Acceptability of using the Raising Awareness Tool for Endometriosis (RATE) in general practice: a mixed methods pilot study.

AIMS: The Raising Awareness Tool for Endometriosis (RATE) was developed to facilitate discussions with health providers regarding endometriosis-associated symptoms. We aim to evaluate the acceptability of the RATE by general practitioners (GP), including determining the prevalence of symptoms of women presenting to general practice and immediate management of symptoms. METHODS: A mixed-methods study was undertaken using a combination of quantitative and qualitative data in Western Australian General Practices from 2021 to 2022. A purposive sample of 12 GPs were included, who recruited women (18-50 years) on attendance for consultation over a one- to two-week period, followed by qualitative interviews exploring GPs' experiences with the tool. The quantitative and qualitative components were integrated during analysis of results. RESULTS: A total of 111 women completed the RATE (mean: 33, standard deviation: 8.6 years) prior to routine consultation. The tool was considered to be acceptable for use in general practice and aided discussions on symptoms and management. Overall, 68.5% of patients experienced pelvic pain or discomfort, with 22.4% rating that this interfered with quality of life. Of those with pelvic pain, 75% had associated chronic pain conditions, and 42.1% reported allodynia. The chronic pain questions provoked GP uncertainty. After symptoms were identified, GPs arranged individualised investigations and follow-up. CONCLUSIONS: The RATE was considered to be acceptable for use in the general practice setting. It identified symptoms and initiated discussions on possible diagnosis as well as management of endometriosis. Further GP education on identifying those women at most risk of developing chronic pain syndromes is needed.

Challenges in diagnosing and managing endometriosis in general practice: A Western Australian qualitative study.

BACKGROUND AND OBJECTIVES: To reduce diagnostic delay for women with endometriosis-related symptoms, we need to understand general practitioners' (GPs) perspectives on the challenges they face in diagnosing and managing endometriosis. METHOD: Qualitative interviews were conducted with nine Western Australian GPs to explore their knowledge, experiences and challenges with the diagnosis and management of endometriosis. RESULTS: Three themes were identified as challenges: eliciting symptoms, with subthemes of multiple and complex symptoms, clinician experience and awareness, time constraints and screening opportunities; delivering patient-centred care, with subthemes of cultural factors and health literary, perceived gender biases and women's choices and priorities; and system and service, which included learning on the job, clearer diagnostic pathways, access to services and collaborative care models. DISCUSSION: GPs can be better supported in dealing with endometriosis through raising awareness and education; recognition of endometriosis as a complex chronic condition; and the development of pragmatic guidelines, with increased access to local centres for excellent and collaborative care.

'Everything's neatly tucked away': young women's views on desirable vulval anatomy.

In the context of rapidly increasing requests for female genital cosmetic surgery (FGCS) and a lack of published research in this area, we explored young women's knowledge of vulval anatomy and sources of anatomical information. We conducted 21 semi-structured interviews with young women aged 18-28 years at an Australian tertiary institution. Interviews explored participants' knowledge of 'normal' and 'ideal' genital anatomy and how these perceptions were formed. Interviews were recorded, transcribed and analysis identified 6 major themes and 30 sub-themes. We found that many women were unsure what constitutes normal genital anatomy. Few women knew to which parts the word vulva refers. All participants identified a photograph of hairless female genitals with no visible labia minora as the societal 'ideal', and all strongly agreed on the need for appropriate educational resources. Young women would benefit from access to resources showing the normal range of genital anatomy. Results suggest that doctors receiving requests for FGCS should explore women's understanding of their anatomy and what they believe the surgery will achieve. Some young women may simply need reassurance of their normality. Findings from this study may contribute to educational material for both health professionals and young people.

Female genital cosmetic surgery: Investigating the role of the general practitioner.

BACKGROUND: Labiaplasty, the surgical reduction of the labia minora, has significantly increased in demand in Australia. Although general practice is one gatekeeper for patients requesting labiaplasty, as a referral is necessary to claim Medicare entitlements, there is little information available to assist general practitioners (GPs) in managing these requests for female genital cosmetic surgery. METHODS: Semi-structured interviews were conducted with health professionals, including GPs, gynaecologists and plastic surgeons. Participants were recruited through the Victorian Primary Care Practice-based Research Network (VicReN), clinical teaching hospitals and snowball sampling. All interviews were digitally recorded, transcribed, and analysed using content and thematic analysis. RESULTS: Twenty-seven interviews were conducted. All participants were aware of genital labiaplasty; many had patients who were concerned about genital appearance, for which information had often been sought opportunistically. All participants agreed on the need for resources to inform women of normal genital appearance. DISCUSSION: This novel study demonstrates a need for clinical resources for GPs managing requests for genital labiaplasty.