Gynaecology Rapid Access Clinic (RAC)

You have been referred to the Gynaecology Rapid Access Clinic (RAC). This leaflet explains:

• the purpose of the clinic

• what will happen during your appointment; and

• what happens next.

We hope the leaflet will help to answer some of the questions you may have. If you have any further questions or concerns, please contact the clinic on 01227 864240.

What is the Gynaecology Rapid Access Clinic (RAC)? and, why have I been referred?

The purpose of the Gynaecology RAC is to make sure that patients whose symptoms might be caused by a serious problem, which can occasionally be cancer, are seen as quickly as possible. This avoids the waiting that can happen with ordinary clinic referrals, so that:

• those patients who do not need further treatment (about 9 in every 10 cases) can be quickly reassured; and

• those who do need further treatment can have it organised without further delay.

Referrals are usually made by your GP. However, sometimes they are made by the scan department, if during a routine scan they see, for example ovarian cysts or thickened womb linings.

What will happen in the clinic?

When you arrive at the clinic you will be met by the receptionist, who will ask you to take a seat in the waiting area. If an abdominal and / or pelvic scan is needed before your appointment, you will be directed to the scan department for this.

During your appointment, your doctor will ask you questions about your symptoms and past medical history. They will ask for your consent to proceed with a pelvic examination (sometimes called an internal). A pelvic examination will check your vulva, vagina, cervix, uterus, and ovaries. Rarely, the rectum (back passage) will also be examined.

For most patients this is a painless examination, although it may be a little uncomfortable. Please tell the doctor or nurse if you have a latex allergy.

Your doctor may ask you to have some tests while you are at the hospital or arrange these for another day.

There will be a female chaperone present, she is there to support you and assist the doctor.

Why do I need to give consent?

All patients must give permission before they receive any type of medical treatment, test, or examination. Consent is given verbally before this treatment.

• You must give your consent voluntarily.

• The hospital must give you all the information you need to make a decision about your treatment. This is so you can give us informed consent.  If you have not been given this information, or you have but you still have questions, please speak to a member of staff. 

• You must be capable of giving consent. This means that you understand the information given to you and can make an informed decision.

When we ask you to give consent, please use this time to ask any questions you may still have. For more information, please go to the NHS Consent for Treatment web page. Remember, you can withdraw your consent for treatment at any time.

How long will I be in the clinic?

You may be in the clinic for one to two hours, as tests and examinations may take time to complete.

You are welcome to bring a friend or relative with you to your appointment.

What tests / procedures might I have at the clinic?

The tests you need will depend on your symptoms. We have listed below the types of tests carried out in this clinic. You may need more than one test and some may be arranged for a later date.

• Pelvic examination

  This is an examination of your abdomen and pelvis. The doctor will use their hands to feel your abdomen, to check that there is nothing unusual. Your GP may have done a similar examination already. The doctor may also need to place their fingers inside your vagina or back passage whilst carrying out this examination.

• Speculum examination

  This is an examination to look inside your vagina. An instrument called a speculum is used to open your vagina; this is the same instrument that is used when you have a smear test.

  It may be an uncomfortable feeling for some patients, but it is not usually painful.

• Blood tests

  You may have a blood test to make sure you are not anaemic and to check your hormone levels. Special blood tests may also be carried out to help diagnose your condition.

• Endometrial biopsy

  A biopsy (a sample of tissue) will be taken from this area for testing in the laboratory, if:

  • you have been having abnormal bleeding; or

  • a scan has shown an abnormality within the lining of your womb (endometrium).

• Pipelle biopsy

  A thin flexible instrument (like a straw) called a pipelle is inserted through your cervix (neck of the womb). The pipelle sucks away a small sample of your womb lining. This procedure can sometimes cause period-like pains, but these should not last long. You may need to take simple pain relief (such as paracetamol) for a few hours after your biopsy.

• Hysteroscopy

  A very thin telescope is used to look inside your womb (uterus). A sample of cells (pipelle biopsy) may be taken from the lining of your womb and sent to the laboratory to be checked. For more information, ask a member of staff for a copy of the Hysteroscopy leaflet.

• Colposcopy

  A colposcopy is similar to a smear test and is usually painless. A microscope with a light (colposcope) is used to look at your cervix (neck of the womb). If there are any abnormal areas, a cervical biopsy will be taken (see below) and sent to the laboratory to be checked.

• Cervical biopsy

  This is performed as either a small pinch of tissue (punch biopsy) or a larger biopsy called a loop biopsy. If a loop biopsy (LLETZ) is needed, you will be given a small injection of local anaesthetic in your cervix. This will stop you feeling any discomfort during your procedure. A small heated wire loop is then passed through your cervix to get the sample.

  For more information, ask a member of staff for a copy of the Large loop excision transformation zone (LLETZ) leaflet.

• Vulvoscopy and vulval biopsy

  These procedures will only be carried out if you have been having problems in this area. The vulva is the folds of skin around the entrance to your vagina. The vulval skin will be thoroughly examined by the doctor using a microscope. If any abnormal areas are found, the doctor may take a biopsy under local anaesthesia to be checked in the laboratory.

What if I need tests that cannot be done during my clinic appointment?

You may need further tests or investigations which will need to be performed at another time. If this happens you will receive an appointment date by telephone or letter. We have listed other types of investigations below.

• Ultrasound scan

  You will need a full bladder for an ultrasound scan. We suggest you do not pass urine for at least 1 hour before the time of your scan. Try to drink one to two pints of liquid an hour before this.

  An ultrasound is a scan that creates pictures of the organs inside your pelvis and abdomen using sound waves. Your doctor may arrange for you to have either a trans-vaginal or abdominal ultrasound scan. Sometimes your doctor may ask you to have both types of scan.

  • An abdominal ultrasound is similar to that done in pregnancy, with the scanner device being rubbed over your abdomen.

  • A trans-vaginal ultrasound involves gently inserting a small probe covered with a protective sheath a short way into your vagina. Many patients find this scan more comfortable than having an abdominal ultrasound, as they do not need to have a full bladder.

• CT (Computerised Tomography) scan

  A CT scan takes x-ray pictures of cross-sections of the inside of your body. The scan takes longer than an x-ray and is painless. You may need an injection of a special dye to highlight any abnormal areas within your body. For more information ask a member of staff for a copy of the Patients having a CT examination leaflet.

• MRI (Magnetic Resonance Imaging) scan

  This test is like a CT scan but uses magnetism rather than x-rays to produce pictures. During the scan, you will lie down and pass through a scanner, which looks like a small tunnel. Some people may feel claustrophobic during this scan, and sedation may be offered to help with any anxiety. An injection of a special dye may also be needed to highlight any abnormal areas within your body.

  For more information, please see the Trust's Radiology web page.

What happens next?

The waiting period may be an anxious time. We will try to contact you (as agreed during your consultation) when your results are ready.

If further investigations or treatments are needed, we will write to you or make you an appointment in one of the clinics to explain / discuss with you what will be needed.

The government’s target for telling you the results of your investigations is 28 days from the date your GP referred you to the Rapid Access Clinic.

What if I feel unwell at home?

If you have discomfort after your examination or biopsy, please take simple pain relief (such as paracetamol and ibuprofen) if your doctor has told you that you can. If you feel unwell, please contact your GP. In an emergency go to your nearest Emergency Department.

Contact details

If you have any questions or concerns, please contact the:

• Gynaecology Rapid Access Clinic
  Telephone: 01227 864240
  Open Monday to Friday 8am to 6pm, and weekends 8am to 3:30pm