Procedures

Information about the procedures that Dr Foote performs.

Gynaecology

There are a wide range of normal shapes and sizes of the labia minora (or vaginal lips). Labioplasty is a day surgical procedure to alter the shape of the labia, usually by removing excess skin. Dissolvable sutures are used, with abstinence from intercourse usually required for around 6 weeks.

Indications for Labiaplasty

  • Chaffing, discomfort
  • Laxity after childbirth
  • Incorrect healing after childbirth
  • Cosmetic concerns

Mona Lisa laser vaginal rejuvenation arrived in Australia in 2014, and is now available at Total Womens Health.

Please see our brochure here.

Indications:

Non surgical office Mona Lisa vaginal laser treatment can reduce dryness, discomfort, prolapse, laxity & urinary frequency by up to 90%. Treatment only takes minutes, with minimal discomfort. Three treatments are required at 0, 4 & 8 weeks.

How Does it Work?

Fractional CO2 laser has been used for over 10 years on the skin for the treatment of acne, rhytides (wrinkles), photo damage, and scars. Studies have reported the safety in over 2,000 cases (Hunzeker 2009).
Vaginal fractional CO2 laser acts to stimulate fibroblasts and promote tissue remodelling, in particular the vaginal collagen and elastin fibres. After treatment vaginal tissues are rejuvenated with a thicker epithelium, greater glycogen, and better organisation of the lamina propria.

A study by Salvatore in 2014 of 49 women over 12 weeks found significant improvements in:

  • Burning
  • Dryness
  • Itching
  • Painful intercourse
  • Urinary burning

Does it Cause Harmful Side Effects?

The pulse of laser is very small, being applied for 1,000 us duration at 1,000 um intervals. All women in the Salvatore study reported the procedure as “very easy” or “easy”. On completion of the treatment 84% were satisfied and reported no related adverse events.

Informational video:

Endometriosis

This is a condition that has become more frequently diagnosed today and is associated with pelvic pain, heavy painful periods and infertility. It is a chronic inflammatory condition of the pelvis that mostly involves the peritoneum or skin of the pelvis but may involve ovaries, bladder, or even bowel.

Heavy Periods

Many women who enter their 40’s start to get heavy periods. It is rare in this age group to be malignant but should always be checked. The common reason is the loss of tight control of periods that a women once had as her hormones wind down towards menopause.

Once other causes (fibroids, polyps, cysts) have been excluded, many simple procedures can treat this life inconvenience. I recommend the use of the Mirena IUCD or Endometrial Ablation. Rarely a hysterectomy is discussed, and if required, keyhole or laparoscopic surgery is recommended.

Fertility Control

At the end of childbearing, this practice offers full advice for fertility control. This may involve a discussion as to which contraceptive pill is right for you, the use of Implanon or discussion of newer methods such as the Mirena IUCD or Nuvaring. Laparoscopic sterilisation (keyhole method of tying tubes) is also available.

Abnormal Pap Smears

Being told by your GP that you have an abnormal pap smear can be very stressful at any age. The anxiety can be allayed by careful discussion and explanation as to what the abnormality is.

Many minor abnormalities are treated by a wait and see approach and reassurance that this is the right way can be given after initial assessment, probable small biopsy and HPV assessment (a special test done on the pap smear). When further treatment is required, both the treatment and follow up will be planned so that you can have confidence in the future.

Polycystic Ovarian Syndrome (PCOS)

This is mostly associated with fertility management, but many women have fears that some possible symptoms they may have could be PCOS. A complete examination and ultrasound assessment combined with blood evaluation can usually give a clearer picture of possible PCOS. A complete discussion of management options can then be undertaken.

Cysts, Fibroids, Polyps

These cysts can arise from the ovary, tube, uterus or vagina. Treatment may be required depending on their size, location, or any suspicion of abnormal features. Many are treated by keyhole or laparoscopic surgery (See Laparoscopic Surgery).

Post Menopausal Bleeding

This very important condition is treated as high priority in my clinic, so please let my staff know if this is the reason for consultation.

Urogynaecology

This procedure is also known as transvaginal tape (TVT), Sparc, Monarc, Miniarc, and Secure. A sling procedure is designed to cure urinary incontinence that is caused by coughing, sneezing, laughing or exercise (stress incontinence). It may not cure urinary incontinence that is caused by urgency (or rushing to the toilet) or frequency (going to the toilet many times during the day or night).

The aim of this operation is to cure incontinence by lifting up the neck of the bladder and supporting it with a sling made of prolene. This sling, attached to the abdominal wall, is then passed underneath the urethra to provide this support. The operation is performed from the vagina with just two small cuts (1cm) in the lower abdomen below the pubic hairline or around the labia. These wounds are closed with steristrips. The operation is performed under local anaesthetic, or sedation, so that the exact tension on the sling can be determined while you cough in order to prevent leakage. You will usually only be in hospital as a day case, with recovery for 2 weeks. Occasionally you may need a catheter overnight if the bladder temporarily will not empty.

Many women, after the completion of childbirth, start to have a dragging sensation or notice lumps or discomfort where they never were. Some women request a return to the sensation of intercourse they had before childbearing. Surgery treatment can vary from day surgery to more intensive overnight surgery.

Vaginal repair or tightening procedures can improve quality of life for many after childbirth. Recently incontinence procedures have become available as minimally invasive day surgery.

Sacrospinous colpopexy is an operation designed to cure vaginal vault prolapse (in which the uppermost part of the vagina slips forward) which may occur after previous hysterectomy. The operation restores the vagina to its normal position and function. The highest part of the vagina is located and attached to the ligaments at the back of the pelvis (sacrospinous ligaments) using a synthetic mesh made of prolene.

The operation performed through a vaginal incision, with no cuts on the abdomen.

After the Operation

This procedure usually is day or overnight surgery, and a relative or friend should be available to take you home and stay with you overnight.

At Home

You will need a two to four week recovery period at home. It is important to let your family know this, so that you are not expected to do too much work during this time. Get up once a night for a week after your operation to empty your bladder, as this will avoid an over-filled bladder in the morning. Gradually try and return to normal activities for the first week. Do not overtire yourself. Gradually increase the exercise you take beginning with short walks" target="_blank">Learn more.

This is the least invasive form of hysterectomy, with no cuts on the abdominal skin. Vaginal hysterectomy is indicated for a variety of reasons including: heavy periods, prolapse, and a severely abnormal Pap smear. At the same time the front and/or back vaginal wall may need repair (anterior and/or posterior vaginal repair). The operation is performed vaginally with disolving stiches being placed internally. A small catheter, placed through the abdominal wall (suprapubic catheter or SPC), will drain the bladder. A drip is left in your arm to allow you to have fluid until you can drink normally.

After the Operation

You will usually be in hospital for three to five days, depending on how soon your bladder starts to function again. The catheter is allowed to drain freely until Day 2, when it is closed off (clamped) at about 6 am. You will be encouraged to pass urine naturally every two- three hours. If you cannot pass urine, or are in pain, please let the nursing staff know and they will release the catheter. Each time you pass urine, the amount will be recorded by the nursing staff. After you have voided, the catheter will be released and the residual urine (the amount drained into the bag) will be measured. Overnight the catheter is once again unclamped and will drain freely. If the residual is less than 100mls on two occasions, and you are passing amounts of urine greater than 200mls, then the catheter will be removed and you will be able to go home. This removal is a pain free routine nursing procedure.

Occasionally if the bladder function is slow to return you may be allowed to go home with the catheter in place, with instructions about how to manage things.

On the first day after the operation it is usually possible to start drinking, however there is often some temporary nausea which will determine when you may eat again (usually within a few days). There is often some cramp-like pain from wind which will settle after a few days. It will take longer than normal for the first bowel motion to pass.
From the morning after the operation you are encouraged to sit out of bed, exercise the legs, deep breathe and move about. It is common to have a light vaginal bleeding for up to four weeks, but if this smelly, or heavy bleeding develops, a doctor should be contacted.

At Home

You will need a two to four week recovery period at home. It is important to let your family know this, so that you are not expected to do too much work during this time. Do not overtire yourself. Gradually increase the exercise you take beginning with short walks.

Some Common Questions

What are the complications of vaginal hysterectomy surgery? There are 5 main complications:

  1. The procedure may not work and prolapse may return. The success rate is about 90%
  2. The bladder may be more irritable, with new symptoms of urgency and frequency in about 10-15% of women
  3. Infection of the urine, vagina or chest (treatable with antibiotics)
  4. The bladder may be more difficult to empty, with about 1-2% of women needing help to empty their bladder by self-catheterisation
  5. Constipation. Try increasing daily fiber, fruit and fluids. Daily Metamucil can also help
Other rarer complications include: severe bleeding requiring blood transfusion, blood clots in the calf muscles or lungs, general anaesthetic complications, and intraoperative damage to nearby structures such as bowel/bladder/blood vessels/ureters.

When can I resume intercourse?

Sexual intercourse should be avoided until after your first check up at around six weeks. This is because the surgery leaves a scar at the top of the vagina and intercourse in the first six weeks may be uncomfortable. After the operation the vagina may feel a bit tighter to begin with, but usually there is no change in sensation for you or your partner.

When can I go back to work?

This depends a little on your job. Most women return to work after six weeks, however if heavy lifting is required it may take longer.

When can I drive?

You can drive after two weeks. This is because until then the wound may be still tender and if you suddenly had to turn the steering wheel to avoid an accident, and could not do so because of pain, you may be held liable for any accident caused.

When can I resume aerobics?

It is advisable to avoid strenuous exercise until after your first check up at 6 weeks. After this you may gradually resume sporting activities, although it may be several weeks before you are back to the same level of fitness as before the operation.

If you have any further questions please ask!