Gynaecology

Most women will have to visit a gynaecologist at least once in their life and we aim to make your visits to see Dr James Moir as stress free as possible. The reception staff will assist in identifying the nature of your problem, advise you on what sort of appointment you need and assess the urgency of your problem. Non-urgent appointments can be booked by the reception staff. For urgent appointments, your General Practitioner or referring Specialist is required to phone and speak to Dr Moir.

The following services are available in the rooms:

  • Assessment and treatment of abnormal pap smears
  • Contraceptive advice, including insertion of the Mirena IUCD, and Implanon implant
  • Infertility assessment
  • Ultrasound for obstetric, gynaecology and infertility problems
  • Minor local anaesthetic procedures

Pap Smears – An Important Preventative Step

A pap smear, also known as a cervical smear, is a screening test that your doctor will carry out to check if any abnormal changes have taken place in the cells of your cervix. The cervix is the lower part of the uterus that extends into the vagina.

Regular pap smears are very important, as they provide early detection of the presence of abnormal cells in the cervix. If left untreated, these cells can develop into cervical cancer. There are no other symptoms that come with the development of pre-cancerous cells – the only way to discover them is with a pap smear.

The good news is that since the routine pap smears and a national screening program were introduced, the number of deaths from cervical cancer each year in Australia has more than halved.

There are two layers of cells that your gynaecologist will be interested in when doing a pap smear. The first are called squamous cells, which line the outside surface of the cervix. The other layer of cells are the glandular cells – these line the endocervical canal between the cervix and the uterus.

During a pap smear, your doctor will gently scrape some cells from these areas. The cells are then prepared on a microscope slide and sent to a pathology lab for examination. The lab will look for abnormal changes in the size or shape of the cells. Abnormalities are much more likely to be found in the squamous cells than in the glandular cells. These abnormal cells are not cancerous, but can develop into cancer over time.

If you have a pap smear test, and for the first time it comes back showing low grade abnormal cells, your doctor will usually take no action except to recommend that you have another test done in 12 months time. Most abnormalities are due to infection from Human Papilloma Virus (HPV). In around 80% of mild or low grade cases, HPV infections are usually cleared up by your immune system, with no further treatment needed.

If the pathology report suggests more serious abnormalities or high grade changes, you should be referred to a gynaecologist for a colposcopy and biopsy. Colposcopy is a simple visual examination performed in the doctor’s office to test if the lesions are low grade or high grade. A biopsy involves taking a tiny piece of the cervix lining, which is sent to the lab for microscopic examination.
If the abnormalities are considered high grade, the gynaecologist may recommend treatment to remove the abnormal cells. This can be done in a few ways, performed in the doctor’s rooms with local anaesthetic, or as a day surgery procedure under general anaesthetic.

If your pap smear test does show abnormal cells, the important thing is not to be overly concerned, but to speak to your doctor about it. If the changes are low grade, there’s a good chance the cells will disappear by themselves. If high grade changes are shown, remember that cervical cancer usually takes many years to develop, and removing the abnormal cells within a few weeks or months, is highly effective in curing the problem. If abnormal cells are found in early pregnancy, for example, excision treatment can wait until after the baby is born.

Regarding the cervical cancer vaccine, developed recently by Professor Ian Fraser (a fellow Scot from Aberdeen, I have to mention!) The vaccine provides immunity to four of the HPV virus strains that are most likely to produce high grade changes or cancer. However, no vaccine is 100% effective, and teenagers and young women who have completed a full course of vaccines (starting usually at age 12 or 13) are advised to start routine pap smear screening, a year or two after they become sexually active. Cervical cancer usually takes a long time to develop, and the preventative treatments I’ve mentioned are very effective.

Please don’t put off your regular pap smear test. It is very important. Next to being vaccinated early, it’s the best thing that any woman can do protect herself from the possibility of cervical cancer.

Treatment of Abnormal Pap Smears

At your initial consultation, Dr Moir will examine the cervix with a special magnifying instrument and a dye is put on to the surface of the cervix which will show up any abnormal cells. A small biopsy of the area is taken (about the size of a pin head) and this is sent to the laboratory.

Your treatment is based on the results of this test and we will be able to advise you in 2-3 days. If it is recommended that the abnormal cells are removed, this can be done as a procedure in the rooms under local anaesthetic. It is known as a LLETZ procedure (pronounced LETS). It usually takes between 15-30 minutes. You may require someone to accompany you to drive you home and you can return to normal activities the following day.

Contraceptive Treatments

Some women want to prevent pregnancy without the need to take a daily contraceptive pill, insert a diaphragm or use other contraceptive measures.

There are two methods of contraceptive treatment, which we can insert in the rooms.

Implanon implant: This is a small rod which contains contraceptive medication (progesterone only) which is slow release. The rod is inserted under local anaesthetic just below the skin of the inner upper arm, and can remain in place for 3 years. It may be removed at any time if you wish to achieve a pregnancy. Normal fertlility returns very quickly after removal of the device (again under local anaesthetic). Over 90% of women will ovulate within a month of removal.

Mirena or Copper intra-uterine contraceptive device (IUCD): An IUCD is a small device placed inside the uterus. It makes the environment in the uterus and fallopian tubes unsuitable for fertilization and implantation of a fertilized egg. The most commonly used IUCDs in Australia are made of flexible plastic and contain either copper or a slow release progesterone hormone. Both devices have a nylon string attached so a Doctor can remove it. Once the IUCD is removed, the woman’s fertility is restored promptly. Both types of IUCD need removing and replacing every 5 years.

Essure Procedure

A more recent method for sterilisation is the Essure procedure. This involves a light general anaesthetic and insertion of two small coils into the inner opening of the Fallopian tubes. This is done using a small telescope through the cervix, so there are no surgical incisions in the body. It usually takes 10 to 15 minutes, and is a day surgery procedure.

Ultrasound Scanning

Ultrasound scans are commonly performed in gynaecology to assess the ovaries and to detect abnormalities in the uterus. Further treatment can be recommended, based on these findings.

Surgical Procedures Performed by Dr Moir in the Operating Theatre

  • Tubal sterilisation, including the Essure procedure
  • Pelvic floor repair for a prolapse
  • Treatment of endometriosis
  • Hysteroscopy (an examination under anaesthetic to view the uterus and identify any problems)
  • Laparoscopy (an examination under anaesthetic to view the internal organs and identify any problems)
  • Hysterectomy, either abdominal or laparoscopic
  • Removal of fibroids
  • Correction of stress incontinence, by laparoscopy or tape procedures
  • Ectopic pregnancy (where possible the procedure is performed laparoscopically and the tube preserved for future use)
  • Removal of polyps
  • Removal of ovaries
  • Suction curette (this can be following a miscarriage)
  • Minor procedures such as Marsupialisation of Bartholin's abscess, enlarge the vaginal opening and the removal of genital warts