We welcome referrals to Clinic 66 for Reproductive & Sexual Health matters.

 

Whilst our specialist GPs do not require a referral for Medicare reasons, if we receive a referral letter we strive to respond with a treatment summary.

 

Referral letters are required for our gynaecologists and sexual health physicians, in order for the patient to claim a Medicare Rebate.

 

We prefer electronic communication where possible, and are enabled for Healthlink (ID: gynaecar), Medical Objects and Argus (argusreports@gynaecare.com.au) .

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Intrauterine Device Insertion / Replacement

 

Most women requesting an IUD will only require information about the different types of IUDs and options for pain relief. This information is available on our website. Alternatively an IUD counselling appointment can be booked with one of our doctors (face to face or telehealth). IUD procedures are undertaken awake (with local anaesthetic spray or gel), Penthrox or IV twilight sedation. Please advise all women who opt for an awake procedure to take oral analgesia 45min before their procedure. 

 

Routine cervical screening and routine STI screening can be performed at the same time as an IUD procedure. If a patient is at high risk of an STI, it is useful for the STI screen to be done in advance of the procedure .  STIs must be adequately treated before an IUD procedure. 

 

Whilst we perform point-of-care ultrasound to check IUD position after an insertion at Clinic 66, this is not adequate to exclude pathology and this is not the same as inserting under ultrasound guidance.  These are some circumstances when we will require some investigation to be performed prior to an IUD insertion: 

 

Abnormal vaginal bleeding (e.g. Heavy menstrual bleeding, intermenstrual bleeding or post coital bleeding)  MUST be adequately investigated before an IUD is inserted.

 

1. Heavy Menstrual Bleeding: (losing 80ml blood or more per day, changing sanitary protection hourly, clots, flooding) or Intermenstrual bleeding (bleeding in between periods). 
   
   These women MUST have a normal, recent (within 3 months), Day 5-9 transvaginal pelvic ultrasound preferably at a gynaecological imaging provider before an IUD can be safely inserted. Blood tests, such as thyroid function, may also be appropriate. We will require a copy of the ultrasound report in advance of her appointment.  If there are any endometrial hyperplasia or polyps found on ultrasound, she should be referred to a gynaecologist for a hysteroscopy.
    

2. Post coital bleeding: these patients should have an STI  screen, CoTest and potentially a colposcopy before considering an IUD. 
    

3. Abnormal ultrasound:  Any women with known uterine cavity distortion due to an intracavitary fibroid are not suitable for IUD insertion at Clinic 66 (subserosal and intramural fibroids are usually OK as they do not distort the uterine cavity. If there is a known congenital uterus anomaly such as Bicornuate Uterus, patients are not suitable for IUD insertion at Clinic 66 as we do not perform ultrasound guided IUD insertions at Clinic 66.  Uterine polyps should be referred to a gynaecologist for hysteroscopy. 
    

 

IUD Removal/Replacement

 

Clinic 66  can remove/replace most IUDs at Clinic 66 (even threadless IUD). If an IUD is known to have no threads, please arrange an ultrasound for your patient prior to her appointment. 

 

If an IUD has no visible threads at the cervical os, (AND the IUD is proven to be in utero by USS) AND the patient would like the IUD removed or replaced at our clinic, then it is recommended that she have a discussion with one of our clinicians to decide if she should book her procedure under sedation, as instrumentation of the uterus may be required. 

 

We do not have hysteroscopy facilities at Clinic 66 so, if an IUD is embedded, she will need referral to a gynaecologist for removal.

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Implanon Removals

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We can often remove deeply located implanon devices if they are still palpable (and not intramuscular). However, we will not attempt a non palpable Implanon removal and do not perform ultrasound guided Implanon removals at Clinic 66 - these women should be referred to an interventional radiologist.

 

Medical Termination of Pregnancy

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The majority of women seeking medical termination of pregnancy do not need any work-up prior to referral as long as she is reasonably sure of her dates and there is no concern about pregnancy unknown location. Women requesting Medical Termination of Pregnancy should be under 63 day (9 weeks) gestation.

  

We can perform first trimester point-of-care Ultrasound, on site, for pregnancy dating. If bhCG blood tests are indicated to determine the success of the medical termination procedure, we will instruct the pt accordingly as the blood tests need to be timed.

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Blood group is no longer required as it is no longer recommended to give Anti-D to gestations under 10 weeks. 

RANZCOG Guidelines for the use of Rh(D) Immunoglobulin (Anti-D) in obstetrics  

 

Surgical Termination of Pregnancy

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First Trimester sTOPs do not need a work-up prior to referral as long as the patient is reasonably sure of her dates and there is no risk of ectopic pregnancy. . 

 

For Second Trimester sTOPs, we require a recent dating scan; for accurate dating and placental position. The upper limit for surgical termination of pregnancy at Clinic 66 is 16 weeks for nulliparous patients and 16+6 weeks for women who have had a vaginal birth. 

 

Misoprostol may also be offered to all sTOP patients as there is evidence to suggest that this may reduce complications. 

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Vasectomies

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Vasectomy at Clinic 66 is performed by a GP specialist ( not a urologist). We are unable to perform vasectomy on a patient in whom there is pre-existing scar tissue or other pathology. All vasectomy patients should be examined by their GP prior to referral to Clinic 66 to ensure they are anatomically suitable.  Clinic 66 offers vasectomy under offer local anaesthetic or IV twilight sedation. Men known to have a small or tight scrotal sac should be booked for twilight sedation. 

 

Colposcopies

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A referral letter will be required for a colposcopy with one of our colposcopists. Please attach the cervical screening report to your referral.

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