Gynaecological consultation
Your appointment
When you attend an appointment with your gynaecologist you can expect a comprehensive assessment of your gynaecological and general health.
You may like to bring a support person with you to your appointment. It is your choice if they wait outside, or come into the consult room for any part or all of the consultation.
History
A complete history will include questions about the reason you have come to your appointment, what you are hoping to get out of the appointment and your gynaecological care, and about your medical and surgical history. A full history often includes questions about your work, family, and relationships too.
Examination
A gynaecological examination is an important part of the assessment. You should expect that there will likely be an examination during your first consultation at least. An examination may be recommended even if an examination has been done by your GP or another specialist previously.
Depending on the situation, a gynaecology examination can include:
- inspecting the vulva,
- a speculum examination to see the vagina and cervix, and
- a digital examination to assess for masses and tenderness relating to pelvic organs.
You can choose not to have an examination. If you choose not to have an examination, the risks and alternatives will be discussed with you.
During the examination some tests may be done. For example, swabs for infection, a cervical screening test, or an endometrial biopsy. Any tests that are performed will be discussed with you. You can choose not to have one or all of the recommended tests. If you choose not have tests performed, the risks and alternatives will be discussed with you.
Procedures and tests (eg biopsies) that can be done during your appointment when indicated are detailed below.
Further testing
At this point in your consultation, some further testing may be recommended. In gynaecology, these are commonly ultrasound or blood tests.
It is important to know that ultrasounds in gynaecology often require a transvaginal probe to obtain sufficient detail of the pelvic organs. If you don’t think you will be able to have this type of ultrasound, please make sure that you discuss this in your appointment.
Your care plan
At the end of the appointment, a plan will be made with you as required. This plan can include:
- How results from tests performed will be communicated to you
- Recommendations about further tests
- Advice about treatment options, which could involve lifestyle modifications, seeing other health professionals, starting a medication, or having a procedure
You do not have to agree to the recommended plan at the end of your appointment. Health decisions, especially those involving surgery, sometimes require time to consider or a second opinion. You are welcome to do so and to return on another day to rediscuss if you wish to.
After your appointment
Your account is due at the conclusion of your appointment. Information about fees is below. We will process your Medicare claim on your behalf.
Outpatient Procedures
Colposcopy
A colposcopy is a detailed examination of the cervix, vagina and vulva performed by a doctor with special training. It involves colposcope, which is a microscope with a light source, and requires a speculum examination. Sometimes swabs or a cervical screening test is performed at the same time. A weak vinegar-like preparation is applied to the cervix to determine if there are cell changes associated with HPV (human papilloma virus) infection. If changes are identified, a biopsy may be taken during the examination. A biopsy is not always required.
IUD Removal & Insertion
An intrauterine device is a small device the sits inside the uterus and can be either hormonal or non-hormonal. Non-hormonal IUDs are made from copper and, depending on the device, they can provide long-acting acting and reversible contraception for 5-10 years. Other devices have a small amount of progesterone hormone (levonorgestrel) that they release over the lifetime of the device, which can be 3 or 5 years. You may recognise their brand names as either Mirena or Kyleena. Like copper IUDs, the Mirena and Kyleena provide long-acting reversible contraception, but they can also provide relief for heavy and painful periods. Mirena is the device with the highest level of evidence for achieving lighter and less painful periods.
These devices can be inserted and removed in the clinic rooms or in the operating theatre. The appropriate setting for you may depend on whether you require another procedure at the same time, whether you have had a pregnancy or a device before, and what your preference is. Insertion of an IUD in my clinic will include the use of local anaesthetic and other pain relief. If you choose to have your IUD inserted in theatre, then you will be given an anaesthetic.
You can expect some light cramping and some spotting after inserting your IUD. An IUD is immediately effective for contraception. The effect of a Mirena on your bleeding and pain will normally take 3-4months to appreciate.
Removal or exchange of your IUD can also be done either in the clinic or in the operating theatre. Removal is normally very straightforward and not painful making it very safe and suitable for the clinic room. If you require it to be replaced then you may elect to have it done in theatre for the reasons described above.
Endometrial biopsy
An endometrial biopsy in the rooms can be done in some circumstances to investigate abnormal bleeding. It involves a speculum examination and a very thin pipelle is passed through the cervix into the uterus and a small of the lining of the uterus can be obtained. A sample like this can be useful for people who are premenopausal to quickly exclude abnormal cells in the uterus without needing to have a procedure in theatre. It is not always appropriate or helpful to sample the lining of the uterus this way, because some conditions require a hysteroscopy (a camera in the uterus) to assess properly.
You may experience slight cramping during the procedure and a small amount of spotting after the procedure. There are no special precautions required after an endometrial biopsy.
Cervical polypectomy
A cervical polyp is a usually benign growth on the cervix. They are a common finding and may be a cause of abnormal bleeding or discharge. They may also not cause any symptoms at all. They do not always need removal, but if they are causing symptoms or are large your doctor may recommend removal. Some cervical polyps can be easily removed in the clinic. Some require removal in theatre. It may also be your choice to have a cervical polyp removed in theatre rather than in the clinic.
You may experience slight cramping during the procedure and a small amount of spotting after the procedure.
Vulval biopsy
There are a range of conditions affecting the skin on and around the vulva. All conditions require an examination, but not all conditions require a biopsy. If the diagnosis is not clear based on the examination, or if treatment is not as effective as expected, a biopsy may be recommended. This is done using local anaesthetic. The biopsy taken is usually very small, approximately 3-4mm.
After your biopsy, you can return to usual activities. You may require some simple pain relief.
Word catheter for a Bartholin’s gland cyst/abscess
A Bartholin’s gland cyst is a lump that can develop at the entry to the vagina. They can become large and bothersome and, in some cases, infected. If infected, they can become very painful. An infected cyst is called an abscess.
One possible treatment for a Bartholin’s gland cyst or abscess is the insertion of a Word catheter, which can be done in the clinic. The Word catheter is inserted into the cyst to allow the contents to drain. They remain there for 4-6 weeks and then are removed.
Grey Street Tower at Epworth Freemasons
Our Facilities
My rooms are located in the Grey Street Tower at Epworth Freemasons, Level 6, directly opposite the lift doors. There is parking available in the car park or in the surrounding streets. The lifts are on the ground level when you enter from Grey Street. If you arrive via the carpark lifts, you should exit at lower ground (LG), turn left and the Epworth Reception desk will be in front of you. Ask the friendly staff there for directions to the Grey Street Tower lifts.
When you arrive you will be welcomed by my reception team who you will have already spoken to over the phone or via email in the lead up to your appointment.
My rooms are fully equipped for a comprehensive gynaecological assessment and to perform some in office procedures.
Friendly Staff
Friendly staff ready to respond to your needs.
Pathology and Radiology
On-site pathology (Melbourne Pathology) and radiology (Epworth Medical Imaging) for your convenience.
Parking
Underground and street parking available.
Ready to book an appointment?
Dr Holbeach is an experienced gynaecologist that has cared for patients with the conditions described here for over 10 years. She is a Fellow of RANZCOG and has a Masters of Reproductive Medicine and a PhD in Bioethics.
Outpatient Procedure Fees
| Item number | Description | Fee (incl GST) | Medicare rebate |
| 104 | Initial consultation (30mins) | $300 | $86.15 |
| 105 | Follow up consultation (15mins) | $180 | $43.35 |
| 105 | Phone consultation (<10mins) | Bulk-billed | $43.35 |
| 105 | Phone consultation (>10mins) | $180 | $43.35 |
| 35614 | Colposcopy | + $100 | $63.35 |
| 35620 | Endometrial biopsy | + $150 | $52.95 |
| 35503 | Insertion of Mirena | + $250 | $183.60 |
Frequently Asked Questions
How can I make an appointment with Dr Holbeach?
You will need to see your GP for a referral.
The referral does not need to be addressed to Dr Holbeach specifically. It is still valid for Medicare purposes even if it names a different gynaecologist or is left open (eg. Dear Doctor or Dear Specialist). A GP referral is valid for 12 months.
Once you have a referral, you can use the enquiry form on this website, email or call the rooms to make an appointment.
Do I need to do anything to prepare for my appointment?
A patient intake form will be sent to you to complete ahead of your appointment. Your GP may have sent your referral letter and relevant investigations to us already, but if not we may contact you to get a copy.
Some examinations and procedures have pre-appointment instructions. For example, taking paracetamol and ibuprofen 40mins before your IUD insertion or colposcopy. Sometimes vaginal oestrogen is prescribed prior to a colposcopy for patients after menopause. The rooms will let you know whether these instructions apply to you.
I have my period, can I still come to my appointment?
In most cases, it does not matter if you have your period at the time of your appointment. If you are uncomfortable having your appointment during your period, you can call to reschedule your appointment.
If you are having a colposcopy, then your appointment should be at a time that you are not bleeding. Please call us to reschedule and we would be very happy to accommodate you as quickly as possible.
I would like to have an IUD inserted, will this be done at my first visit?
I do not usually insert IUDs at your first visit. During your first visit, I will complete a full gynaecological assessment which may include further investigations. This is to ensure that there are no contraindications to the device and that will provide you with the solutions your require.
I will discuss your options with you based on that assessment. If you choose to have an IUD, I will step you through the options for having it inserted and plan for this with you.
How will I get the results from my appointment?
Any tests that are performed during your appointment or that have been requested and will be done following your appointment will be discussed with you. The results will be sent to me and, once received, I will arrange an appointment with you to discuss them.
Sometimes results can be delivered over the phone. In that case, a phone appointment will be made for you. Short phone consultations are bulk-billed. Long phone appointments will be billed as a review consultation. See the fee schedule for details.
If your results require a more detailed discussion, or if in-person attendance is your preference, the reception staff will contact you to make an appointment in the rooms.