this involves pinching a tiny fragment (routinely abour 2mm) from the area of abnormality. The area is then sealed to prevent bleeding, and you are asked to abstain from intercourse, tampons and swimming for 3 days. This is generally not a painful procedure, and no special preparation is required. However, it is very important to abstain from intercourse for 2 days prior to the appointment. Otherwise you will have to be re-scheduled. Likewise, you shouldn't book a colposcopy appointment when you are expecting your period, as it will be impossible to effectively carry out the examination.
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Vulvoscopy including biopsy
This is similar to the above, but focused on the vulva. Referral may be made by your GP for investigation of chronic itch, pain or abnormal lesion. Any biopsy suggested would be done under local anaesthetic, with one small dissolvable suture placed to ensure appropriate healing.
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Pessary fitting
This treatment is a non-surgical vaginal “face lift” for prolapse. It is not suitable for everyone, but after assessment by Dr. Kiesey-Calding, then it can be fitted at the time of the consultation. This will then need to be checked every 3-4 months, but can give a great result for many years.
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Mirena/Copper IUD fitting
Revolutionising many women’s lives with it’s “set and forget” advantage, intrauterine devices (IUD’s) are either medicated (Mirena (trademark)) or non-medicated (Copper IUD’s). They can be used for contraception, or for treatment of heavy, painful periods (Mirena(T) only). They each work in slightly different ways, and so an individual assessment by Dr. Kiesey-Calding is important to ensure that you have the best one for you. Women who have never laboured with a baby, or have very low estrogen levels may not be suitable for an insertion in the rooms, and the place of a general anaesthetic in these patients will be discussed. Prior to fitting an IUD, we require a recent negative result for pelvic infective agents, as well as an up to date pap smear. If these things have not been done prior to the initial consultation, they will usually need to be addressed before an IUD can be inserted. It is also advisable to insert an IUD during a menstrual period, both for comfort and to ensure that there is no early pregnancy. About half an hour prior to the fitting, it is useful to take some anti-inflammatory medication – this is available at the rooms or you can obtain this at the chemist “over the counter”. After the procedure, a warm beverage and a sit in our massaging armchair is recommended before leaving; a “recovery period” to make sure that you are having no problems. Some women prefer not to have to drive home after an IUD is inserted, but the majority of patient’s should be fine to drive themselves. Apart from the day of insertion, no further time of work should be needed, unless there are problems. Your appointment should take roughly an hour from consultation, through fitting and recovery period
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Implanon insertion
This is a small plastic rod impregnated with progesterone which is inserted under the skin of the inner arm for contraception. It is done under local anaesthetic and lasts for 3 years. It requires certification in its use, which is held by Dr. Kiesey-Calding. This should always be done at the time of a menstrual period and takes between 30 and 45 minutes for your appointment. Again, prior to booking, it is important to have a proper gynaecological assessment to ensure that this is the best choice for you. Aside from the day of the appointment, there should be no need for extra time off work, unless you have a very physical job. Driving yourself to and from the appointment should likewise not be a problem.
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Zoladex administration
This is a small pellet which is injected under the skin of the abdomen (tummy) with local anaesthetic cover. This is used to create a “medical menopause” for a variety of gynaecological conditions. The government will cover the cost of the medicine for certain gynaecological conditions but not all; part of the discussion prior to insertion will centre around your eligibility for this rebate. Your appointment should take around 30 minutes, have no implications for driving home, and require no extra time off work.
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Estrogen and Testosterone implants
Used for hormone replacement therapy and libido problems, this method of delivery requires a new implant every 6-12 months. The medicine comes as a small pellet which is inserted under the skin of the abdomen (tummy) with local anaesthetic cover. There should be no problem going back to work after the procedure unless you have a very physical job, and no problem driving yourself home after the procedure.
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Local excision of vulval skin lesions
This could be a skin “tag” or other benign skin lesion. Under local anaesthetic this can be dealt with quickly and relatively painlessly. Depending on the exact location of the excision, this may impact on your ability to drive to and from the appointment. There should be no need for extra time off after the appointment, but it is recommended to abstain from intercourse for 3-5 days after the procedure.
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Ultrasound
Gynaecological ultrasound is offered on-site at the rooms as part of the end-to-end care that is offered at Cairns Obstetrics and Gynaecology. To enable appropriate time to be scheduled for your examination, when booking your appointment please indicate to our reception staff whether or not an ultrasound will be required. They will then ascertain that the correct referrals have been made from your GP and allocate an appropriate time slot. This service is particularly helpful for those patients coming from a distance, so that everything can be done at the same time. At this time, the service is somewhat limited, as we are awaiting our new sonographer.