What Is Endometriosis?

One common cause of pelvic pain, painful periods, as well as painful sex and painful bowel movements is endometriosis.

Endometriosis is a condition where cells normally found in the lining of the uterus / womb grow elsewhere in the body e.g. in the fallopian tubes, ovaries or along the pelvis.  These cells, however, still behave as though they were in the womb, and break down as menstruation. This leads to the chronic pain, cramps, heavy periods, and other symptoms that characterise the condition.

The exact causes of the condition aren’t known, although there are several different theories.

Not Just Physical

Endometriosis can affect every area of sufferers’ lives.  Trying to manage and live with the painful symptoms of the condition, and in many cases, the struggle to get a diagnosis can also lead to psychological and social problems for many sufferers, including depression and anxiety.

One survey of the members of the charity Endometriosis UK even found that 25 per cent had considered suicide because of the condition.


Endometriosis is a relatively common condition among women of reproductive age.  For example, in the US, surveys show that one in ten women suffer from it, and here in the UK around 2 million women suffer from it. It is thought that as many as 176 million women worldwide suffer from the condition.

Despite it being common, women with the condition seem to face a number of challenges including:This condition is not always prioritized, understood, or taken as seriously as it should be.  This means that it is not uncommon for women to suffer the symptoms of the condition for 10 years before finally being diagnosed.

This condition is not always prioritized, understood, or taken as seriously as it should be.  This means that it is not uncommon for women to suffer the symptoms of the condition for 10 years before finally being diagnosed.

Despite research efforts, the causes of the condition are elusive and there are no clear biomarkers for endometriosis.

Rather than being told that they should seek medical help for the condition, sufferers are often led to believe that the symptoms are simply part of being a woman and are to be endured.

Meeting The Challenges

Even though there is no single cure for the condition (there are a number of different medical and surgical options), getting a diagnosis can enable women to access help that can enable them to find ways to manage their condition, and thereby improve their quality of life.


The fact that endometriosis can often not be picked up on ultrasound scans means that a laparoscopy is often the route that leads to diagnosis for many women.

Specialist Interest

I have developed a specialist interest in pelvic pain and in particular severe endometriosis and work closely with Mr Romi Navaratnam, a Consultant Surgeon. He is a minimal access surgeon.  I also work closely with Mr Vik Khullar, a consultant Urogynaecologist. Mr Khullar is a world authority on bladder function and treatment.

I am trained to carry out and treat major gynaecological conditions, such as endometriosis and pelvic pain.  For a full range of my services please view Outpatient Services or Surgical Procedures or contact me via my contact page here or ring my personal assistant on 020 3318 0263.

Some Thoughts About Labiaplasty

We’ve all recently heard the news about The British Association of Aesthetic Plastic Surgeons (BAAPS) reporting a 40% drop in the number of people in the UK, male and female, undergoing cosmetic surgery.  The BAAPS figures also show that the fall among women was actually 47.8 %.  The sort or cosmetic procedures referred to in this particular survey include Breast augmentation or reduction, Face/Neck Lifts, Liposuction, Abdominoplasty etc.

The reasons given by various analysts for the lowest slump in demand for a decade for popular cosmetic surgery procedures include:

  • People opting for stability and the delaying of big economic or social decisions in a time of political and global uncertainty.
  • The influence of relatable celebrity trends and behaviour as reported on social media.

Labiaplasty – Practical as Well as Cosmetic

One pertinent point to take away from the survey was that numbers were not down on surgical procedures where there is no real non-surgical alternative, or where there are strong practical as well as cosmetic reasons for having the operation e.g. the removal of excess skin after significant weight loss.

It was also interesting to note that one procedure that didn’t feature in the survey results and conclusions, but is often regarded (wrongly in many cases) as being purely cosmetic, is a Labiaplasty. This is a procedure, whereby the inner “lips” or labia minora flanking the vaginal opening are trimmed.

International Society of Aesthetic Plastic Surgery (ISAPS) figures show that in 2015, more than 95,000 women worldwide underwent the procedure, and it was the 19th-most popular surgical procedure that year (with 22nd with vaginal rejuvenation / tightening in 22nd place with just over 50,000 procedures).

Media reports often, for example, focus on trends and possible reasons why some women may want this operation, such as

  • Tends like genital shaving causing females to focus on, and want to improve the appearance of their genitals.
  • Worries about sexual partners’ perceptions, as shaped by popular images of what female genitals ‘should’ be.

The fact is that Labiaplasty is often sought by women for many practical as well as more visual and cosmetic reasons. For example, many women are born with, or develop long / large, pigmented and sometimes painful labia. These can cause urine to spray around when they go to the toilet, and / or can get in the way and be uncomfortable in daily life and in sporting activities.  There is also a perfectly understandable element of women also feeling conscious, and not feeling entirely happy with the appearance of their labia, which in turn can affect their confidence and self-image in the sexual part of their relationships with partners.

How I Can Help

I have been carrying out Labial surgery for over 15 years. I carry out reconstructive surgery and also reduction surgery. The types of operation include labial trimming, flap Labiaplasty and the De-epithelisation.  Labiaplasty is a day case procedure and I carry out Labiaplasty in Central London, West London and Birmingham.  You can find out more on the Labiaplasty page on my website here.

For further information please contact me via my contact page here or ring my personal assistant on 020 3318 0263.

Are You Pregnant and Worried About the Zika Virus?

Pregnancy is obviously a time when women can feel anxious about anything that could adversely affect the health and development of their unborn baby.  Media reports such as those showing the spread and effects of Zika virus can, therefore, be another source of worry.

So, what is Zika Virus, and should it be cause for concern for pregnant women, and those women planning to have children here in the UK?

What is Zika Virus?

Zika virus is a disease that is primarily transmitted by Aedes mosquitoes, and therefore is more likely to occur in area of the world where they can be found, such as in the Pacific region, South and Central America, the Caribbean and South East Asia.

People infected with the Zika virus can display relatively minor symptoms such as a mild fever, skin rashes, conjunctivitis, muscle and joint pain, malaise or headache.  In some cases, Zika has also been linked with other neurological problems in sufferers.

The Zika virus can be passed from an infected mother to here foetus.  The virus has been linked to birth defects such as Microcephaly.  This is the abnormal smallness of the head that many of us have seen in news reports about the virus, and this condition can cause incomplete brain development.

Zika has also been linked to Guillain-Barré syndrome, where the body’s immune system attacks part of the peripheral nervous system.

Has It Spread to the UK?

The World Health Organisation says that it expects three to four million cases worldwide, although this number could increase as the virus spreads geographically (it has now spread through South America, and into the US).

  • 265 cases of Zika virus have been diagnosed here in the UK from 2015 to November 2016, but only 181 of these were actually confirmed as being Zika (BMJ figures).
  • Only 7 of the 265 cases in the UK have been diagnosed in pregnant women.
  • One common factor of most of the 190 travellers infected with the virus is that they appear to have picked it up while travelling in the Caribbean.

Can It Be Sexually Transmitted?

Yes, but it is rare.  Only approximately 60 cases of sexual transmission of Zika have been reported worldwide.  In the UK, the first case of sexually transmitted Zika virus was detected in December 2016.  The case involved a woman who was infected by her partner, who had been on holiday in an area where the virus was active. The woman has since made a full recovery.

Can It Be Cured and Is There a Test?

Yes, it can be cured.  Although there is no vaccine or medicine for Zika yet, it is usually cleared / cured by the sufferer’s own immune system. Infection by Zika can be confirmed with a blood or urine test.

Health During Pregnancy and Childbirth

As a Consultant Obstetrician and Gynaecologist I offer a wide range of services for patients, including a comprehensive Antenatal package.  This package allows you 24/7 care, and combines combine an orthodox practice with a genuinely holistic approach.  For more information contact me via my contact page here or ring my personal assistant on 020 3318 0263.

Do You Feel Pain During Sex? New Survey Shows That You Are Certainly Not Alone.

The results of a recent study have shown that a sizeable minority, almost 1 in 10 of women in the UK, experience pain during sex.  The findings, from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), are significant because they come from the largest scientific study of sexual health lifestyles in the UK.

The survey, which was carried out by London School of Hygiene & Tropical Medicine, University College London and NatCen Social Research, involved asking 8,869 women aged between 16-74 from 2010 to 2012 using computer-assisted self-interviews.

The results showed that 7.5% of women have experienced pain during sex, with nearly 2% experiencing ‘morbid pain’ i.e. symptoms that last for 6 months, re-occur, and cause real distress.

The age groups that reported the most pain were 55-64 year olds (10.4%), and 16-24 (9.5%).  It is also interesting to note that, of the more than 1700 women who had not been sexually active in the past year, 2.05% said they’d been avoiding intercourse because they’d experienced painful sex, and feared doing so again.

What’s Happening?

This kind of pain is grouped under the name dyspareunia, and there can be many different factors and causes. My approach to treatment is a holistic one, and as many physicians agree, this is often a more effective way of providing and effective treatment, because it takes into account the health, sexual and relationship factors. For example, reports of the experience of pain can even have some of their origins in factors like attitudes towards sex, dissatisfaction with sex, anxiety, and sexual relationship factors.

The results of this study are likely to be showing painful sexual experiences for many 16-24 year olds because the first sexual experience is often a painful one for many women, and this is a fact tends not to be highlighted sufficiently e.g. in sex education.

The results of this survey also highlight the fact that, for many older women, post-menopausal sex can be painful. This could be as a result of vaginal dryness, and other factors.

Getting Help

I offer the full range of office gynaecology services, including rapid sexual health screening, fertility management, help with polycystic, and more.  I can carry out assessments for pelvic pain, and for heavy menstrual bleeding.  I offer a humane and holistic approach to gynaecological practice.  I offer a full range of Outpatient Services, including a Well Woman check-up.  This includes full history and examination, assessment of ultrasound scan, cervical smear and Ca 125 screening. It is also a good opportunity to discuss and highlight the likely causes of e.g. pain during sex.

Pelvic Pain?

I have developed a specialist interest in pelvic pain and in particular severe endometriosis.  For more information, contact me via the contact page here or ring my personal assistant on 020 3318 0263.

New Endometrial Cancer Study Results

A recent Medical News Today article has highlighted the results of a study carried out by an international team.  The study identified 5 new gene regions that may increase the risk of a woman developing endometrial cancer.  In order to identify the genetic variants this latest study used the DNA of more than 7,000 women with endometrial cancer and 37,000 without it.

Endometrial cancer refers to cancer of the womb / uterus lining (the endometrium) where the cells of the womb lining grow out of control. This type of cancer tends to be more common among postmenopausal women.

Some of the prominent symptoms of endometrial cancer include unusual vaginal bleeding such as bleeding between periods and much heavier bleeding than is usual, bleeding after the menopause, bloody vaginal discharge, and in some cases pelvic pain and pain during intercourse.

The New Study Results

We already knew about 4 gene regions that could increase the risk of getting endometrial cancer so the 5 other regions identified in this study could mean that we will be able to get a greater understanding of the genetic causes of this cancer. Some of the regions identified in the study were already to be known to be linked to other cancers such as ovarian and prostate cancer.

Cancer Research UK statistics tell us that there were over 9,000 new cases of uterine cancer in 2013 so any advance that could help in the fight against this type of cancer is very welcome indeed.

Now that these gene regions have been linked in this way to endometrial cancer they can hopefully be targeted with new treatments.

Comprehensive Health Check

One of the ways that women like to address many of their health concerns including any worries they may have about endometrial cancer is to have a comprehensive health check.  I offer the Wellwoman check up.  This covers all the important aspects of your health and includes a full history examination, and assessment of ultrasound scan, smear and Ca 125.  It also gives you an opportunity to discuss any health concerns that you may have.  You can find out more about the many different services I offer on my website here:  http://rapidaccessgynaecology.co.uk/gynaecology.php

If you are experiencing symptoms such as pelvic pain, pain with intercourse and heavy and painful periods, or if you would like to book an appointment for cervical smear and ovarian cancer screening for example you can contact me here:  http://rapidaccessgynaecology.co.uk/contact.php

Greater Risks With a High BMI

The results of research published online by JAMA Neurol and highlighted in a recent BMJ article indicate that obese women i.e. those with a BMI of 30 or greater who use oral contraceptives could be at greater risk of suffering a (rare) type of stroke called cerebral venous thrombosis (CVT).  This is essentially a stroke caused by thrombosis of the venous channels in the brain.  This latest research helps to illustrate as part of the wider picture of women’s health how important a factor high BMI is in increasing the risk of many serious conditions, including gynaecological conditions. Studies have shown too that pregnant women with a BMI that is too high (or indeed too low) can be subject to maternal complications that can pose risks to their unborn child as well as to themselves, and lead to increased numbers and increased duration of maternal admissions.

Risks of High BMI Well Known

RCOG figures for example show that you could be considered to be overweight if your BMI is between 25 and 29.9, and obese if it is 30 or above. 20% of pregnant women for example are thought to have a BMI of 30 or above at the start of their pregnancy.  The kinds increased risks that a mother can face during pregnancy if they have a high BMI include gestational diabetes, thrombosis, high blood pressure and pre-eclampsia.

The kinds of risks to the baby due to a mother’s high BMI during pregnancy include higher risks of miscarriage and stillbirth, a higher risk of the baby having neural tube defects, and higher risks of the child developing obesity and diabetes in later life. If the mother has a very high BMI during labour and birth for example this can increase the risk of the baby being born early and of the labour taking longer with a higher risk of the need for e.g. an emergency caesarean.  It could also cause anaesthetic complications and heavy bleeding after the birth.

Support and Expert Help

Getting high quality, professional help during pregnancy and delivery can be a way to make sure that risks such as these can be reduced, and the health of mother and baby can be closely monitored and protected as much as possible.  Making sure that the mother has a healthy BMI and is doing the right things to reduce health risks can also be good news for the child’s health in later life.

Antenatal and Delivery Package

Along with my colleague Gordon Cochrane I offer a comprehensive Antenatal and Delivery Package.  You can find out more about it on my website here: http://rapidaccessgynaecology.co.uk/gynaecology/

Comprehensive Health Check

For women who would like to get a comprehensive health check that covers all the important aspects of their health, as well as a comprehensive and reliable assessment of other areas of their health where they feel that they may have cause for concern I offer a Wellwoman Health Check.  Find out more about it on my website here:  http://rapidaccessgynaecology.co.uk/gynaecology.php

Endometrial Hyperplasia and the Risks of Leaving it Untreated

You may have read in the press that The Royal College of Obstetricians and Gynaecologists (RCOG) and British Society for Gynaecological Endoscopy (BSGE) recently published national guidance on the management of endometrial hyperplasia. This is a condition where there is an overgrowth of the cells that line the womb that causes the womb to thicken.  This often leads to vaginal bleeding that can be described as ‘abnormal’ because it is heavy and perhaps heavier than normal during menstruation. The bleeding associated with this condition can also occur between periods, at irregular times when a woman is on HRT, and it can also occur after the menopause. There are 2 types of endometrial hyperplasia; hyperplasia without atypia and atypical hyperplasia.

What is the Danger?

The danger of endometrial hyperplasia for some women is that it can develop into one of the most common gynaecological cancers, womb cancer. Figures quoted put the number of women diagnosed with this kind of cancer at 8,500 per year, with the number of women with endometrial hyperplasia thought to be around 25,000.  Many women may be suffering from symptoms of endometrial hyperplasia but may not even know that they are and therefore will not have seen a medical professional to be diagnosed and treated. The problem here is that endometrial hyperplasia can be treated if it is caught early, and the risk of the development into womb cancer in many cases could therefore be avoided.

Risk Factors

Woman who are likely to be more at risk of suffering from endometrial hyperplasia are those who are older, those who have a higher Body Mass Index (BMI) i.e. more body fat, those who have polycystic ovarian syndrome, or those who are using tamoxifen or are having HRT.

What to do

It is important therefore to look out for symptoms such as abnormal bleeding or discharge, particularly after the menopause. If you have been / are experiencing these kinds of symptoms it is well worth getting them checked out just to make sure.


I offer the full range of office gynaecology including rapid sexual health screening, fertility management, polycystic ovaries and in one visit, I will be able to carry out assessments for pelvic pain and heavy menstrual bleeding.  I am trained to carry out and treat major gynaecological conditions including endometriosis, investigation of treatment for polycystic ovaries, HRT, menopause, pelvic pain and pre-menstrual tension.

I also offer the NovaSure therapeutic treatment for heavy menstrual bleeding for women who have not responded to any medical (pill or Mirena coil) treatment.  Find out more about it on my website here.

PMS: Not a Psychiatric Condition But An Ovarian Cyclical Syndrome

Why do I say this? I am referring to the naming of what appears to be what we know as PMS by The American Institute of Psychiatrists to Premenstrual Dysphoric Disorder (PMDD). This or course sounds as though there is a suggestion that PMS is a psychiatric condition, which I do not believe. You may also have visited websites (even the NHS website) that set PMDD apart as a more severe form of PMS where the more psychological symptoms are greater than the physical ones.

If you suffer from some of the more pronounced symptoms of PMS there is one important fact to remember, and that is that the pathology of PMS is clearly linked to ovulation and ovarian activity – it is an ovarian cyclical syndrome. This means that the suppression of ovulation should be, and IS an effective treatment for this condition. For example drugs like transdermal oestrogens or GnRH analogues are effective at removing the symptoms of PMS by doing just this i.e. stopping the ovarian function and suppressing ovulation which then stops the cyclical hormonal changes that would normally cause the symptoms.

If you have been reading my website you may also have noticed a discussion about the relationship between PMT, postnatal depression and the Menopause. It tends to become worse in middle age, but I also see a large number of women who become increasingly in fear of the range of symptoms, which are both physical and psychological, and are therefore psychosomatic.

The many symptoms of PMS are well known – depression, anxiety, irritability, breast pain, headaches, bloating etc. and the fact they fade away with the onset of a period is a further reminder that they are ultimately an endocrinological disorder (linked to hormones).

What many people may not know is that there are quite a few other physical conditions that can worsen pre-menstrually such as asthma, epilepsy, and depression, rheumatoid pain, and these symptoms can also be lessened by suppressing ovulation because they depend on the hormonal changes of the ovarian cycle.

You may however have heard the term ‘Empty Nest Syndrome’ to describe the psychological effects of a number of factors. For example, in women who have had a hysterectomy but still have ovaries there can be cyclical depression, anxiety and irritability for 10 days or more followed by 2 or 3 days of headaches or migraine. These women are also vulnerable from the psychological effects of hysterectomy, middle age loss of fertility and sometimes a loss of purpose, hence the ‘Empty Nest Syndrome’ label.

Help and Support

If you suffer from many of the unpleasant symptoms of PMS you are certainly not alone. Some estimates suggest hat over 80% of menstruating women experience at least one symptom of it every month, and PMS symptoms are most common for menstruating women aged between their late 20s and early 40s.

There are several supportive measures which can help. You may for example choose to become linked to NAPS, the National Association of Pre-Menstrual Syndrome. The good news is that there are now effective medical therapies which will reduce the impact of PMS or Ovarian Cycle Syndrome. Even endometrial ablation procedures have been shown to alleviate these symptoms.

If you are experiencing disruptive PMS symptoms, you can seek medical advice in order to improve the quality of your life. You can contact through my website here or by calling call 0203 318 0263.

Polycystic Ovaries & Polycystic Ovarian Syndrome

There is a lot of information available out there about polycystic ovaries, and one important thing that I need to point out here is that an ultrasound finding of polycystic ovaries is not the same thing as having the metabolic disease called Polycystic Ovarian Syndrome. This is why if you have an ultrasound finding of a polycystic ovary you should not be alarmed, particularly if you have normal periods. It is not uncommon for polycystic ovaries to show up the scan of a patient who has periods and who will get pregnant. In fact it is thought that only a small proportion of the estimated 20% of middle class women who have polycystic ovaries will actually go on to have Polycystic Ovarian Syndrome.

Reasons for the Increase in Diagnosis Numbers

The number of women who are being (correctly) diagnosed with Polycystic Ovarian Syndrome (PCOS) appears to me to be on the increase. This is likely to be due to factors such as the obesity epidemic and also the change in the UK population dynamics. The UK population for example now includes more women from South Asia and the Middle East who are at risk of developing this disease. Many of these women have abnormal endocrine disease, may suffer from thyroid disease, and can have abnormal adrenal disease (Congenital Adrenal Hyperplasia). They can also have high levels of male hormones like Testosterone and Androstenedione. In these cases it is common to find a strong history of either early onset or late onset diabetes, and in these families the male members often have premature balding under the age of 30.

Overweight Risk

We now know that PCOS is associated with Diabetes, Metabolic Syndrome, and with infertility because PCOS patients do not ovulate and may need ovulation induction treatment. PCOS also increases the risk of miscarriage, and leaving the condition untreated is therefore very risky as far as your reproductive health is concerned. The situation could be most serious for women who are overweight because they run the risk of developing Diabetes and becoming infertile.

Symptoms & Physical Examination

The most noticeable symptom of the condition in the patient is irregular periods that can be very heavy and can be spaced by more than 6 weeks. When examining physical signs, indicators for this condition can also include increased facial and body hair (particularly on the abdomen and back), acne, male pattern baldness in the family, a history of a late puberty, and a black mark in the armpit known as Acanthosis Nigrans.

Taking Action

Getting an early diagnosis is the best way to safeguard your reproductive health and, as you may read in medical literature the combined oral contraceptive pill can protect the PCOS ovary, and can stop the disease from getting worse. It is really important therefore to see a Gynaecologist who has a specialist interest in this disease, and who also works with an interested Endocrinologist. I always like to exclude Diabetes because PCOS is related to Insulin Resistance, and this is the precursor to Diabetes. I carry out a formal Glucose Tolerance Test as part of my screening, and if my patient is screened positive, I ensure that they are seen by an Endocrinologist.

When it comes to treatment there are a number of things that can be done depending on the individual circumstances. These can include working with a Dermatologist to address the acne and hair loss (Dianette, sometimes a combined pill, and Cypropterone Acetate), use of the drug Metformin (particularly if you want to become pregnant), ovulation induction with Clomiphene (sometimes with Clomiphene – great for weight loss and improving ovarian function), ovarian drilling (a laprosopic keyhole treatment), and often dietary advice.

For more information visit my main website, or to arrange for an appointment call 0203 318 0263 or contact me online.

Outpatient Services

You may already have visited my website via the search engines (this Blog is part of that website although not linked via the menu) because you are searching for information about gynaecological services or obstetrics. You will see that I do list many of the main services on there with some detailed information. There are however many different outpatient services that I offer and I’d just like to give you an outline of some of the main ones here.

The Wellwoman Health Check is something I’ve written about in more detail on this Blog before but it is a very popular service which includes a full history examination, an assessment of an ultrasound scan, and the chance to discuss all of your health concerns. It also includes a Ca 125 test. This is a test to detect a protein called Ca 125 in the blood as the presence of a high level of this protein could be an indication of the presence of ovarian cancer cells. High levels of Ca 125 however can indicate conditions other than ovarian cancer such as endometriosis (where pieces of womb tissue are found outside the womb itself), fibroids (benign tumours in the womb), and of course pregnancy. All things considered the Wellwoman Health Check can be a great way to put your mind at ease about any health worries you may have, identify / detect possible threats to your health, examine and identify any symptoms you may be experiencing, explain smear results that you may have questions about, and get a clear snapshot of your health and wellbeing at this point.

Other outpatient services include Screening for thrombosis risk for contraception and hormone replacement therapy. HRT is something I’ve also written about earlier in this Blog and on my website, and this subject is something that I am asked regularly about. HRT advice is therefore an important outpatient service that I offer.

I also offer assessments for the treatment of premenstrual tension, urinary incontinence, and therapeutic management of polycystic ovarian disease and hirsutism (hairiness). I am also able to offer treatment of genital tract disorders such as bacterial vaginosis. Another outpatient service that I offer is the treatment for vaginal prolapse, both operative and non-surgical treatment treatments. Vaginal prolapse can have some very unpleasant symptoms and I am pleased to be able to offer help, advice and treatment options.

For more information about the different outpatient services visit my website, contact me online, or call 0203 318 0263.