General gynaecological presentations out of scope

Public outpatient services in NSW are generally not provided to patients presenting with these conditions.

Adult patients (aged 16 years or over)

Presenting condition	Out of scope (not routinely provided) criteria
Abnormal cervical screening	Positive human papillomavirus (HPV) not 16/18 with a normal liquid-based cytology (LBC) or pLSIL/LSIL on 1 test Post-coital bleeding on 1 occasion Note: recommended that general practitioner collects co-test Undergoing test of cure
Abnormal uterine bleeding	Histopathologically confirmed genital tract malignancy Note: referral to gynaecological oncology is indicated, where available Uncomplicated (i.e. normal haemoglobin, normal pelvic ultrasound, negative cervical screening test) heavy menstrual bleeding where there is no trial of first-line treatment
Dysmenorrhoea	Dysmenorrhoea for < 3 months Single presentation with dysmenorrhoea
Pelvic mass	Asymptomatic fibroids < 8 cm Asymptomatic simple ovarian cyst < 5 cm on pelvic ultrasound in pre-menopausal patient Persistent, asymptomatic simple ovarian cyst < 5 cm on two pelvic ultrasounds performed 6-12 weeks apart in pre-menopausal patient and normal CA-125 Note: annual ultrasound in primary care is recommended for monitoring
Persistent pelvic pain	Known lesion as a cause of pelvic pain or mass in the pelvis Note: refer to pelvic mass state-wide referral criteria for more information
Post-coital bleeding	Histopathologically confirmed genital tract malignancy Note: referral to gynaecological oncology is indicated, where available Known genital tract malignancy undergoing treatment Post coital bleeding that ceases following treatment of chlamydia or gonorrhoea infection Single episode of post-coital bleeding with normal cervical screening test and liquid based cytology (LBC) without oncogenic human papillomavirus (HPV)
Post-menopausal bleeding	Expected, regular withdrawal bleed in patient taking cyclical menopausal hormonal therapy (MHT) < 12 months since last menstrual period Note: refer to abnormal uterine bleeding SRC for more information Single episode of bleeding with endometrial thickness < 4 mm on transvaginal pelvic ultrasound and negative cervical screening result
Prolapse	Asymptomatic prolapse Obstructive defecation associated with rectal prolapse Note: referral to colorectal surgeon is indicated Prolapse where the symptoms are well-controlled with a vaginal pessary and patient does not desire surgery Recurrent urinary tract infections not directly attributable to pelvic organ prolapse
Urinary incontinence	< 6 weeks from a gynaecological procedure Note: recommended to seek advice from treating doctor Post-partum < 6 weeks with overflow incontinence Urinary incontinence as a complication of poorly controlled diabetes (i.e. neurogenic bladder) Note: referral to urologist is indicated Urinary tract malignancy Note: referral to urologist may be indicated
Vulval disorders	Any skin abnormality that is part of a widespread skin disorder Note: referral to dermatologist is indicated Cosmetic vulval procedures and any associated complications (e.g. labioplasty) Histopathologically confirmed genital tract malignancy Note: referral to gynaecological oncology is indicated, where available
Non-condition specific	Cosmetic genital surgery or elective cosmetic surgery Experienced one miscarriage Gender affirming surgery of all types Heavy menstrual bleeding where there is no trial of first-line treatment Chronic pelvic pain without trial of 1st line treatment Post-natal check-up Recurrent, simple ovarian cysts in patients who have not tried hormonal contraception Reversal of tubal ligation Routine cervical screening (unless access to cervix is difficult) Routine contraceptive counselling Routine diagnosis and management of polycystic ovarian syndrome (PCOS) Routine gynaecological check-up Routine Implanon/Mirena/progesterone-releasing intrauterine device (IUD) insertion for contraception, or removal Note: exception applies where general anaesthetic is required for insertion and/or removal Uncomplicated sexually transmitted infections Vulval disorders without a trial or 1st line treatment