GP GYNAECOLOGY - Full extract 

Sally was just getting over a nasty bout of sinusitis. She had already missed several days at work and was looking a bit exasperated when she came into the consulting room. " Just as my face stops aching, I get this awful itch and a vaginal discharge," she said. " I've been scratching all night and I feel like I'm falling apart." 

No great feat of deduction was required to work out what the problem was. When I examined Sally, it was obvious that her vulva was quite reddened and swollen. There was also a thick white discharge in the lower part of the vagina. The picture was typical of vaginal thrush, otherwise known as candida or monilia. I explained to Sally that the antibiotics she had been taking for sinusitis had probably predisposed her to developing the thrush. 

I gave her a prescription for vaginal pessaries and a cream to be applied to the outside of her vulva. Fortunately, after a few days her symptoms had fully settled. 

Gynaecology  means the study of disorders that affect the female reproductive system. Naturally, there is considerable overlap with other branches of medicine. Contraception, hormone replacement therapy and Pap smears are important areas of gynaecology. However, there are other conditions and symptoms that are frequently seen in general practice.... 

Vaginal thrush  is due to an overgrowth of yeast organisms. It is encouraged by wearing tight jeans, nylon knickers and anything else that prevents circulation of air around the vulva. It is more common just before a period and at times of hormonal change, such as pregnancy and being on the pill. Taking antibiotics changes the balance of organisms that normally live in the vagina; this may also cause thrush to appear. 

Some women are prone to repeated episodes of thrush. When this occurs the urine should be tested for sugar to rule out diabetes. Although topical vaginal treatments are usually effective, a course of oral medication may also be required. At times it is necessary to treat the woman's sexual partner as well. There are a number of similar vaginal infections that can be difficult to distinguish from thrush. A swab from the vagina can help to identify the organism in case a change of treatment is necessary. 

Painful periods  are another common problem, especially in younger women. Usually no specific cause is found. Several effective medications such as Ponstan and Naprogesic are available. These treatments work even better if they are commenced a day or two before the period starts. With more severe period pain, going onto the contraceptive pill can also give considerable relief. 

Heavy periods  can be quite disabling and may eventually lead to anaemia. The cause usually turns out to be hormonal imbalance. Sometimes benign lumps in the uterus, called fibroids, can also be responsible. A number of hormone preparations are available to reduce menstrual loss. Sometimes the contraceptive pill and medications such as Ponstan can also be tried. If the bleeding is very heavy, referral to a gynaecologist may be necessary. 

Irregular vaginal bleeding  always has to be carefully checked, even if there has been a recent normal Pap smear. Minor spotting is sometimes due to a low dose pill, and may be corrected with a dosage adjustment. However, bleeding that occurs at odd parts of the cycle, or after sexual intercourse, requires referral to a gynaecologist for investigation. Cancer of the uterus and cancer of the cervix always have to be ruled out as possible causes of abnormal bleeding. 

Pelvic pain  is another common symptom and it can have many causes. Sudden pelvic pain can be due to conditions such as ovarian cysts. An ultrasound of the pelvis is often helpful in identifying the cause. Chronic pelvic pain is quite different. It may be present nearly all the time, or occur only with intercourse. Chronic pelvic infection around the ovaries and tubes can be the cause. The presence of symptoms such as a previous fever and vaginal discharge would make this diagnosis more likely. 

Endometriosis is an important cause of chronic pelvic pain, and it is not always easy to diagnose. It is caused by tissue identical to the lining of the uterus occurring in the pelvis and elsewhere. With menstruation, these deposits become inflamed and may cause considerable pain. The condition is usually diagnosed by laparoscopy; under an anaesthetic, the gynaecologist inserts an instrument through the umbilicus and the pelvic structures are directly inspected. Medications are available for endometriosis but the symptoms often recur. 

Prolapse  of the uterus and the walls of the vagina is very common, especially in women who have had children. Some women notice a lump in the region of the vaginal opening. Other women experience a dragging feeling in the back or lower abdomen. Sometimes there is an associated loss of urinary control, especially with sneezing and laughing. Early diagnosis and exercises to strengthen the pelvic floor muscles can be very helpful. In more severe cases, referral to a gynaecologist may be necessary. 

Health Tips:
* Women should have a gynaecological check-up each year. This can be included in an overall medical check with your family doctor, or a specialist gynaecological assessment can be arranged.

* All women who have ever had sexual intercourse should have a Pap smear every two years, until the age of seventy.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001