Bowel cancer is a term used to describe cancer in the colon, rectum or the small bowel.

The symptoms of bowel cancer can include:

• Bleeding from the back passage (rectum) or blood in your stools
• A change in normal bowel habits to diarrhoea or looser stools, lasting longer than 4 to 6 weeks
• A lump that your doctor can feel in your back passage or abdomen (more commonly on the right side)
• A feeling of needing to strain in your back passage (as if you needed to pass a bowel motion)
• Losing weight
• Pain in your abdomen or back passage
• A lower than normal level of red blood cells (anaemia)
• Because bowel tumours can bleed, cancer of the bowel often causes a shortage of red blood cells. This is called anaemia and may cause tiredness and sometimes breathlessness.

Bowel cancer screening

How do I get a screening kit?

If you are aged 60-69 years, you will be sent your screening invitation automatically through the post. All you need to do is make sure that your GP has your correct address.

‘People aged 70 years and over or under the age of 60, who wish to be screened, should request a kit. Simply telephone the free helpline on 0800 707 60 60.’

Macmillan cancer support

Have questions about cancer? Visit www.macmillan.org.uk or call 0808 808 000 free (Monday to Friday 9am – 8pm).

Although still rare compared to other cancers, testicular cancer is the most common cancer in men aged between 15-45 years with around 2,200-2,300 men being diagnosed each year. It is more common in Caucasian males.

If found at an early stage a cure rate of 98% is usually possible and even when testicular cancer has spread to other areas of the body cure can still be achieved. In fact according to recent research overall 96% of men diagnosed with any stage testicular cancer will be alive 10 years after treatment.

It is important to visit your GP as soon as you notice any lump or swelling on your testicle. Your GP will examine your testicles to help determine whether or not the lump is cancerous.

Symptoms

The earliest warning signs of testicular cancer usually include the following:

• A change in size or shape of a testicle.
• Swelling or thickening of a testicle.
• A firm, smooth, initially painless, slow-growing lump or hardness in a testicle.
• A feeling of testicular heaviness.

Useful Links

Self-Examination Guide

Testicular Cancer Facts

Orchid – Fighting Male Cancer

Your Privates – Testicular Cancer Awareness

New Pregnancy

You can choose to refer yourself directly to the antenatal services, rather than via your GP. The information you provide will be placed in your medical records and only accessed by staff involved in your care.

Please choose a hospital to link to the relevant self-referral form:

St George’s Hospital antenatal self-referral 

King’s College Hospital antenatal self-referral 

Guy’s and St Thomas’ antenatal self-referral 

Chelsea and Westminster antenatal

Antenatal Care

If you are planning a pregnancy, please book a routine appointment to see a nurse for health advice, preferably three months before you start trying for a baby. In particular, we suggest a check for immunity for German measles (rubella) and that all women are taking folic acid.

If you know you are pregnant (a home test is very accurate).  We usually provide shared care with your hospital.  You can self-refer to the above hospital of your choice once your test is confirmed positive.  Once self-referred, you will be contacted by the hospital midwife for further appointment and care.

Post-natal & 8 Week Checks

Following the birth of your baby, we combine your baby’s check with your own post-natal check when your baby is 8 weeks old.  The doctor sees you and your baby first for a postnatal and a full developmental check, followed by an appointment with a practice nurse who checks your baby’s growth and gives their first immunisations.

These appointments are scheduled by our Maternity Administrator, who contacts parents directly to arrange date & time, and must not be booked on-line.  If you have had a Caesarean, and need a post-natal at 6 weeks, please let our Maternity Administrator know.

Further information on Health Visiting services can be found here.

Health Visiting Services

Additional resources

BRITISH PREGNANCY ADVISORY SERVICES (BPAS)

MARIE STOPES

Telephone: 0345 300 8090

Helping people with their reproductive health options for over 40 years. They provide NHS-funded and self-funded abortion and vasectomy care through a network of local clinics all over England.

Booking and advice line is available 24 hours a day, 7 days a week.

FIND YOUR NEAREST ANTENATAL SUPPORT SERVICES

Contraception is free for most people in the UK. With 15 methods to choose from, you will find one that suits you.

Contraceptive methods allow you to choose when and if you want to have a baby, but they do not protect you from sexually transmitted infections (STIs).

Condoms help to protect against STIs and pregnancy, so whatever other method of contraception you are using to prevent pregnancy, use condoms as well to protect your and your partner’s health.

The Practice provides you with contraceptives (it is a free prescription), and we offer long acting reversible contraception (LARC) such as Coil (IUD/ISU), injection and implant.  We also provide service to remove and /or replace these if you wish to change your type of contraception.

All of these types of contraception including IUD/S are available to you regardless of you have been pregnant before.

The methods of contraception

There are lots of methods to choose from, so do not be put off if the first thing you use is not quite right for you, you can try another. You can read about each of the different methods of contraception by visiting these pages:

• Combined pill
• Condoms
• Contraceptive implant
• Contraceptive injection
• Contraceptive patch
• Diaphragms and caps
• Intrauterine device (IUD)
• Intrauterine system (IUS)
• Natural family planning
• Progestogen-only pill
• Vaginal ring

Emergency contraception (morning after pill)

Emergency contraception (morning after pill) which prevent pregnancy after unprotected sex. These pills are effective for up to 72 hours after unprotected sex.

These also can be obtained from your local pharmacy.

Coil fitting/removal service

Dr. Ismat Nasiruddin runs a Coil Fitting Clinic on a weekly basis. We also fit and remove and counsel regarding subdermal contraceptive implants. The schedule is subject to changes according to staff availability.

Please note that Reception cannot book you in directly to these clinics, but will add you onto the waiting list and a member of the team will contact you to book the appointment in due course.

Please be aware that we cannot fit a coil if you have had unprotected intercourse since your last period, or if there is any possibility of pregnancy, unless fitting a copper coil for emergency contraception.

Dr Nasiruddin advises taking 2 x 500mg Paracetamol and 2 x 200mg Ibuprofen before attending the surgery for a coil fitting. She will run through the fitting procedure in detail at the appointment.

Useful links

More information on copper coils at NHS.uk

More information on the Mirena coil NHS.uk

Sexual Transmitted Infections (STIs)

It is important to look after your sexual health whatever your age. Safer sex means protecting yourself and your partners from unwanted pregnancies and from catching STIs.

If you are sexually active, you may be at risk of catching an STI (also known as a STD). Practising safer sex and always using a condom reduces the risk of infection and pregnancy.

If you think you may have an STI we would advise you to get tested.

Where to get a test?

Visit Sexual Health South West London for a full list of clinics across Wandsworth, Richmond and Merton.

There are six clinics across the three boroughs, offering contraception and sexual health testing, treatment and advice and are opened for six days a week including Saturdays. The services provided in these clinics are free and confidential. You can book an appointment yourself or attend in an emergency. You do not need your GP to refer you for care, nor do you need to live locally.

You can also call the booking and advice line on 0333 300 2100 to check which clinic you should use. Lines are open 8am to 8pm Monday to Friday and on Saturday mornings. A recorded message gives useful information outside of these hours.

You can also find other clinics and services near you on the NHS Choices website.

Useful Links

• Sex & Young People
• STIs (Sexually Transmitted Infections)
• Sexual Health Facts
• Netdoctor – Sex & Relationships

• The National Chlamydia Screening Programme (under-25s) has more
• NHS UK Chlamydia

Sexual health advice for young people

Getting it on offers information for young people aged 13 to 19 about sexual health and drug and alcohol services in South West London.

Young people under the age of 25 can get free condoms from the Come Correct scheme available across a number of boroughs in London, and those aged between 16 and 24 can get a free chlamydia test.

To facilitate young people’s access to condoms and STI testing, METRO has introduced a new online service for under 25s living in Richmond and Wandsworth to order free condoms, lube and chlamydia tests.

Your local pharmacy 

Young peoples services in pharmacies provide free condoms and chlamydia testing for under 25s.

What is Cervical Screening?

Cervical screening, or the ‘smear test’, is a routine health check that identifies potentially harmful cells and changes on the cervix. Cervical screening is not a test for cancer but catching any changes early can reduce your risk of developing cervical cancer. Cervical cancer kills two women every day. Regular screenings can help reduce that number, which is why it’s so important you attend your screening when invited.

Who is the screening for?

If you are a woman, or someone with a cervix, you will be invited for your cervical screening at regular intervals:

• If you’re aged 25-49, you’ll be invited every 3 years
• If you’re aged 50-64, you’ll be invited every 5 years

It is advisable you have regular cervical screenings, but ultimately, it is your choice whether you attend.

What happens during cervical screening?

Your screening will only take a minute or two, the whole appointment usually takes around fifteen minutes. During your screening, a nurse will give you a private space in which to undress from the waist down. They will also give you a paper sheet to cover yourself and will ask you to lie on the bed. They’ll then place a speculum (a hollow cylinder with a rounded edge) in your vagina. This helps them see your cervix. Then, using a small brush, they’ll gently gather some cells from your cervix. They’ll remove the speculum, put your sample in a pot and send it off for testing. You’ll get your results around two weeks later.

Your appointment

The nurse is there to answer any questions or concerns you may have before your appointment, so please talk to them if you are feeling nervous. There are also a range of things you can do to put yourself at ease during your screening:

• If you would like, you can take a trusted friend or family member with you
• Wear a long, loose dress or skirt. It may make you feel more covered during your screening
• Take long, deep breaths to help you relax
• Listen to a podcast or some music during your screening to put you at ease
• Speculums come in a range of different sizes. It is a rounded cylinder which is gently opened so nurses can see your cervix. You may want to discuss the size of the speculum with the nurse before you have the test.

If you are due to have a cervical screening, you will receive a letter in the post. Do not ignore it book your cervical screening with your GP practice today. If you are unsure on whether you are due in for a smear test, you can contact the practice and our reception team will be able to check the last time you had your smear test done.

How to book your cervical screening appointment

If you are due a cervical smear, you can now book by contacting our reception team on 0208 675 3521.

Why are women under 25 not invited?

This is because changes in the young cervix are normal. If they were thought to be abnormal this could lead to unnecessary treatment which could have consequences for women’s childbearing. Any abnormal changes can be easily picked up and treated from the age of 25. Rarely, younger women experience symptoms such as unexpected bleeding or bleeding after intercourse. In this case they should see their GP for advice.

Why are women over 65 not invited?

Women aged 65 and over who have had three consecutive negative results are taken out of the call recall system. The natural history and progression of cervical cancer means it is highly unlikely that such women will go on to develop the disease. Women aged 65 and over who have never had a test are entitled to one.

What about women who are not sexually active?

The NHS Cervical Screening Programme invites all women between the ages of 25 and 64 for cervical screening. But if a woman has never been sexually active with a man, then the research evidence shows that her chance of developing cervical cancer is very low indeed. We do not say no risk, only very low risk. In these circumstances, a woman might choose to decline the invitation for cervical screening on this occasion. If a woman is not currently sexually active but has had male partners in the past, then we would recommend that she continues screening.

Human Papilloma Virus (HPV)

How human papillomavirus (HPV) is spread?

Many types of HPV affect the mouth, throat or genital area. They’re easy to catch.

You do not need to have penetrative sex.

You can get HPV from:

• any skin-to-skin contact of the genital area
• vaginal, anal or oral sex
• sharing sex toys

HPV has no symptoms, so you may not know if you have it.

It’s very common. Most people will get some type of HPV in their life.

Important – You do not have to have sexual contact with a lot of people to get HPV. You can get HPV the first time you’re sexually active.

How to protect yourself against human papillomavirus (HPV)

You cannot fully protect yourself against HPV, but there are things that can help.

• Condoms can help protect you against HPV, but they do not cover all the skin around your genitals, so you’re not fully protected.
• The HPV vaccine protects against the types of HPV that cause most cases of genital warts and cervical cancer, as well as some other cancers. It does not protect against all types of HPV.

For more information, please click here.