Australian guidelines suggest that most women have a Pap smear at least every two years. A Pap smear involves a gynaecological exmaination, and the sampling of some cells from the cervix (the opening of the uterus into the vagina). A Pap smear generally takes only a few minutes, and is very effective in the early detection of cervical cancer.
Colposcopy is an examination that some women may need if they have an abnormal Pap smear. Colposcopy involves using a microscope to examine the cells of the cervix visually, rather than sampling with a brush as in a Pap smear. Sometimes a small (about 2-3mm) sample of skin from the cervix will be removed to be examined by a pathologist. Local anaesthetic will be used if a biopsy is taken. For most women colposcopy takes about 10 minutes and uses the same instruments that they would have used when the original Pap smear was taken.
Dr Daniels is a member of the Australasian Society for Colposcopy and Cervical Pathology, and actively participates in the C-QUIP Colposcopy Quality Improvement Program coordinated by the Royal Australasian College of Obstetricians and Gynaecologists.
Our practice procedure room contains a colposcope and all the equipment necessary to provide up to date colposcopy assessment. Most women can have their consultation and colposcopy in a single 30 minute appointment.
Further information regarding abnormal Pap smears is available in a booklet published by the National Cervical Screening Program, available online at: Abnormal Pap Smear Booklet
Heavy, irregular or painful periods have a significant detrimental effect on lifestyle for many women. Problems can range from period pain and irregularity in teenagers, to heavy bleeding in women approaching menopause. The absence of periods may also be an issue for women wishing to become pregnant. In a minority of cases a significant change in bleeding pattern can be a symptom of a more serious gynaecological issue.
Dr Daniels is able to provide a detailed assessment and treatment for menstrual issues.
Assessment may include physical examination, ultrasound and/or hormonal and other blood tests.
In some cases medication and lifestyle changes can relieve problems, but in some cases other options are appropriate. These may involve the placement of a Mirena IUD, or a surgical solution such as endometrial ablation or hysterectomy. Dr Daniels is able to provide the full range of tretatments, either in the practice or in hospital.
Pelvic pain can be a debilitating condition for many women. Pelvic pain may range from period pain, to pain during intercourse or pain in the vulva. Assessment and treatment of pelvic pain covers a wide range of medical and surgical approaches and careful assessment of each woman's needs is essential. Dr Daniels has a strong interest in pelvic and vulvar pain and is happy to consult women with this often distressing condition.
Dr Daniels offers a number of contraception methods. He is very happy to discuss your contraceptive options and provide you with the one most appropriate for your circumstances.
Oral contraceptive pill: Dr Daniels can provide advice and prescriptions for the pill most appropriate to a woman's circumstances. The Pill provides reliable, easily reversible contraception for many women. It may also provide benefits for some women including a reduction in acne and the ability to control their menstrual cycle.
Intrauterine devices (IUD): Dr Daniels inserts both hormone releasing (Mirena) and copper releasing (Multiload) IUDs. In most cases this can be performed in the procedure room at the practice, but insertion under a general anaesthetic can be arranged if necessary. The Mirena (Mirena website) lasts for 5 years and provides extremely reliable contraception. For the majority of women the Mirena also reduces menstrual bleeding. Copper releasing IUDs are more common in countries other than Australia and may be suitable for women who are sensitive to hormonal contraception.
Implanon NXT: The Implanon NXT (Implanon website) is a small plastic rod that is inserted into the upper arm after a local anaesthetic. It lasts for 3 years. It may be most suitable for young women who have not yet had children. Dr Daniels is certified to both insert and remove the Implanon.
Depo Provera: This hormone injection lasts for three months. It is less commonly used today but may be suitable for some women.
Tubal ligation: Dr Daniels is very experienced at performing laparoscopic tubal ligation. This is commonly performed as day surgery and provides reliable, permanent contraception.
Essure: The Essure device (Essure website) is a permanent contraceptive device that is inserted via hysteroscopy.
Starting a family can be an exciting but stressful time for many couples. While the majority of couples will fall pregnant without medical help some will require assistance.
For most couples approximately 70% will become pregnant within months of stopping contraception, and 90% within 12 months. Couples who should seek fertility advice sooner than after 12 months of trying to conceive include: women with irregular or no periods (including women with polycystic ovarian syndrome), women over 35 years old, women with a significant history of gynaecological disease including endometriosis and men with a known sperm dysfunction.
Women and couples are of course able to seek a consultation at any stage theat they are considering trying to conceive.
Assessment of infertility may involve history and physical examination, ultrasound, sperm function tests and blood tests to examine hormone levels. A laparoscopy is sometimes performed to determine if there are physical problems preventing conception. Treatment for infertility may include advice on lifestyle modifications and medications to induce ovulation in women who are not ovulating spontaneously.
For many women the cessation of periods is associated with symptoms such as hot flushes, poor sleep, skin changes, decreased bone density and decreased libido. Medical treatment of of menopause continues to develop rapidly with hormonal and non-hormonal treatments being appropriate for women depending on their individual circumstances. Dr Daniels has experience with assisting women cope with menopause, including women with complex needs such as those with a hostory of breast cancer.
Prolapse refers to the 'falling down' of the pelvic organs including the uterus, bladder and bowel into the vagina. Women may feel a lump or dragging sensation, or have difficulty urinating or using their bowels. Treatment of prolapse can include pelvic floor exercises, vaginal support devices such as pessaries, or surgery.
Urinary incontinence is common and occurs in about a third of women at some point in their life. Urinary incontinence can be divided into three main types: stress incontinence, overactive bladder (also known as urge incontinence), and mixed incontinence.
Assessment of incontinence involves a history and examination, focussing on the frequency, volume and circumstances of episodes of incontinence, and the presence of pelvic floor symptoms. Tests such as ultrasound and urodynamics studies may be used to further assess incontinence.
Stress urinary incontinence
Stress incontinence is the leakage of urine with laughing, coughing, exercise or other activities. It is caused by a loss of support of the bladder and urethra. Treatment of stress incontinence can include pelvic floor exercises. If exercises are not successful in treating stress incontinence then Dr Daniels may recommend surgery. Surgery for stress incontinence is generally very effective in eliminating leakage and enabling women to return to a normal active lifestyle.
Dr Daniels performs surgery for stress incontinence including mid-urethral sling procedures. These procedures are minimally invasive and allow a rapid return to normal activities.
Overactive bladder is also known as urge incontinence. In most cases this results in a feeling of needing to rush to urinate immediately, with leakage sometimes occurring. Overactive bladder is caused by overactivity in the bladder muscle and is best treated by medication rather than surgery. Dr Daniels takes care to ensure that urinary incontinence is diagnosed accurately, before commencing treatment. In mixed urinary incontinence there are elements of both stress incontinence and overactive bladder, and treatment must be tailored to both problems.
Incontinence of flatus and/or faeces
Some women also suffer from involuntary passage of flatus (wind) or faeces. This is most common after childbirth and is due to damage to the muscle and tissue around the anus and perineum. This symptom is often accompanied by vaginal prolapse and may respond to physiotherapy and/or surgery.