Your visit to the Rapid Access Gynaecology Clinic

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Why have I been referred to this clinic?

Your GP has referred you to the Rapid Access Clinic because they have concerns about your symptoms, and/or an unusual finding on your ultrasound scan and would like you to have further tests.

You have been referred through the ‘two week wait’ appointments system.

This is an NHS system designed to make sure that patients with symptoms that might be caused by a cancer are seen quickly by a specialist team.

We understand that you may be concerned that this means you have cancer. 

Most patients referred in this way do not have cancer.

When cancer has been excluded, patients might be referred on to our benign gynaecology clinics for further management.  However, lots of patients require no further tests, investigations or treatment.

These symptoms could be:

• an area on the cervix (neck of the womb) that looks unusual.
• vaginal bleeding after the menopause
• unusual bleeding when you are not expecting it 
• a lump or itching on the vulva or vagina
• abnormal swelling or lump in the pelvis.

What will happen at my appointment?

During your appointment, the doctor will talk to you about your symptoms and what tests they would like to do.

These tests will depend on your symptoms and whenever possible, further tests and investigations will be done at the same time, so you do not have to come in more than once.  

Sometimes it might still be necessary for you to come back when it is not possible for us to do certain tests at the same time as your clinic appointment, but we will try to avoid this where we can. If you need other investigations or need to come in for a procedure under general anaesthetic, your doctor will discuss this with you in the clinic and arrange for you to come back.  

You may bring a friend or relative to your appointment, if you wish, to support you with receiving any results or a diagnosis.

What sort of tests or investigations might I have at my appointment?

Ultrasound scan

This test uses sound waves to show a picture of your pelvic organs.

You may need to have two different types of scans. For a transvaginal scan, the probe is placed inside your vagina, and for an abdominal scan, the probe is put on the skin on your tummy.

Please note this is likely to happen before you see the doctor so they can give you the results when they see you and can arrange further tests if required.

Pelvic or speculum examination

This is an examination of your abdomen and pelvis. The doctor will use their hands to feel your tummy.

If the doctor needs to examine your cervix and vagina, they may use an instrument called a speculum, like when you have a smear test. These tests may be uncomfortable but should not be painful.

Endometrial Pipelle biopsy

If you have had abnormal vaginal bleeding and an ultrasound has shown that the lining of your womb is thickened it may be necessary to take a biopsy from the lining of the womb (endometrium).

This sample is then sent off to the laboratory for further tests.

A fine plastic tube is placed through the cervix and into the womb.

The biopsy is taken by slight suction and can sometimes cause a period-type pain.  

This pain generally settles once the procedure is finished however taking over the counter painkillers beforehand may help.

You could experience some crampy period pains in the lower part of your tummy on and off for a day or two after the procedure. You may also have some light bleeding, like a period or blood-stained discharge which might last a few days.

It is advisable to use a sanitary towel rather than a tampon to reduce the risk of infection.

Vulval biopsy

If you have been referred because you have an area of itchy or sore skin on the vulva, it may be necessary for a small biopsy to be taken of the affected area. This will be done using a local anaesthetic to numb the skin and the biopsy then sent to the laboratory for further tests.

Cervical biopsy

It may not be possible to perform a colposcopy or cervical biopsy in your appointment. If we can, this involves using a speculum to examine the surface of your cervix should the Clinician see any abnormal areas; they might want to take a sample (biopsy) to send to the laboratory for further tests.

Blood tests

After you have seen the doctor, you may be directed to the hospital’s phlebotomy service to have these taken. These tests will be explained to you in more detail at the clinic by your doctor.

What other types of investigations might I need in addition to those at the appointment?

MRI scan (magnetic resonance imaging)

Thisscan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body. An MRI scan is a painless and safe procedure. You may find it uncomfortable if you have claustrophobia, but most people are able to manage it with support from the radiographer.

CT scan (Computed Tomography)

ACT scan is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce images of the inside of the body. A CT scan is usually done in hospital by a healthcare professional called a radiographer. It usually takes between 10 and 20 minutes.

Hysteroscopy

A hysteroscopy is an examination of the inside of the uterus (womb).

The doctor or Specialist nurse will pass a narrow camera through the vagina, along the cervix (neck of the womb) into the uterus. It might also be necessary to take a biopsy of the lining of your womb at the same time.

Depending on your preference this procedure can either be performed in the outpatients or under a general anaesthetic.

This will be discussed with you before the procedure is arranged.

Colposcopy

Using a speculum like with a smear test.

Specialist stains and a colposcope (similar to a large microscope), are used to examine the surface of your cervix by a doctor or Nurse Specialist.

If they see any abnormal areas, they might also take a sample (small biopsy) to send to the laboratory for further tests.

When will I find out the results of my tests?

This will depend on the investigation(s) you have. Sometimes we can give you your results on the same day. If a biopsy is taken, it can take a few weeks before you receive the results. You will either be sent a letter or may need to return to clinic. We also encourage bringing a friend or relative to your appointment, if you wish, to support you with receiving any results or a diagnosis.

How long will I be in the clinic for?

Every effort is made not to keep you waiting on the day of your appointment, but delays can sometimes happen. The length of your appointment will depend on your symptoms and whether we need to carry out further tests at this appointment. It is best to allow at least 2 to 3 hours in the department so that you are not worrying about being delayed.

Should I still come to the clinic if I have my period?

Yes, do attend so that an initial assessment of your symptoms can be carried out. You may need to come back for some tests, but this will be explained to you.

I would prefer a female Clinician. Who should I contact to arrange this?

Please phone the appointments team when you get this information. The contact number is on your appointment letter and at the end of this information. 

What if I cannot attend?

If you cannot attend the appointment, please let us know as soon as possible so another appointment can be organised for you.

For all appointments at The Princess Royal Hospital and The Royal Sussex County Hospital -Please call the Booking Centre on: 0300 303 8360

For all appointments at Worthing Hospital and St. Richards Hospital – Please call the Booking Centre on: 0127 344 6067