Genital warts: causes, treatment options & how to reduce your risk

Genital warts is one of the most common STI in the UK in men and women however with HPV vaccination, the incidence is rapidly declining. Miss Julie Bowring MRCOG MFSRH, our consultant gynaecologist reveals more about genital warts from what causes them to how they’re treated and how to reduce your risk…

What causes genital warts?

Genital warts are caused by low risk subtypes of Human Papilloma Virus (HPV). This is a very common sexually transmitted virus that can affect the lower genital area in men and women. The virus can be passed on easily by having vaginal or anal sex, but also from close skin-to-skin contact with someone who already has HPV.

There are several different strains of HPV, some strains cause a person to develop lumps on the genital skin or inside the vagina or anus, these are known as genital warts or condylomas. The commonest strains linked to genital warts are 6 and 11.

It is important to note that HPV strains causing warts are low risk strains and do not cause cancer.

How are genital warts treated?

There are treatments that can be offered to help warts go away. Treatments currently offered include creams that you can apply yourself, freezing (cryotherapy) often performed by a nurse or doctor using liquid nitrogen. If the warts are very large or persistent, laser surgery might be performed to remove them. Often, treatment is not needed and the warts will disappear spontaneously through your own immunity.

How can I reduce my risk?

Whilst condoms are advised for preventing sexually transmitted infections, they won’t always stop HPV passing from person to person as close skin contact is all that’s needed to spread HPV.  The (HPV) vaccine GARDASIL-9, protects against HPV subtypes 6&11 and thus reduces the risk of getting genital warts by 90%.

Talking about genital warts can be difficult and many people worry about passing it on to their partners. Having a sexual health check for both partners is advisable before starting a new relationship.

If you think you may have genital warts, please speak with your local sexual health clinic or gynaecologist.

Make an appointment

If you would like to book a consultation with Miss Julie Bowring or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]

The fight against cervical cancer and HPV in the pandemic

Professor Albert Singer, co-founder and trustee of the British Society for Colposcopy and Cervical Pathology and a founding member of the British Gynaecological Cancer Society, discusses in depth the fight against cervical cancer and HPV in the current coronavirus pandemic.

Professor Albert Singer says, “With the present pandemic it is said that life will never be the same again, and this will apply to many things in our present life.  For those concerned with eliminating cervical cancer, the effect of the Pandemic are extremely worrying. With resources being diverted to the COVID-19 response and social distancing, we face scarce supplies of the HPV vaccine; challenges of reduced or delayed screening for women; and the issue of cervical cancer plummeting down governments’ agenda. We must act now to mitigate the impact this pandemic could have on our fight against cervical cancer.”

You can read the full article on Professor Singer’s blog here 

How much does it cost to see a private gynaecologist?

Should you decide to book an appointment with a private gynaecologist, fees are often an important factor.  We believe that it is crucial for patients to be aware of the cost of fees as early in their journey as possible and have created self pay packages in order to make costs as transparent as possible.

The cost of a new appointment with a gynaecologist

The cost of a new appointment with a private gynaecologist at London Gynaecology is £280. The appointment will last for 30 minutes and this will be with one of our highly experienced consultant gynaecologists, many of whom hold senior positions at their NHS hospitals and collectively bring a wealth of knowledge and expertise to London Gynaecology.

The cost of an appointment includes the following:

• A 30 minute appointment with a consultant gynaecologist
• Full history taking
• Blood pressure and BMI measurement
• Pelvic examination (if necessary)
• Recommendation for any required tests (tests are always charged in addition to the appointment)
• Detailed written report emailed or posted to you and your GP
• Explanation of results via letter
• Arrangement for prescription and onward referral if required
• Direct access for any urgent health concerns

Please see our fees page for details of pricing for our services.

Full details of pricing for services at London Gynaecology including outpatient procedures and self-pay packages can be found here.

Make an appointment

For appointments and enquires or to learn more about any of our services please call 0207 10 11 700  or email the team on [email protected]

How to Make Your Smear More Comfortable

Around 600,000 smear tests that would have normally been carried out in UK during April and May 2020 were cancelled or delayed due to Coronavirus. This does not include the. 1.5 million people who were overdue before the pandemic.'(Source: Jo’s Cervical Cancer Trust.)

It is extremely important to attend your regular cervical screening when due, it helps save approximately 5,000 lives a year.

We know that discomfort is a major factor in women putting off their smear, here are some tips to make your smear test more comfortable.

1. Listen to music or watch TV:  Nowadays with smart phones, watching a movie or listening to music or a podcast is easy to do in any location.  Take your headphones and your phone and get prepared to zone out.  And don’t worry, if you do forget your headphones ask the nurse if she minds you watching or listening anyway.

2. Equipment:  Ask, if available, for the nurse to use a plastic speculum or a small speculum.  Plastic is often warmer than metal and it’s clear so it’s easier for the nurse to see the cervix and a smaller speculum is more comfortable. They aren’t always available but don’t be afraid to ask.

3. Count from 1 to 100: Paula Radcliffe used to use this strategy towards the end of her marathon and many patients have found it useful. Often the smear is done well before you get to 50.

4. Paracetamol:  Take a dose of paracetamol 30 minutes before your smear which will take some of the discomfort away.

5. Numbing gel:  If all else fails, ask the nurse to use a small amount of numbing gel.  Previously there was a concern that the gel would affect the smear cytology but with liquid based cytology which is used nowadays a small amount of gel will not interfere with the quality.

Nurses understand that smears aren’t the most pleasurable of experiences and will often do as much as they can to help.  If your smear test is overdue, please don’t delay, book it today with your GP or gynaecologist.

Gynaecological Cancers: What you need to know

As today marks World Cancer Day, Consultant Gynaecologist and Gynaecological Oncologist Mr Saurabh Phadnis discusses the different types of gynaecological cancers, from how to recognise the early signs and symptoms to who is most at risk and how common they are amongst women.

What are the different types of gynaecological cancers? – How common are they?

Gynaecological organs include womb, cervix, fallopian tube/ovary, vagina and vulva. Cancer can arise from any of these organs.

Cancer of womb is the most common with 9,300 new cases every year, ovarian or fallopian tubal cancer 7,500 cases, cervix cancer 3,000 new cases. Whereas vulval and vaginal cancers are rare with 1,300 and 250 new cases every year respectively.

What are the early signs and symptoms?

The red flag symptoms of gynaecological cancers are:

• Unusual vaginal bleeding (bleeding after menopause, bleeding in between periods, bleeding after sexual intercourse
• Unusual vaginal discharge
• Abdominal bloating, pain, change in bowel or urinary habits
• Unusual swelling or ulcer on the vulva
• Weight loss or loss of appetite

Who is most at risk of developing a gynaecological cancer?

Some gynaecological cancers may be hereditary i.e. linked to faulty genes. Genetic testing is available to determine an individual’s risk.

• A faulty gene linked with Lynch Syndrome is associated with a lifetime risk of about 40-60% for developing womb cancer.
• Some other risk factors for womb cancer include obesity, diabetes, use of estrogen alone as hormone replacement and medication such as tamoxifen used in maintenance treatment of breast cancer.
• 10-15% of ovarian cancers are related to faulty genes such as BRCA1 and BRCA2.
• Presence of HPV infection is associated with cancer of cervix and vagina and may be associated with some cancers arising from the vulva.

I have some of the above symptoms and I’m worried. What should I do?

If you have symptoms, you should seek appropriate medical advice. Either visit your GP or you can make an appointment at London Gynaecology.

What is the survival rate?

Survival rate depend on the stage of cancer. For example, stage 1 cancer of uterus has the best survival rate of 99% at 5 years whereas stage 3 and 4 ovarian cancer 40% at 5 years.

What can I expect from a consultation?

A consultation will include history taking, examination and relevant investigation such as ultrasound scan of pelvis. Occasionally further investigations such as examination under anaesthesia are necessary for diagnosis or planning treatment.

Make an appointment:

If you have any concerns and would like to book a consultation with Mr Saurabh Phadnis or any other member of the London Gynaecology team, please call 0207 10 11 700 or email [email protected]

To learn more about Mr Saurabh Phadnis, visit his profile here

View Mr Saurabh Phadnis’s latest patient reviews

Understanding the new screening programme and what this means for you

Consultant Gynaecologist & Gynaecological Oncologist Mr Saurabh Phadnis at London Gynaecology helps to clarify the changes and addresses concerns surrounding cervical screening. Mr Phadnis answers a range of questions from what these changes mean for women, to revealing what the possible outcomes are following a screening, plus what it means to be HPV positive and what happens next if abnormal cells are found…

What changes have been made and when did this occur?  

 From April 2019, Primary HPV (Human Papillomavirus) screening was implemented in UK. This is new way of examining cervical smears, where the sample is checked for abnormal cells only if HPV is detected.

Why was this introduced?

Nearly all cervical cancers are caused by HPV infection. Screening for HPV is a better method for identifying those at a higher risk of developing cervical cancer. Also this reduces the need for further test such as colposcopy.

 What does this mean for women?

The actual test remains unchanged. Women still have a cervical smear. The benefit would be reduction in the number of women having unnecessary colposcopy examination.

Which means if high risk HPV is absent then chances of developing cervical cancer is extremely low. When you compare the pre-primary HPV screening era, many women were referred to colposcopy when the smear had borderline or low grade changes.

These will not be referred now on the basis of HPV negative smear and therefore reduction in colposcopy referral eventually. 

What happens during a cervical screening? How long does this take?

A cervical smear test involves vaginal examination to obtain cells from the cervix using a soft brush. It usually should not take more than 2-3 minutes.

What are the possible outcomes following a screening? What happens next?

If the screening smear is HPV negative, then the cervical smear is not checked for abnormal cells as the likelihood of one developing cancer is extremely low and recommendation is to repeat the cervical smear in 3 years.

If the screening smear is HPV positive, then the cervical smear is checked for abnormal smear. If no abnormal cells are found, recommendation is to repeat smear in 12 months. If abnormal cells are found then a special test called colposcopy is recommended. Colposcopy is simply examination of the cervix in detail using a telescope and special stains. It identifies if there is a precancerous area on the cervix. A biopsy from this area may be required for diagnosis.

Following a screening I’m HPV positive. Should I be worried and what should I do?

HPV infection is very common and does not need treatment. Most HPV infections are cleared by one’s immunity in approximately 2 years. HPV infection can cause genital warts, which may need treatment or abnormal cells from the cervix, which may need further investigation like colposcopy.

Make an appointment:

If you have any concerns and would like to book a consultation with Mr Saurabh Phadnis, please call our team on 0207 10 11 700 or email [email protected]

To learn more about Mr Saurabh Phadnis, visit his team profile here

View Mr Saurabh Phadnis’s latest patient reviews

Chia Seeds: Laura Southern reveals everything you need to know

Nutritional Therapist Laura Southern at London Gynaecology reveals everything you need to know about Chia seeds and why you should be sprinkling them onto your food.  Laura reveals their health benefits, from how they can help if you’re prone to constipation and irregular bowels to hormone issues.

You can read the full article in Women’s Health here.

A fantastic £17,643.25 raised for The Eve Appeal & Jo’s Trust

We are delighted to present The Eve Appeal and Jo’s Trust jointly with a cheque for £17,643.  Funds were raised by Consultant Gynaecologist Narendra Pisal running and completing the world’s oldest and largest marathon, the Comrades Ultra Marathon in South Africa in June.  Over the summer many patients and friends of London Gynaecology generously donated and sent messages of support and London Gynaecology matched the first £5000 raised.

The amount raised will be split between both charities and joining us on the day to collect the funds was Dan Joyce from Jo’s Trust and Becky Griffiths from The Eve Appeal.

Robert Music CEO of Jo’s Cervical Cancer Trust said, “We’re so grateful for Dr Narendra’s commitment to supporting Jo’s over the years, continually taking on incredible feats to raise money. Jo’s Cervical Cancer Trust is funded almost entirely by donations, so we rely on the generosity and enthusiasm of people like Dr Narendra.

The money raised will go a long way to ensuring we are able to support more people affected by cervical cancer and cell changes and be there when they need us most.”

Athena Lamnisos Chief Executive of The Eve Appeal said, “We are hugely grateful to Dr Pisal for taking on this incredible challenge and for raising over £18,000 for The Eve Appeal and Jo’s Cervical Cancer Trust. We would also like to extend a huge thank you to his colleagues, friends and patients who donated so generously.

The money that Dr Pisal has raised will enable us to continue to fund research into the prevention and earlier detection of gynaecological cancers, bringing us closer to our vision of a world where less women develop and more women survive these cancers.”

To find out more about how we support The Eve Appeal and Jo’s Trust along with the vital work they do, click here.

Consultant Gynaecologist Saurabh Phadnis Joins The Team

We are delighted to announce that Mr Saurabh Phadnis is joining the London Gynaecology team. 

Mr Phadnis is a Consultant Gynaecologist at The Royal London Hospital (Bartshealth NHS Trust), London. He completed his general gynaecology training in busy hospitals in the East of England and his subspecialty training in gynaecological oncology at Barts Gynaecological Cancer Centre.

His research included investigations into association of pregnancy related complications following treatment of precancer of cervix. He has won several prizes in national and international conferences. He was awarded the RCOG-Bernhard Baron Travelling fellowship to visit centre of excellence in Germany to expand his expertise in ovarian cancer surgery.

He is an expert in complex minimally invasive and open abdominal surgery. His particular interests include fertility preservation in gynaecological cancer, counselling and management of familial gynaecological cancer and advanced stage ovarian cancer cytoreduction surgery. He is an experienced hysteroscopic surgeon. He has more than 10 years of experience as a colposcopist and is an accredited trainer with the BSCCP.

Mr Phadnis believes in holistic and individualised approach to patient care.

If you would like to book an appointment with Mr Phadnis, please call 0207 10 11 700 or email [email protected].

Mr Pisal’s Comrades Ultra Marathon Story

On Sunday, Consultant Gynaecologist Narendra Pisal ran the Comrades Ultra Marathon in South Africa in aid of The Eve Appeal and Jo’s Cervical Cancer Trust. So far, he has raised over £13,000 thanks to the incredibly grateful donations of family, friends, patients and colleagues. It is still possible to donate, and if you would like to, please click here.

Below, Mr Pisal recounts his full Comrades experience from start to finish, explaining his sources of motivation and how he kept going during the most difficult parts of the race:

Runners are often trying to find the next challenge. While driving to work one day, I was listening to Marathon Talk podcast presenter Tom Williams and his 73yr old dad Brian doing the Comrades this year and then was chatting the same day to Simpi, my surgical assistant whose brother in law was doing it for the 30th time this year! It was the same day the entries were opening up and I thought the serendipity of all that was pointing towards me doing this ultimate human race.

When I told Karen Weir (of runwithkaren), she was not phased. She had done Comrades in the infamous 2013 race and knew exactly what to do.

We started training with back to back long runs and I was astonished to get a 8min30sec PB (3:43) in Manchester Marathon in April which was only a training B-race. My foot kept hurting after that and I was sadly diagnosed with a stress fracture in cuboid bone of right foot. We were seven weeks from the start of Comrades. This was a devastating blow and I thought my challenge was over before it had started.

I was fortunate enough to get some very sensible orthopaedic advice from my mate and ace foot and ankle surgeon, Mr Pinak Ray. He said no impact, but ok to cross train. Karen chalked out a cross training plan for me which included rowing, spinning and use of a cross trainer. At this stage I still didn’t know if I was going to do it.

19th May was a Sunday when most other Comrades runners were starting their taper. I had missed a 4weeks chunk of running and started tentatively with a half marathon in Hackney (Thank you Julia Henderson). I ran that at a sensible pace chatting to Amara Hughes and was relatively pain-free in my foot (in runner speak it means ‘hurts like hell, but a morphine shot was not needed’). We then decided to go for it and Karen gave me double weekend workouts with long run-walks on Saturday followed by epic long walks on Sunday. Pradnya my wife would cycle around Regents Park (she is training for London-Surrey 100mile bike race) to accompany my walks at 5am! Simon Tanner joined me last Sunday and we had a great walk talking about life, work and politics!

Marta Solova who is an amazing sports massage therapist and Darran Marshalleck my personal trainer also kept me in reasonable shape when I was off my feet. I was so fortunate to be supported by these expert professionals in Karen, Marta and Darran. Couldn’t have done it without you guys! Your experience of working with injured athletes and still getting them race ready in time was so instrumental.

Meanwhile, Emma Orman and Florence were getting a campaign ready for using this as a platform for raising much needed money for cancer. We selected two charities that are doing amazing work in the field of women’s cancers (Jo’s Cervical Cancer Trust and Eve Appeal). The response from my friends, colleagues and patients was simple astounding. My private practice (London-Gynaecology.com) also decided to put in 5000£ and to date we have raised over 13000£. I am so amazed and indebted by the kindness and generosity of so many people. Really humbled. Thank you so much, it means a lot!

We arrived in Durban with hope rather than confidence. We knew that ‘DNF’ (did not finish) was a real possibility but we thought it was better than ‘DNS’ (did not start). I was constantly chatting to Rob and Mike who between them have done 12 Comrades and their experience, advice and detailed race strategy was enormously helpful on the race day. I also spoke at length to my son Rohit who has successfully completed two Ironmans in very challenging circumstances and he gave me some very useful tips about mental strength. He said sometimes in a race, you have to have a word with yourself and tell yourself why you are there and stop feeling sorry for yourself. It is always a choice and quitters don’t win. That advice was needed in the first 10k itself of this 87k ultramarathon where I had to have a very strong word with myself.

In South Africa, I met so many legends! I met the above-mentioned Tom and Brian Williams. Tom has been a legendary celebrity in my eyes as he along with Martin Yelling has done nearly 500 marathon talk podcasts and I have listened to them regularly over last 3-4 years. I met Bruce Fordyce who won the Comrades nine times in the 80s and I was fortunate enough to go on his bus tour of the route and benefit from his advice. I met Coach Parry whose Comrades podcasts I have been listening to and benefitted from his advice too. Finally I also met Jamie, co-founder of Runderwear, who is doing so much to make life easy for us long distance runners. I also met Isaac, Simpi’s iconic brother in law who was doing his 30th Comrades (triple green number).

On the race day, we got up at 3:15am, had a jungle-oats porridge at the hotel and walked 10 minutes to the start. The start of this race is spectacular and I was really pumped up after listening to Shosholoza, Chariots of fire and Cockerel followed by the gunshot. The race had started! I was in D-pen having qualified with a marathon time of 3:43 but was soon overtaken by EFGH runners as I was planning to start very conservatively.

The up run is famous for the hills. You have to climb more elevation than when you go up Ben Navis and the hills hit you right from the beginning. For some reason my (fractured) right foot went completely numb and I had to resort to walking in the first few km itself as I could not feel the foot landing and was afraid of falling. I then started getting shin pains and had to stop and massage those out. That was the first time I had to have a strong word with myself. I decided to go even slower than my planned pace and follow my plan C. This was to run at a pace just below the cut off pace. This was a dicey plan but I could not have sustained a faster pace.

In Comrades, there are six cut offs and you have to get to those points before a certain time. The time allowed is gun to gun 12 hours to finish this iconic 87km race with over 2000m of elevation. I made all the cut offs (obviously) but only by a few minutes and ended up giving palpitations to all my friends and family who were live-tracking me.

I decided (was forced) to walk all the hills and run all the flats and down-hills. This was again a risky strategy as the downhills come in the second half of the race and I had never run more than 42k even in training (I ended up missing all those long runs post-marathon). But I felt I had no other choice on the day. I had also suffered from flu in the week of the race and my strength must have taken a battering.

During the race, I was so excited to see Pradnya and Rohit five times! They carried a helium balloon with them and I could spot them from a long distance away. I talked to them, received my drinks and nutrition and also got much-needed motivation. One thing I got right in this race was nutrition and hydration and I could keep the cramps away (mostly). One time I was troubled by calf cramps, there was a spectator just there ready with a deep heat spray!

The atmosphere and spectator support throughout the 87k was nothing short of amazing. The whole population of South Africa appeared to be on the route of Comrades singing, shouting names, offering all sorts of food from boiled salted potatoes to barbecued meat to crisps and sandwiches. Water was provided in plastic sachets which meant I could drink from a corner but also use it as my personal hand-held shower! When I needed some Vaseline (don’t ask why), a lady took out one of the biggest tubs of Vaseline I have ever seen! There was coke, cream-soda and ice-cream! It was one long street party!! Thank you South Africa for making it so special.

Meanwhile, my running was going steady. I got into my rhythm and kept going. I was warned about the cats eyes but ended up tripping badly in the early part of the race. This was rather lucky as my aching muscles suddenly stopped hurting as the grazed knee and hands were hurting more!

My Garmin watch was amazing! I was tracking my average race-pace and keeping it as close to 8km/hr as possible. This gave me a 15sec/km cushion for the cut offs. This cushion was much needed in the latter part of the race. Thanks to a technician in the Garmin stand at the expo who had kindly switched off all nonessential functions such as heart rate monitor to vibrating alerts, the battery lasted the whole distance. It could have been a disaster otherwise.

About 15km from the finish-line I was woken up from my slumber when I was overtaken by the 12-hour bus. Buses are groups of runners following an experienced pacer who keeps them motivated and gets them to the finish line. Being overtaken by a bus at 12hr pace meant that I was going to be swept off at the next cut off on top of a nasty hill called Polly’s Short. That’s when I had to have another strong word with myself and get my act together. I made the cut off with just a few minutes to spare. Luckily it’s all downhill from there and I was so excited to see Pradnya and Rohit 2km from finish line. I hugged them and said ‘I have got this!’. I then had the luxury of high-fiving pretty much every spectator in the impressive stadium finish. I had tears in my eyes as I completed this ultimate human race 11:53 with just 7 minutes to spare. I didn’t think it was possible before the race and at so many times during the race. Your mind is stronger than your body and this was an example of my mind carrying my broken body over the finish line.

During the race, I was thinking of my cancer patients. The challenge they face is much much greater than mine. I ask them to focus on the next step and trust the process. Good nutrition, good hydration and positive mental attitude in addition to professional help and strong support from family, friends and colleagues is what you need. I had all of the above on the day and for that I am eternally grateful. This was one of the hardest but also one of the best days of my life.