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Experts in Women’s Gynaecological Care

Welcome to Northern Medical Women’s Health Clinic, Ahoghill, Ballymena.

We offer the most up-to-date advice and treatments for women of all ages. This care is provided by a friendly experienced  team in private, professional and comfortable consulting rooms. If surgery or procedures are required, these are performed in the safest surgical environment with state-of-the art equipment and a highly trained team.



Painful Intercourse (Dyspareunia)

This is a very distressing both physically and psychologically for many couples sometimes putting great strains on their relationship. This is called “dyspareunia” and can be subdivided into superficial or deep.

Superficial dyspareunia causes may be simple secondary to dryness, atrophic (thin) vaginal skin, previous scaring at vaginal entrance introitus for example from an episiotomy. Sometime a more complex condition called “vaginismus” exists. This is where if a woman’s vaginal muscles involuntarily spasm /contract in anticipation of pain at penetration. This condition is harder to treat as there are can be often underlying psychological factors and requires the expertise of a psychosexual counsellor to treat and resolve.

Deep dyspareunia i.e. penetration is achieved but is very painful.This suggests that there may be underlying gynaecological conditions such as endometriosis, ovarian cysts, pelvic adhesions (internal scarring) or chronic pelvic infection. Often a Laparoscopy is required to make a diagnosis however some treatments can also be tried before embarking on surgical exploration.

Pelvic Pain

This can be a very simple or a very difficult condition to manage particularly if it is a chronic condition i.e. lasts more than 6 months.The gynaecologist must do his best to try and identify a cause and sometimes after extensive investigation no gynaecological cause is found. This is not necessary a bad thing as the gynaecologist can then refer to another speciality to focus in on another a cause. Again this begins with a detailed history and an examination. Cyclical pain is usually gynaecological in origin especially when associated with painful, heavy periods and deep pain on intercourse (dysparaenia).

This also requires investigations include a transvaginal (internal) scan, abdominal/pelvic ultrasound, genital tract swabs, sometimes CT / MRI scans. If indicated a laparoscopy to try and diagnose a gynaecological cause would be considered a gold standard investigation. There are several gynaecological causes including endometriosis, adenomyosis, ovarian cysts, adhesions, and pelvic infections that should be discussed with your gynaecologist. Depending on the condition suspected or diagnosed there a usually multiple treatment options that can also be offered.

Vaginal Discharge

Many women attend their general practitioner concerned about vaginal discharge. Sometimes this is an issue that the patient herself notices or sometimes her partner may report this.A lot of the time there is no infection and this is simply a normal or “physiological” discharge. If foul smelling, abnormal colour, persistent or associated with itch or discomfort it may be sign of a vaginal infection. Often this is a simple infection such as “thrush” (candidiasis) or bacterial vaginosis but may also be a sign of an acquired sexually transmitted infection. Simple swabs can be taken to make a diagnosis and treatment again is usually very simple.

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Primary infertility investigations

Sub-fertility is very common problem affecting about 1 in 8 couples. This can be defined as “primary” i.e. no previous pregnancies or “secondary” the woman has had a previous pregnancy, even if this ended in a miscarriage. Most gynaecologists would not investigate sub-fertility until the couple have being trying to conceive for 12 months without success.

Sub-fertility causes can simplistically be divided into 4 categories. Ovulatory problems, tubal factors, male factors and “unexplained”. A basic history and examination including a vaginal ultrasound should be undertaken. Other basic investigations namely blood tests; a HSG or hysterosalpingogram (a dye test to check if the fallopian tubes are blocked), semen analysis and sometimes a laparoscopy should be performed before the patient is referred onto a tertiary fertility centre.

Ovarian Cysts

An ovarian cyst is a fluid-filled sac that develops on a woman’s ovary. They are very common and do not usually cause any symptoms.

In most cases, they are benign, harmless and usually disappear without the need for treatment. However, if the cyst is large or causing symptoms, it may need to be surgically removed.

An ovarian cyst will usually only cause symptoms if it ruptures (leaks or bursts), bleeds or twists on itself (torts) blocking the blood supply to the ovaries. This is the case, women often experience pelvic pain.

Ovarian cysts can also become very large over time and women may notice swelling or pressure symptoms in there pelvis or abdomen

Diagnosis is often by ultrasound in the first instance.

If the gynaecologist wishes to try and exclude malignancy sometimes a CT scan is indicated A blood test called a CA 125 (a tumour marker) can be helpful in these cases but it must be remembered that it can be non specific elevated for many other benign conditions also.


If not too large, asymptomatic and simple looking often observation a repeat scan after 3-4 months to look for resolution is reasonable.

If surgery is required and there is no suspicion of malignancy this is can almost always be performed through laparoscopy “keyhole surgery”. The surgeon should consider fertility, hormonal status in undertaking the surgery i.e. try and remove just the cyst and preserve the ovary.