What happens at our clinic?

Who runs the clinic, what is involved in clinic appointments and how to prepare, and next steps after clinic are summarised here.

Who runs the EXPPECT Pelvic Pain Clinic?

The EXPPECT Pelvic Pain Clinic is run by different specialists with a particular interest in pelvic pain. Professor Andrew Horne is a Consultant Gynaecologist; Dr Lucy Whitaker is a Clinical Lecturer in Obstetrics and Gynaecology; Dr Lorraine Harrington is a Consultant in Anaesthesia and Pain Medicine; Dr Sarah Young is a Clinical Psychologist; Dr Ooi Thye Chong is a Lecturer in Integrative Medicine and practises Chinese Medicine, which includes acupuncture; Alison Hennessey is a Pelvic Pain Physiotherapist; and Mia Jiang is a Specialist Nurse.

What do the different specialists do?

Gynaecologists work with people to help them manage the health of their reproductive system. The pain specialist is a doctor who is trained to understand pain from a broad perspective.

Clinical Psychologists work with people to reduce their distress and enhance their wellbeing. They work with people with a wide range of physical health problems to cope with the emotional consequences of these difficulties, and to improve their quality of life. The fact that a psychologist is meeting you does not mean that we think that the pain is not real or that it is “in your head”. Pain is complex and can affect people in lots of different ways, not just physically.

The Specialist Nurse is present in the clinic to get to know you better. She works with people referred to the clinic to review how things are going with their medication or development of other strategies to manage their pain.

The Chinese Medicine Practitioner aims to make a significant difference to the experience of pain by providing acupuncture treatments and easy to use self-care skills, such as breathwork.   Working closely with the patient’s presentations and tongue diagnosis, for example, advice might be given to adjust the diet, through the lens of Chinese Medical nutrition.

What will happen to me at my appointments?

Most appointments with our specialist team last 30-60 minutes. These appointments may be face-to-face, by video or over the telephone. We discuss all referrals to our service at a bimonthly multidisciplinary meeting and decide which specialist would be most appropriate to see you. Sometimes, a combination of specialists may see you together (either face-to-face, by video or over the telephone). If so, each specialist will ask you questions in turn about you and your pain. This may feel strange at first. However, there are advantages in seeing the specialists at the same time in that they are able to pool their knowledge and experience of working with women with pelvic pain. They can also offer advice on why the symptoms may have developed and provide help in managing the problem. This will be tailored to your specific situation and needs. The joint appointments can last for 45-60 minutes. After each specialist has asked you questions, an examination may be carried out which may include a vaginal examination. Following this, the specialists will discuss their thoughts and recommendations with you. You may be asked to leave the room for a few minutes (or switch off your video/phone) while your case is discussed. You will have an opportunity to ask questions and to comment.

How can I prepare for my appointment?

If you are attending for the first time and seeing a combination of specialists, you will receive the following with your appointment letter:

1. Patient Information Questionnaire

This is a questionnaire asking you to answer some questions about your pain, how it affects you and the different treatments you have tried. Please complete this as best you can and bring it to your appointment. Don’t worry if there are questions you can’t answer.

2. Additional Questionnaires

You will also receive two additional questionnaires to complete. These look at how you are currently coping with your pain. They provide the specialists with information to help identify where additional support may be required.

3. Accompanying Person

We recommend you ask a family member, friend or partner to accompany you to your appointment. This is mainly to help you feel at ease and it can also be useful to speak to someone other than yourself about your pain and how it affects your life. It is fine to come on your own if you prefer. If you need an interpreter please let us know before your appointment.

4. Questions and Concerns

You may have further questions which have not been covered in this booklet. It is helpful if you make a note of them and bring them with you when you attend.

What will happen after my appointment?

After your visit to the clinic, a letter will be written to your GP/referrer outlining the outcome of the appointment and any recommendations made. You can ask to receive a copy of this letter.

It may be that you will be offered an appointment to meet again with one of the specialists from the clinic. This would involve working with you to help you manage your pain. If one of the treatment options for you involves trying a different dose or type of medication you may be offered an appointment to see the Consultant Gynaecologist, Consultant in Anaesthesia and Pain Medicine or Specialist Nurse.

You may want to consider meeting the Clinical Psychologist or specialist nurse to find out more about pain management. Pain management involves learning about chronic pain and looks at strategies to help people manage their pain. This aims to support them to continue with, or develop, the areas of their life that are important to them.

Why have doctors asked me if I have ever had any unwanted sexual experiences?

Some of the women we have worked with in the pelvic pain clinic have asked us why this is discussed.

Research has shown that severe stress at an early age can cause problems with the nervous system and the system that controls the release of hormones in the body. Scientists think that this can result in a variety of different health problems, including persistent pelvic pain. People who have been the victims of abuse may also have low mood and/or anxiety associated with this experience. There is information about the impact of traumatic events on the brain, made available by GetSelfHelp.co.uk [opens PDF on external website].

If you are asked this question it does not mean that we think every woman with persistent pelvic pain has experienced an unwanted sexual experience or suffered abuse, nor does it mean that every woman who has experienced these events will have ongoing problems because of it.

We think that it is important to ask about any difficult experiences that may still be affecting the person now to make sure that our patients can access support to deal with this, if that is something they think would be helpful to them.

What happens at dietetic clinic?

Dietitians can provide evidence-based information on diet as well as personalised nutritional advice for gastrointestinal symptoms or onward referral to other dietetic specialities as required.

Whilst diet cannot cure pelvic pain or endometriosis seeing a dietitian may help improve your quality of life, relationship with food and/or may improve symptoms.

When you see a dietitian at clinic, you will be asked about your nutritional concerns and health goals. The dietitian will then complete a nutritional assessment which includes asking questions about your weight and weight history, checking your blood results, gathering information about your clinical condition, asking about your diet and dietary habits and environmental factors which may affect your diet.

At the start of your appointment your weight will be taken, if you feel uncomfortable being weighed or do not wish to know your weight, please make this known to the dietitian.

A new appointment takes 45 minutes, and a review appointment is 30 minutes.

Referrals to the EXPPECT Dietitian usually come from a member of the EXPPECT Team.