Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • acute/severe pelvic pain
  • significant or uncontrolled vaginal bleeding
  • severe infection
  • ascites resulting from known malignancy
  • urinary retention resulting from known malignancy
  • acute urinary obstruction resulting from known malignancy

Please contact the gynaecology on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • cervical cancer
  • ovarian cancer
  • people with high-risk presentation due to Risk of Malignancy Index (RMI) or International Ovarian Tumour Analysis (IOTA) classification
  • uterine/endometrial cancer
  • vaginal cancer
  • vulvar cancer

Category 2 (appointment clinically indicated within 90 days)

  • nil

Category 3 (appointment clinically indicated within 365 days)

  • nil

For more on outpatient referrals, see the general referral information.

All referrals for people less than 16 years of age, or those less than 18 years with intellectual disabilities, complex medical conditions, primary amenorrhea, pubertal delay, or Mullerian anomalies are to be sent to Women’s and Children’s Hospital (WCH).

Central Adelaide Local Health Network only accept referrals for people greater than 18 years of age.

Due to limitations in infrastructure and resources, the WCH cannot accommodate referrals for individuals with a body mass index (BMI) equal to or greater than 45, as well as individuals over the age of 69 years of age.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • for adult patients, relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • for paediatric patients, identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • past medical/surgical/obstetric/psychosocial/vaccination history
  • family history where relevant
  • menstrual history:
    • cycle, day/months
    • days of bleeding
    • blood loss
  • current medications and allergies, including hormonal contraception use
  • onset, duration and course of presenting symptoms/red flags
  • physical examination
    • height/weight
    • BMI
    • pelvic examination findings
  • pathology:
    • complete blood examination (CBE)
    • beta human chorionic gonadotropin (ßhCG)
    • an up-to-date cervical screening test as per the cervical screening guidelines/Co-Test
  • confirmation diagnostic pathology, reports, and imaging including location of company and accession number
  • computed tomography (CT) chest-abdomen-pelvis (CAP)

If ovarian cancer

  • cancer antigen 125 (CA125)
  • cancer antigen 19.9 (CA19.9)
  • carcinoembryonic antigen (CEA)

Women less than 35 years of age

  • alpha-fetoprotein (AFP)
  • lactate dehydrogenase (LDH)

If vulval cancer

  • biopsy of lesion, this should not delay referral if clinical suspicion is high.

Clinical management advice

Vulval cancers may present as unexplained lumps, bleeding from ulceration or pain. Vulval cancer may also present with pruritus or pain. For a patient who presents with these symptoms and where cancer is not immediately suspected, it is reasonable to use a period of ‘treat, watch and wait’ as a method of management.

This should include active follow-up until symptoms resolve or a diagnosis is confirmed. Refer if unexplained symptoms persist.

Clinical resources

Consumer resources