At Maven Centre, we recognise and acknowledge that seeing a gynaecologist can be a somewhat nerve-racking experience. Understandably, patients often feel a little vulnerable and nervous while waiting to see us.

But fear not! We are all delightful, caring clinicians, who will take the time needed to get to know you, hear the details of your symptoms, and make a patient-centred plan regarding options for future management.

We hope that reading this post will help to lessen any anxieties you have about your upcoming appointment…

So, what is your first appointment with your Maven gynaecologist likely to involve?

Hearing your story

Hearing your story (aka. ‘taking your history’) is a vital part of your first consultation with a gynaecologist: it helps us to work out what’s going on, and gives us hints as to how we can best help you. Being gynaecologists, we love hearing all about the nitty gritty of your symptoms: there is no such thing as too much information!

Parts of your story that your gynaecologist is likely to ask about include your:

• Past medical history: any medical conditions that have affected you in the past, and any that continue to impact upon you. (For example: high blood pressure, diabetes, migraines, asthma…) Details regarding which clinician manages them for you, and how.
• Past surgical history: any operations you’ve had in the past, when and where they were done, and which surgeon did them. The more information the better! In particular, any operations you’ve had on your tummy (eg. gallbladder removal; appendix removal; operations on your pelvic organs, such as on your ovaries, uterus, or endometriosis removal).
• Current medications and supplements.
• If you have any drug allergies.
• Any conditions that run in the family: in particular, any family members with breast, ovarian and / or bowel cancer. If relevant, approximately how old were these family members when they were diagnosed?
• Social situation: if you work, and if so in what area; your living situation.
• Obstetric history: if relevant, how many pregnancies you’ve had previously. For each pregnancy: whether it was a spontaneous conception or not; whether or not the pregnancy was ongoing; if any children were born vaginally or by Caesarean section; and if you or your baby had any complications afterwards. Knowing whether or not you are hoping to have any more children can also guide future management.
• Gynaecological history: what your periods have been like throughout your life, in terms of regularity, heaviness, pain, and any related symptoms.
• Your history of cervical screening tests (which used to be called ‘Pap smears’). If you have a Medicare card, we are able to look up the results of every cervical screening test you’ve ever had in Australia, via a government website called PRODA.
• Details regarding your current symptoms and concerns, how they have been investigated and managed so far.

Some questions that we may ask can seem a little confronting, for which we apologise in advance. For example:

• Your height and weight
• Whether you have any pain or problems during or after sex
• Whether you have any urinary or bowel symptoms

We only ask questions that help to guide the future management of your symptoms / condition. If you are uncomfortable answering any particular question, you can always clarify why this information is needed, and then choose whether or not to answer.

Being examined

Your gynaecologist may or may not ask to examine you: it depends on your presenting symptoms, and what investigations you’ve had done so far. Examination may include:

• Your height and weight.
• Feeling your tummy.
• An internal (or ‘bimanual’) examination, which involves your gynaecologist having their non-dominant hand on the outside of your tummy, and two fingers of their dominant hand inside your vagina. This can provide information about your pelvic floor muscles, uterus, ovaries, and possible endometriosis. This examination is not often needed. If you feel uncomfortable having this done, please say so: your gynaecologist may be able to find out this information another way (eg. a transvaginal ultrasound).
• A speculum examination. A speculum is a plastic instrument that is inserted into your vagina. It enables your gynaecologist to see inside your vagina, including your cervix (which is at the top of your vagina). Speculum examinations can be quite uncomfortable, but should not be painful.

If anything we are doing is too uncomfortable for you, please say so.

‘Bedside’ investigations

There are several investigations that can be performed in the consulting rooms at Maven Centre. These include:

• Vaginal swabs, to investigate possible infection (eg. bacterial vaginosis, thrush, chlamydia, gonorrhoea…)
• Urine test, to investigate a possible urinary tract infection, pelvic infection (eg. chlamydia or gonorrhoea), or a urine pregnancy test
• Colposcopy. A colposcopy is a detailed examination of the cervix, vagina, and vulva using a specialised instrument called a colposcope, which looks rather like a big microscope on a wheeled base. For more details regarding colposcopic examinations, please read this blog post.
• Ultrasound. Your gynaecologist may do a bedside ultrasound, for example to make sure your intra-uterine device (IUD) is sitting correctly inside your uterus.

Reviewing your previous investigations

For many gynaecological problems, a transvaginal ultrasound is needed. If so, we’re hoping that your GP will already have arranged this! If you have a copy of the ultrasound report, please email it to reception@mavencentre.com.au prior to your appointment, and / or bring it with you to your appointment.

Clarifying your understanding

By this stage, your gynaecologist will probably have a pretty good idea as to what’s going on. At Maven Centre, we’re firm believers that knowledge is power! So your gynaecologist will talk you through what they think is going on and why. Feel free to ask lots of questions at this stage, to make sure that we’re all on the same page.

Your gynaecologist may give you some printed information about the relevant condition(s), either written by Maven Centre, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), or another reputable source.

Making a plan…

Once everyone’s on the same page, as to what the likely underlying conditions are that are contributing to your symptoms, it’s time to discuss what management options are available to you! This may include:

• Tracking down details from your previous investigations (esp. ultrasounds), operations, and / or hospital admissions.
• Requesting additional investigations (eg. a repeat and / or more specialised ultrasound, an MRI).
• Suggesting changes to your current medications.
• Referring you to an additional or alternative clinician. Very occasionally, it may not be clear from a GP referral letter what the exact nature of your problem is: for example, you may be referred for fibroids, but it turns out that the more pertinent issue is pelvic organ prolapse. If so, we may need to refer you to an alternative clinician (either within Maven Centre, or outside it).
• Procedural options. Your gynaecologist may suggest a minor procedure, such as an intra-uterine device insertion.
• Surgical options. If relevant, your gynaecologist may suggest surgical options to manage your condition. The surgical approach may be some combination of: vaginal surgery; keyhole (or ‘laparoscopic’ surgery); hysteroscopic surgery, using a slim video camera that is inserted through your vagina and cervix, into your uterus; or an open procedure (via an incision > 5cm big in your tummy).

We see our role as supporting you to make an informed choice about your management options. This often involves discussions around the pros and cons of different management options available to you.

Your gynaecologist may suggest that you make another appointment to see them, in order to: have more detailed discussions about the management options available to you; to assess any change in your symptoms after trying a new medication for a few months; and / or to review the results from any investigations that have been ordered (eg. a more detailed transvaginal ultrasound). Your next appointment may be able to be completed via telehealth or videohealth, if that is more convenient for you.

After your consultation…

After your appointment, your gynaecologist will write a letter back to the referring clinician (eg. your GP), summarising what we’ve learnt about you, and what the plan is.

At Maven Centre, we routinely CC patients in to such letters. If you haven’t received an electronic copy of this letter (from your Maven gynaecologist) within a few days of your appointment, please email reception@mavencentre.com.au to ask for a copy.

Frequently asked questions

What can I do to prepare for my first appointment with a gynaecologist?

There are several things you can do to prepare for your first appointment with a Maven Centre gynaecologist. These include:

• Arrive 5 minutes early, to complete any outstanding paperwork (eg. our registration form).
• Bring a list of your current medications. Sometimes the simplest thing to do can be to take photos of the boxes / bottles your medications are in, and show your doctors these photos!
• Details of previous operations. It’s a huge help if you’re able to source and bring with you details such as: operation notes; laparoscopic photos; histopathology reports from the laboratory; any correspondence between your previous gynaecologist(s) and your other clinicians (such as your GP); any hospital discharge summaries or other similar documentation.
• Reports from previous investigations, such as ultrasounds. Hopefully your GP has included these in your referral letter. But it never hurts to bring in such reports with you, if you have them! Even just the name, suburb, and approximate date that you had an ultrasound performed can be helpful.

How long will the appointment be?

We tend to schedule at least 30 minutes to get to know new patients. Depending on the complexity of your situation, you may need even more time than this. Very occasionally, we may not have time to gather all the necessary information in one appointment – especially if you’ve had numerous gynaecological operations in the past, and don’t happen to have all the details at hand. If this is the case, we may need to schedule an additional appointment at a later date, once we’ve had time to do some information-gathering.

Appointments for a medical termination of pregnancy or insertion of an IUD may be scheduled for 45 minutes’ duration.

Can I bring someone with me to my appointment?

Yes, of course! We actively encourage you to bring your partner, or a close relative or friend, with you to your appointment. Sometimes they can help to flesh out some of the details of your story. It can also be helpful to have a support person there listening to the conversation with your gynaecologist – they can help you to remember the details down the track!

Can my first appointment be via telehealth / videohealth?

If it’s not convenient for you to attend your initial appointment in-person, it may be appropriate to do so via telephone or video. Please discuss this with our reception team, who will (in turn) discuss it with your gynaecologist.

If you have your first appointment by telehealth or videohealth, an in-person appointment may be needed in future to enable you to be examined. More often, an in-person initial appointment can be followed up with telehealth or videohealth appointments in future (eg. to discuss the results of a transvaginal ultrasound, and implications for managing your condition).

Conclusion

While seeing any medical specialist can be somewhat nerve-racking, all of the clinicians at Maven Centre are delightful, warm people, who aim to put you at ease. Please ask lots of questions during your appointment: together (with your gynaecologist), we hope to come up with a patient-centred management plan that you understand, and are happy with!