When it comes to their female-specific health (eg. menstrual / reproductive / sexual / genitourinary concerns) sometimes women are not sure whether they need to see a gynaecologist or if their GP will be able to help them. In any case, to see a gynaecologist in Ireland you need a referral from a GP, so they should be your first port of call.
What is a gynaecologist?
A gynaecologist is a consultant hospital doctor with training in Obstetrics and Gynaecology. If they trained in Ireland, they would have completed a 1-year internship, followed by a minimum of 3 basic specialist training. They would then complete 4-6 years of higher specialist training. Most doctors will do extra years, for example, as a registrar before starting the specialist training scheme, or completing a fellowship after specialist training, or further training in a sub-specialist area.
Obstetrics is the care of women during and after their pregnancy. Gynaecology involves the care of other female health needs, particularly reproductive health. It is a mixed medical and surgical specialty. For the purposes of this post I will just be discussing Gynaecology, rather than Obstetrics.
What can GPs or women’s health specialist GPs do?
There are lots of instances where a GP can provide women with the care they need, or at least initiate investigation or management before involving a gynaecologist. Examples include:
Cervical screening test (smear)
Insertion of an intrauterine coil
Investigation of vaginal discharge, and treatment if necessary
Testing for STIs and treatment of some of them
Investigation and medical management of heavy or painful periods
Investigation of irregular periods, and in some cases, management
Initial investigation of post-menopausal bleeding, bleeding between periods or bleeding after intercourse
Conservative management of urinary incontinence eg. with a pessary or medication
Initial examination and investigations for infertility
GPs can refer patients for ultrasound when necessary, whereas Gynaecologists can perform ultrasound themselves.
When is referral needed?
There are circumstances where a GP would refer a patient to a gynaecologist. Examples include:
If a patient with heavy or painful periods doesn’t improve with treatment
If we suspect endometriosis and the patient hasn’t improved with treatment, is experiencing infertility or we think surgical management would be appropriate
If a patient wants their tubes tied for contraception
After a failed coil insertion, or a failed removal if threads can’t be seen
For further investigation of post-menopausal bleeding, bleeding between periods or bleeding after intercourse – a hysteroscopy (camera test) and biopsy might be needed.
Further fertility investigations eg HyCoSy, if no obvious cause has been identified in the initial work-up
Fertility treatment eg. IVF
We refer patients to colposcopy if they have had an abnormal smear and colposcopy is indicated.
If there is ever any suspicion of a gynaecological cancer.
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In some circumstances other specialist services will be needed and your GP can refer to these. For example:
For certain STIs, we involve the hospital STI clinic which is run by the Infectious Diseases department
For vulval skin conditions that don’t respond to treatment we can refer to a Dermatologist
For PCOS, thyroid disease or high prolactin levels in the blood we sometimes involve Endocrinology
For breast issues we may need to refer to a Breast Surgeon or the Symptomatic Breast Clinic in the hospital
These lists are not exhaustive. This information does not replace consultation with your own GP if you have any concerns about your health.
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