Gynaecology Consultation Note

Gynaecology Consultation Note Issues: * Pelvic organ prolapse (POP) with reported sensation of a bulge. * Stress urinary incontinence (SUI). * Anterior vaginal wall prolapse – Grade 2; Uterine prolapse – Grade 1. * Previous laparoscopic appendectomy (2010). Plan: * Proceed with pelvic floor physiotherapy (PFP) for 12 weeks. * Prescribe Ovestin cream 0.5mg/g, apply twice weekly. * Discuss surgical options for prolapse and SUI if PFP is unsuccessful, including sacrohysteropexy and tension-free vaginal tape (TVT) procedure. * Refer for urodynamic studies. Age: 58 years Gynaecology History: * Hysterectomy for fibroids in 2005. * Gravida 2, Parity 2 (two successful full-term vaginal deliveries in 1990 and 1993). Gynaecology Issues: * "Something coming down" sensation in the vagina for the past 6 months, worse with standing and coughing. * Leaking urine with coughs, sneezes, and exercise (SUI). * No dyspareunia or abnormal bleeding. Abdo infxn/surgeries: * Laparoscopic appendectomy (2010) – uneventful recovery. * No history of abdominal infections. Medications: * Lisinopril 10mg daily for hypertension. * Atorvastatin 20mg daily for hyperlipidaemia. Other Medical Conditions: * Hypertension (diagnosed 2015) – well-controlled. * Hyperlipidaemia (diagnosed 2018) – stable. Social: * Lives with husband. * Sexually active. * Attends Pilates classes twice a week. * No caregiving responsibilities. Examination: * Pelvic examination: Anterior vaginal wall prolapse Grade 2, Uterine prolapse Grade 1. Perineal body intact. Good anal tone. Vaginal mucosa healthy. * Stress test positive for urine leakage with cough.