Well woman Clinics and Gynaecology

The symptoms and pathologies that affect he health of the female reproductive system must be diagnosed and treated by a doctor specialised in Gynaecology. A Gynaecologist must perform routine well woman clinics, one of the pillars of modern preventive medicine. But it is also the specialist dealing with breast disease, cancer of the reproductive organs, fertility problems, menopausal disorders, or female contraception. At our Clinic we specialize in all aspects of Gynaecology, from well woman checks through to a wide range of screening tests and gynaecological surgery.

Well-Woman Clinic. What does it include?.

Dr. Berral Ginecólogo - Revisión ginecológica anual The annual well woman check-up is a one-stop clinic in which we conduct a number of screenings and tests to investigate and diagnose a variety of gynaecological conditions affecting the genital tract and reproductive system of women. Its aim is the prevention or early diagnosis of:

  • Gynaecological cancer (cervix, uterus, ovaries, vagina or vulva).
  • Breast cancer.
  • Sexually Transmitted Diseases.
  • Other diseases whose symptoms and consequences may have an impact on women's present and future health: infections of the vulva or the vagina, menstrual disorders, diseases of the ovaries, genital prolapse, urinary incontinence, etc.

An essential part of this review is the evaluation of individual risk factors with a view to recommending guidelines that promote sexual health.

All women over 18 or sexually active should have a routine annual well woman check-up. In the case of women being suffering from any Gynaecological problem already diagnosed, the frequency of the check-ups must be adapted to the follow up of the problem. Gynaecological check-up must be maintained even after the menopause. The timing must then be adapted to each woman's age, risk factors and gynaecological history.

Dr. Berral Ginecólogo - Revisión ginecológica anual Our well woman clinics include:

  • Gynaecological Clinic, where your medical history is taken and any issues of concern are addressed (contraception, fertility, infectious diseases, etc, etc.).
  • Complete examination of the cervix with colposcopy and cervical smear test for the early detection of cervical and other gynaecological cancers.
  • Ultrasound scans of the cervix, uterus and ovaries using combined 2D/3D and colour Doppler examination.
  • Breast examination
  • A wide range of gynaecological specific tests can be carried out on site when required (hormonal studies, blood and urine tests, cervical swabs and biopsies, etc.).

A postnatal check-up is recommended six weeks after giving birth.

The complete check-up takes about an hour.  .

General Gynaecological problems. Gynaecology Endocrine problems in the pubertal age and reproductive age: Painful Periods. Other Gynaecological Problems, ...

Dr. Berral Ginecólogo - General Gynaecological problems. Gynaecology Endocrine problems in the pubertal age and reproductive age A Gynaecological clinic and check-up is required if you suffer form any of these problems:

  • Irregular, painful or very abundant menstrual cycles.
  • Vaginal bleeding outside the menstrual cycle.
  • Premenstrual tension syndrome.
  • Amenorrhea (unjustified lack of periods).
  • Breast or genital lumps.
  • Any vaginal infection caused by Candida, bacteria, trichomonas, or other agents.
  • Any other symptoms that you find worrying or that somehow rest you quality of life.

These and other gynaecologicalproblems are very common and can be treated sucessfully. They must be diagnosed properly and treated promptly so that they do not become chronic or recurring problems. Some gynaecological infections can also leave serious sequels that affect fertility.

Dr. Berral Ginecólogo - General Gynaecological problems. Gynaecology Endocrine problems in the pubertal age and reproductive age Most of the times an ultrasound scan, smear test or vaginal swab are sufficient to diagnose and treat the problem. On other occasions certain diagnostic tests for specific diseases are needed -colposcopy with directed cytology, hysteroscopy, breast cytology, cervical biopsy, or HPV typing. Our centre is equipped to carry out these and other outpatient tests. We also offer pathology and laboratory services for the analysis of tests and screenings required.

Gynaecological Infections. Sexually Transmitted Diseases (STD).

Vaginal infections are a very common problem that can affect any woman regardless of her age or sexual life. These are caused by various agents that need to be diagnosed and treated. One of the most common symptoms of infectious gynaecological diseases is an increase or alteration of vaginal discharge. Physiologically vaginal discharge can be increased during ovulation, just before menstruation and in pregnancy.

A discharge increment can also be caused by an infection for:

  • Candidas.
  • Bacterial vaginosis (BV).
  • A variety of infectious agents such as those that cause Gonorrhea, Trichomonas or Chlamydia.

These infections can also lead to changes in the appearance of vaginal discharge and symptoms like stinging, itching, burning sensation and discomfort. An accurate diagnosis of these infections requires a physical examination and the appropriate microbiological studies to identify the causing agent.

Some infectious diseases are transmitted through sexual contact. These pathologies are known as STD (Sexually Transmitted Diseases) (Enfermedades de Transmisión Sexual). Such are the cases of Chlamydia, Gonorrhea, HIV (AIDS), herpes, HPV (Human Papilloma Virus), and others. Sometimes the symptoms secondary to the infection are mild and can even pass unobserved. The untreated infections can cause irreversible damage to the fallopian tubes, such as the tubal factor infertility caused by chlamydia and other agents, cancerous lesions (HPV), and other medical problems of importance (Hepatitis or AIDS).

Women or couples that think they might been at risk of contrating a STD should undergo a STD screening. A specific clinic for the detection and treatment of STDs does include the assessment and examination of the patients and a number of tests when indicated, including

  • Swabs for the screening of Gonorrhea, Trichomonas, Candidas, etc.
  • Specific tests for the screening of Chlamydia.
  • Cervico-vaginal cytology. Colposcopic assessment of the cervix and smear test for the detection of HPV. HPV testing and typing.
  • When required, specific tests for the screening of others STDs are done, ie: serology for HIV, hepatitis B and C, and others.

Early diagnosis of gynaecological cancer.

Most of the resources used nowadays in women's healthcare clinics are aimed at the early diagnosis and treatment of gynecological cancers. At our Center we offer an exhaustive programme for the prevention of gynaecological cancer according to the latest scientific evidence and using the most innovative technology available, including three-dimensional (3D) and Doppler ultrasound, colposcopy and diagnostic hysteroscopy.

Most of the resources used nowadays in women's healthcare clinics are aimed at the early diagnosis and treatment of gynecological cancers. At our Center we offer an exhaustive programme for the prevention of gynaecological cancer according to the latest scientific evidence and using the most innovative technology available, including three-dimensional (3D) and Doppler ultrasound, colposcopy and diagnostic hysteroscopy.

The early diagnosis of cancer of cervix is best achieved with the conjunction of an annual smear test and the colposcopic examination of the cervix. We conduct both screenings together because it is known that smear tests on their own does not have a 100% detection rate in women who have been already infected.

The origin of cervical cancer is directly related to an infection of the female genital tract caused by different types of human papilloma virus (HPV), a family of viruses of which we know that the types 16, 18, 31 and 35 are the most dangerous. When a HPV infection is detected in the course of a check-up, special tests can be carried out to establish which particular type of the virus is affecting the patient. This is called HPV typing, and provides information about the risk, in each particular case, of developing cancer of the cervix.

The knowledge that there was a cause-effect relationship between HPV and cervical cancer has made possible the development of a vaccine to immunize with a protection rate of up to 90%. This vaccine, recently launched in Spain, can be administered at the Clinic.

Endometrial cancer can be diagnosed using a vaginal ultrasound which values the thickening and vascular characteristics of the endometrial lining. The endometrium is the tissue that covers the uterine cavity and is released with every menstrual period. This examination is particularly important for women between 45 and 55 years old with very irregular cycles, and for those who suffer post-menopausal vaginal bleedings. When the ultrasound images obtained are suggestive of endometrial disorders, a diagnostic hysteroscopy and biopsy must be carried out. A hysteroscopy allows the direct examination of the endometrial cavity and the release of samples of endometrial tissue that will be analysed. Ambulatory diagnostic hysteroscopies and biopsies can be performed at our Center when required.

Ovarian cancer is the pathology whose early diagnosis is more complicated given the absence of specific changes to the ovary that allow its screening in the initial stages. It is known, however, that its incidence increases after the menopause. The screening currently performed consists of the scanning of both ovaries with high definition and Doppler ultrasound to assess the ovarian vessels and detect any changes caused by the formation of new vessels, linked to ovarian cancer. The ultrasound study is completed with the determination of certain blood markers whose rise may alert about a possible cancerous ovarian growth.

The early diagnosis of breast cancer should be procured with both the self-examination of women, which is recommended every month in the days that follow the menstrual period, and with the doctor's examination and breast scans, that are normally carried out in the course of your annual check-up. A physical examination by a specialist doctor is necessary if a lump appears in the breast or armpit area, if there are changes in the skin colour or the shape of the breast, or if you observe any other suspicious alteration.

The exploration by mammography is recommended at least once between 35 and 40 years of age and then annually for women aged 40 to 50. If the patient has a history of breast cancer in first-degree relatives (mother or sister) breast scans must begin at least 10 years before the age at which your relative was diagnosed.

Other gynaecological pathologies are the vulvar and vaginal cancers. These are normally detected through changes in the skin colour or texture, lesions that bleed, and other symptoms that can be detected by women or in the course of a well woman clinic.


When it comes to choosing a contraceptive method it is important to be illustrated about the wide range available and to understand which one will suit you better. The general health of a woman, her lifestyle or her personal preferences will finally determine the use of one method or another. The method of your choice must be reliable and safe as a contraceptive and also for your overall health, and should meet your needs present and future.

Dr. Berral Ginecólogo - Contraception The use of hormonal contraception in any of its various forms -pills, patches or rings-, and the intrauterine devices, coils, hormonal or not, require the advice and intervention of a specialist. Some aspects of your health may be affected by the use of certain methods of contraception: blood pressure, varicose veins, history of migraines, infectious diseases of the fallopian tubes, smoking habit, etc. It is therefore important to understand the ovarian cycle and the implications in terms of safety and use of the different methods. The decision, once informed about the options that best her age and health conditions, should fall mainly on the part of the woman.

Contraceptive methods can be classified into hormonal and non-hormonal. The hormonal forms of contraception have evolved both in the dosage and the forms of administration. The birth control pills now available offer the options of lower and better tolerated doses. The arrival of contraceptive patches, subcutaneous hormonal implants, or vaginal rings, have also widen the options of women. These are all very innovative methods, very reliable and well accepted. The coils, traditional or Mirena, are other popular options. They are usually required by women who which to postpone a pregnancy for a longer period.

The surgical techniques for female sterilization enjoy wide acceptance. The tubal ligation (ligation of the two fallopian tubes) continues to be the preferred choice for those women who have completed their families. This should always be seen as an irreversible procedure. It can be by laparoscopic surgery under general anesthesia. This is a day hospital procedure.

Assessment of the Infertile Couple.

Over the past 15 years we have witnessed a revolution in the field of human reproduction, which continues to make progress in resolving problems of infertility.

It is estimated that one in every ten couples will not achieve a pregnancy in the first year of trying. Our recommendation is that, after six months, they seek professional advice. By attending a consultation and undergoing some simple tests, we may find indication as to whether we are facing a fertility problem or not.

At our Center we make the preliminary investigations for the diagnoses of fertility problems. At our Center we carry out the preliminary investigations for the diagnoses of fertility problems. A series of test are conducted and the treatment options that can be followed to improve the prospects of a pregnancy are explained.

These studies typically include:

  • Hormonal tests.
  • Monitoring of ovulation by ultrasound study.
  • Seminograms.
  • Permeability test.
  • Blood screenings ( , ...).

The absence of a normal ovulatory cycle is one of the most common causes of female infertility. This problem can be treated with the administration of drugs that stimulate the ovaries, increasing the likelihood of achieving ovulation and the number of activated follicles in each cycle. On the male side one of the most common causes is a low number of sperm or sperm concentration, or diminished sperm mobility. Sometimes the fertility problems, both for males and females, have been caused by an infectious process suffered in the past, such as Chlamydia infection or other sexually transmitted diseases. The environmental and social factors (stress, environmental pollution, the postponement of motherhood for personal reasons …) should not be underestimated. Undoubtedly these are largely responsible for the problem of sub-fertility that affects so many couples nowadays. The good news is that, once detected the problem, there is a wide range of treatments available that may help couples to achieve their desire to be parents.

Menopausal Problems.

The term menopause actually refers to the last menstrual period a woman has in her life. In general it is also used to designate the transitional period since the moment women start to experience menstrual disorders to the moment that menstruations disappear completely. This period can vary from a few months to even a year or two. Menopause occurs because the ovaries stop working. This is something that happens naturally as part of the aging process, and the age at which it occurs is variable. The average age for the onset of menopause is 51 years and most women experience it at the age of 45 to 55 years. Some women may suffer an abnormally early menopause. While the cessation of menstrual periods may occur abruptly, many women experience various alterations of the menstrual cycle with ovarian cycles getting increasingly long.

During the menopause the ovaries stop producing eggs and the hormones estrogen and progesterone. The symptoms of menopause are caused by hormonal disorders caused by low levels of estrogen and also perhaps by the high levels of hormones FSH and LH.

These are some of the symptoms that women may experience during the menopause:

  • Hot flashes and sweating, which can occur only occasionally or many times a day.
  • Decreased vaginal lubrication, which may cause infections and even vaginal bleeding.
  • Changes of mood, insomnia and depression.
  • Changes in the skin, breasts and hair, that may contribute to the sense of aging that women can suffer at this stage.
  • Bone decalcification.

In the longer term other diseases may appear such as:

  • Osteoporosis.
  • Cardiovascular disorders that increase the risk of myocardial infarctions (heart attacks) and vascular accident.

Sometimes it is difficult to differentiate what are symptoms due to the menopause and what symptoms are due to psychological factors that may be taking place at this time in the life of a woman. Many women do not experience any of these problems. With today's life expectancy, post-menopause can be a third of a woman's life. It is therefore important to take measures to ensure the highest possible quality of life.

Treatment s for the various problems and possible disorders are available at the Clinic:

  • Advice on hormone replacement therapy (HRT), with medical controls as appropriate.
  • Prevention and treatment of osteoporosis.
  • Prevention and diagnosis of gynaecological cancer.
  • Prevention of breast cancer.
  • Gynaecological cancers.
  • Correction of the pelvic floor pathology.
  • Problems of urine incontinence.

A healthy diet, adequate to your own individual needs, is very important for your physical and mental wellbeing after menopause. At our Center we offer a dietetics and nutritional advice service for the treatment of metabolic problems that may occur or worsen during this period (high blood pressure, diabetes, hyperlipidaemias, ..). . Personal diets for specific purposes: slimming, weight control, weigth gain, food intolerances or allergiest, etc. are also available.

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