Gynaecology clinics and surgery

The gynaecological treatment process usually follows the following steps.

1. First visit to your healthcare provider (local GP).
2. Referral to our gynaecology department.
3. Triaging team - referrals are priorities and sent to the correct clinic stream.
4. Extra tests may be required.
5. Consultation and diagnosis in one of our clinics - General gynaecology, Period pain and endometriosis, Colposcopy, Urogynaecology and Early pregnancy loss.
6. Treatment information and decision
7. Chosen treatment - multiple options available such as changes in lifestyle, medications, surgery.
8. Follow up consultation - if treatment does not work or more treatment is needed then we go back to step 6.
9. Treatment success and discharge form service.

We understand that seeing a gynaecologist can be very stressful — especially the first time. The following information will give you an idea of what to expect and help you get the most out of your appointment.

• Visit our patient and visitors information before you come to one of our clinics — if you understand some of the basics, we can spend more time on the things important to you.

North Shore Hospital (internal link)

Waitākere Hospital (internal link)

• Write down your biggest aims in being seen and your biggest worries — it makes it easier to address these things during the first appointment.
• Be on time — factor in traffic and parking when you plan your day. We do our best to accommodate last-minute hiccups but sometimes have to cancel latecomers.
• Go to the right hospital — we have clinics at Waitakere Hospital and North Shore Hospital so double-check where your appointment is before you leave.
• Go to the right building — our clinics are not all in the same place.
• Bring your appointment letter with you, so you have the location, time and date handy
• Tell us if your mobile number changes — we want you to get our text reminders.

There is a lot to get through at your first appointment, and we want you to get what you need from us. It can really help to think through your medical history before you come so that it is clear in your head. Write down key dates and events if you cannot remember them.

The gynaecology clinic checklist contains the main questions you should have answered by the time you have been through our clinic process.

You may fill it out yourself during your clinic appointment or ask your hospital doctor to help you.

Gynaecology clinic checklistPDF140 KB

Your healthcare professional will want to understand:

• how your symptoms have developed
• how much these symptoms impact on you
• whether you have other medical or lifestyle conditions that might be important
• once they have a clear picture of what’s going on, they will usually wish to examine you.

Vaginal examination in the clinic

A vaginal examination is when your healthcare provider uses one hand's fingers to feel inside your vagina while pressing with the other hand on your lower abdomen.

You will have a sheet covering your lower body to help you feel less exposed.

• We understand it can make people feel very exposed and that there are some cultures where this area of the body is sacred or tapu.
• We also know that many people have experienced sexual trauma in their past, and having a vaginal examination can be confronting or distressing.
• We may do this in the clinic to help us make a diagnosis or to rule out a diagnosis. If you need surgery, this kind of examination can also help us decide what surgical options you have.
• We may also perform a speculum examination, using an instrument designed to fit in your vagina and help us see your cervix. This also allows us to do a cervical smear or take samples to test for infections.

Having a cervical sample taken (internal link)

Missing these parts of your clinic assessment can sometimes make it more challenging to make certain decisions.

We will not do this if it causes you great distress or have never been sexually active and do not want us to.

To help make your examination easier:

• tell us if vaginal examinations are difficult for you
• ask for a chaperone if you would like more support
• consider bringing a support person, such as someone from your family, friends or whānau
• wear clothes that are comfortable and easy — slip-on shoes and slip-on skirts or pants are good options.

The decision to choose surgery is sometimes made at the first appointment, but often it happens at follow-up appointments.

This can be a big decision, so tell us if you need time to think about it.

You should leave your appointment understanding:

• what the operation involves
• what will be done during the operation
• what the risks of surgery are
• roughly how long the waitlist is
• how long you are likely to need in hospital
• what the expected recovery course is.

By this stage of your journey:

• your hospital doctor has filled in a form to prioritise your operation
• you have filled in some health-related forms
• we have checked your blood pressure, weight and height.

This helps us identify any risks for your surgery and plan a safe operation.

How long will you wait

• If your healthcare provider is worried or knows that you have cancer, your surgery will usually be within 4 weeks, either at North Shore Hospital or Auckland Hospital.
• If we are not worried about cancer, the waitlist can be up to 4 months.
• Some specialist surgeries, such as urogynaecology or advanced endometriosis, can only be done by certain hospital doctors. These surgeries may take even longer to arrange.

What else you should expect in this time

If you need to see or talk to an anaesthetist, they will speak to you about:

• your general health
• any medications you usually take and give you clear instructions if any of them need to be changed in the days before your operation
• how to prepare for surgery
• what to expect on the day.

Otherwise, you will meet your anaesthetic doctor on the day of surgery.

From this point, our booking and scheduling team will organise your surgery date. This is the team that you should contact if you have any questions about your planned operation.

When a surgical date comes up, booking and scheduling will contact you and let you know. We do our best to give you plenty of notice, but sometimes extra dates become available at the last moment, and they may call you to see if you are available.

Some people have very important reasons for wanting all-female staff in theatre and this can usually be arranged. Let us know of this request as early as possible so we can talk to all of the different teams involved.

Infographic

In the lead up to your surgical date, you should:

• feel very comfortable with your surgical plan,
• understand the benefits and risks of your surgery,
• have been checked by the anaesthetic team,
• know what time to come to the hospital, where to go, and have a plan for who will bring you home and support you in your recovery.

There is a lot to consider, especially if this is your first surgery experience, but if you feel confused call the booking and scheduling team and ask for their advice.

You need a contact person

We ask you to give us the name and contact details of someone to call in the case of an emergency during your care.

It is a good idea to think about who this person will be and let them know that they have been named, as well as details about the timing of your surgery.

When to stop eating and drinking

It is important to stop:

• eating 6 hours before your operation
• drinking water up to 2 hours before your operation.

This is to protect your lungs when we get you off to sleep with a general anaesthetic. Any food or drink in your stomach can be inhaled at this time.

Make sure you try to eat and drink well before the 6-hour cut off, as it can make the day of your surgery much easier.

If you eat or drink something other than water within the 6 hours, your operation will usually have to be cancelled and rescheduled on another date.

Taking your regular medicine

As part of your anaesthetic plan, an anaesthetic doctor or nurse will tell you which of your regular medicines to continue and which to stop. These can be swallowed with a small amount of water before surgery.

Blood tests before your operation

If you need blood tests in the days before your surgery, our booking and scheduling team will tell you.

The most common things we test are:

• if your blood count (haemoglobin) is normal
• if you are pregnant
• what blood type you are in case we need to give you a blood transfusion during your operation.

If you have body parts removed

The parts of your body that we remove during surgery almost always need further testing to give you a final diagnosis.

You will be asked if you want to have any of these body parts returned to you once the lab has finished its testing. Your answer will be written on our hospital form on the day of your operation.

Because our tests involve a lot of work, the body parts returned to you may be in small pieces and usually take a week or more to be returned.

If you have surgery anxiety

If you have severe anxiety or panic attacks, it is a good idea to tell us in your health questionnaire so that the anaesthetic team can have a good plan on the day of your operation.

On the day of surgery, while you wait for the operation, we can give you a pre-med which treats anxiety, after all consent forms are signed.

If you are already on a waitlist and think you need a pre-med and this has not yet been addressed, call our booking and scheduling team.

You will be asked to sign a consent form on the day of surgery. For more information about what informed consent means is on our informed consent page.

Informed consent (internal link)

You can only give your informed consent if you feel you have been given enough information to understand:

• your medical condition
• the options available to you
• the risks and benefits of your different options.

Most of this information is given during your clinic appointments and cannot be covered in-depth on the day of surgery. On the day of surgery, the hospital doctors will:

• explain the risks of the operation and anaesthetic
• ask your permission for medical students to examine you
• ask your permission for any blood transfusions in case you have heavy bleeding
• ask whether you want any body parts returned to you.

Signing the consent form means that you:

• choose for us to perform the operation written on the consent form
• understand what the operation involves
• are comfortable with the risks involved.

Important suggestions

• Please consider these issues before the day of surgery and consider talking it through with friends and family, your healthcare provider, or your gynaecologist.
• Make sure you understand your gynaecological condition well enough.
• If you need more information to give informed consent, please contact our booking and scheduling staff to request another clinic appointment.

Gynaecology — Auckland (West and North) (internal link)

• If we are not meeting your needs because of cultural differences, we do have some cultural support services available.

North Shore Hospital (internal link)

Waitākere Hospital (internal link)

There are many different types of gynaecological surgery.

By the time the day of your surgery arrives, you should feel comfortable about what operation you will have, the specific risks of your operation, and what to expect during your recovery. If you have questions about your operation, contact our booking and scheduling team. If they are unable to answer your question, they can direct you to the right place for answers.

Gynaecology — Auckland (West and North) (internal link)

Gynaecology day of surgery pamphletPDF373 KB

Gynaecological Surgery - Day of Surgery — Vimeo (external link)

Where and when your surgery will be

One of our booking and scheduling team will contact you when the date of your surgery is finalised. They will tell you where to go, what time to arrive, and what you need to do in the lead up to your operation.

Your operation may be at the North Shore Hospital Tower Block, Elective Surgery Centre (ESC) or at Waitakere Hospital.

North Shore Hospital (internal link)

Waitākere Hospital (internal link)

Who will be in your surgery

You will meet a lot of new people on the day of your operation. We work as a team, and everybody has an important part to play in your care. Being a teaching hospital means that we have trainee doctors, nurses and technicians working alongside us and learning on the job.

Trainee doctors or registrars are not the same as medical students. They are qualified doctors who are on the path to becoming specialists. Trainees in theatre may be assisting, operating or anaesthetising depending on how far through their training they are.

We often have medical students in the theatre. They are present as observers only unless you give specific consent for them to be more involved. If you hear the term trainee intern, that means a final year medical student.

We have prepared a pamphlet and video to explain this further.

Vaginal examination pamphletPDF382 KB

Gynaecology - Vaginal Examination video — Vimeo (external link)

Our strength in treating you does not come from one person — it comes from excellent teamwork and passing on our knowledge to the next generation.

How your day will go

Before the operation — in the reception area

• You should arrive at the hospital with the personal items you will need during your stay. You should have been given a rough idea of how long you will be in the hospital.
• You can usually bring a support person with you, such as family, friends or whānau. If this changes, we will make sure you know ahead of time.
• Our reception staff will check you in and explain where to wait.
• You should know the details of the person you want us to call in case of emergency.

Before surgery — in the pre-operative area

• Nurses will take care of you and get you ready for the operation.
• Your blood pressure and pulse are checked.
• Final checklists are done.
• You may have final blood tests or extra treatments like enemas to empty your bowel.
• You will be asked to complete our consent forms.
• If there is something specific we want to teach our medical students (such as vaginal examination), you will be asked. You have the right to say no, and it will not affect your care in any way. Because this is a sensitive and very important area in gynaecology, we have prepared a separate pamphlet and video to explain this further (please refer to our surgical resources).
• Usually, your operation will happen within 2 to 4 hours of your arrival. But bring something to do in case it takes longer, for example, a book to read.

During surgery — in the operating theatre

• Making your operation happen safely commonly takes up to 10 healthcare professionals working together. Some may arrive in the operating theatre after you are asleep.
• Your anaesthetist will confirm your details again, and you will meet the anaesthetic technician who helps your anaesthetist.
• There will be 3 or 4 nurses who will help you get ready and then help with setting up for the operation.
• You will be asked to lie on your bed with your arms by your side. There will usually be special boards for you to rest your arms on, and a blanket to keep you warm.
• You will have an IV line placed in your arm or hand. The technician will put an oxygen monitor on your finger and a blood pressure cuff around your arm.
• Your anaesthetist will then get ready to start your anaesthetic.
• Your body will be covered until you are fully anaesthetised.
• Once you are asleep, you are uncovered and positioned.
• A final vaginal examination may be done so that your surgeon can plan the operation.
• You are then cleaned and covered with sterile surgical drapes.

This is general information regarding recovery from surgery.

You will wake up from surgery in a recovery ward, which is very close to the operating theatres. It can be a strange feeling to wake up surrounded by new people in a place you have never been to before.

The purpose of the recovery ward is to make sure that:

• you have woken up well from the anaesthetic
• your pain levels are under control, and there are no signs of early problems like bleeding or bad vomiting.

Once your nurse is happy with your recovery, you will be transferred to a different ward, usually Hine Ora.

Minor surgery or day surgery

• For day surgery you will need to have someone drive you home and stay with you for the first 24 hours.
• You will wake up in the recovery room and be looked after until you are well enough to go home.
• You will be given information about what to expect in your recovery before going home.
• Your discharge summary will go to your regular general practitioner automatically, along with information about when they should see you or when you will next be seen back in our clinics.

Major surgery

• If you have had major surgery, you will need to stay in hospital for at least 1 night.
• You may wake up to find a tube coming out of your bladder or a drain coming out near your incision. Our nurses will help you manage these.
• You may be sharing a hospital room with other patients. The reason for this is to allow our nurses to keep a closer eye on patients.
• We do have some single rooms for patients with particular needs. This may be because they have infections we need to contain or have a distressing diagnosis or condition that requires privacy.
• Once our hospital doctors and nurses are happy that it is safe for you to go home, you will be discharged with a summary of your hospital care.
• You will be given a prescription for pain relief, and it is a good idea to have this filled at the hospital pharmacy before you leave.
• Please make sure you talk about any worries you have with the hopsital doctors or nurses before going home. It is always a good idea to write down advice.
• Your discharge summary will go to your regular general practitioner automatically, along with information about when they should see you or when you will next be seen back in our clinics.
• Any body parts (specimens) taken out at the time of surgery will be tested in our pathology labs. It usually takes about 2 weeks for the results to come back. Once we have the results, a copy is sent to your healthcare provider and our hospital doctors will check them through our system. If any changes that need to be made because of these results, you will be contacted.