Gynaecologist

Gynaecologist

Training and surgical experience

Dr Evans studied Medicine at the University of Tasmania, winning the Surgery Prize in her final year of Medicine. She completed her specialist training in Gynecology in Adelaide.

Dr Evans personally performed over 100 laparoscopies per year during her 20 years in private practice.

Current Positions:

  • CEO, Alyra Biotech Pty Ltd
  • Fellow, Royal Australia New Zealand College of Obstetricians Gynaecologists (FRANZCOG)
  • Fellow, Australia New Zealand Faculty of Pain Medicine (FFPMANZCA)
  • Clinical Associate Professor, University of Adelaide
  • Executive Chair, Pelvic Pain Foundation of Australia
  • Co-developer and Medical Educator, Periods Pain and Endometriosis (PPEPTalk) Schools Program
  • Graduate of the Australian Institute Company Directors (GAICD)
  • Member of the Women’s Health Innovation Coalition (US)

Prizes:

  • Finalist, South Australian of the Year, 2023
  • SBE 2022 Impact Award for Leadership
  • Surgery Prize – Final year medicine
  • Schering Registrar Prize for research
  • AGES Travelling Fellowship to USA
  • Dr Russell Cole Memorial ANZCA Research Award

Endometriosis and Pelvic Pain (and eBook) are available 
for purchase from the Pelvic Pain Foundation of Australia.

Appointments

PLEASE NOTE: Dr Evans retired from clinical practice in March 2024 to pursue further work in research through Alyra Biotech, and further work in pelvic pain advocacy as Chair of the Pelvic Pain Foundation of Australia (PPFA).

Pelvic Pain Booklet

This booklet provides a free introduction to pelvic pain.

If you find this booklet useful, we recommend reading the book Endometriosis and Pelvic Pain available through the Pelvic Pain Foundation of Australia shop at www.pelvicpain.org.au.

2019 Witch Hunt podcast held at the Sydney Opera House and moderated by journalist Gabrielle Jackson.

Public Speaking

Translating science innovation into real world change, means making knowledge accessible to everyone in our community.
Raising the profile of these conditions, and introducing modern concepts in neuroscience is essential.

To help us all learn a bit outside our comfort zone, Dr Evans has contributed widely to pelvic pain education. This has included everything from medical conferences and journals to women’s magazines, radio, television, and podcasts.

To build multi-disciplinary health practitioner teams, she has also offered training seminars to regional centres including Warnambool, the Sunshine Coast and Bundaberg. These offer a practical approach to the diagnosis and management of pelvic pain, with solutions that work for both sides of the consultation desk.

Podcasts

Dr Evans has been a guest on several podcasts.
You can listen to some of these episodes using the links below:

Ladies, we need to talk, with Yumi Stynes

The rage in my pelvis

The Public Health Podcast with Lori Forner

The language of pelvic pain

Full Story with Gabrielle Jackson

Fibromyalgia and treating chronic pain

Everything from A to V: Decoding women’s health, with Dr Sneha Wadhwani

The rage in my uterus…is it endometriosis?

Research Papers

This article was prepared together with evolutionary biologist, Dr Bernard Crespi, Simon Fraser University, Canada. It considers recent studies demonstrating an inverse association between the presence of endometriosis lesions and levels of testosterone both prenatally and postnatally. It provides new insights into the roles of testosterone in the aetiology, diagnosis, and management of endometriosis and associated symptoms, including fertility and pain. A relatively short anogenital distance (AGD) is indicative of lower levels of testosterone during fetal development. A shorter AGD has recently been correlated with both a higher risk of developing endometriosis in adult life, and with known correlates of endometriosis including earlier onset of reproductive cycling, lower ovarian follicle number, lower postnatal testosterone, and premature ovarian insufficiency.

JPR-389166-prenatal-origins-of-endometriosis-pathology-and-pain–review

This article considers the frequency of 14 additional pain-related symptoms in a group of 168 women with dysmenorrhea. These symptoms include stabbing pains, bladder pain, an irritable bowel, food intolerances, headaches, sexual pain, vulval pain, anxiety, low mood, nausea, dizziness, sweating. It compares the frequency of symptoms in women with and without endometriosis, and considers whether a past history of sexually distressing events affects pain symptoms.

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This is the first study to demonstrate an ex vivo immune relationship in women with dysmenorrhea-related pelvic pain. It provides evidence for the potential of immune modulation as a novel pharmacological target for future drug development in the management of dysmenorrhea.

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Many rodent models of endometriosis are invasive, involving surgery to implant donor endometrial tissue into recipient animals. Here, we have refined a minimally invasive model of endometriosis using naturally cycling mice (donor and recipient matched for cycle phase) to investigate lesion development in two different strains (C57BL/6 and BALB/c), induced in estrous stages of high and low estrogen (proestrus or estrus, respectively), and with varying amounts of donor endometrial tissue (7.5–40 mg), injected intraperitoneally.

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This study used a scoping review design to look at what is known about the content of psychological therapies for women with chronic pelvic pain. This study looked at information on predictors of psychological outcomes. These pieces of information could be used to form and test future psychological interventions. Gaps in the research literature and future research directions
are also discussed.

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Objective: To establish which psychological therapies mental health professionals use with reference to the treatment of women with persistent pelvic pain conditions. This research investigates overall therapies and specific techniques that clinicians believe are the most effective with this patient group, and the challenges mental health clinicians face in administering interventions. The study aims to suggest improvements to clinical practice and establish directions for targeted future research.

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Anecdotally, severe dysmenorrhoea can pre-date the development of chronic pelvic pain (CPP). This study describes the timeline for the transition from dysmenorrhoea to CPP in a cohort of new patients attending a private gynaecology clinic. In 16.4% of cases, transition occurred within one year, and within 12 years in over 50%. Our study suggests clinicians need to observe women with severe dysmenorrhoea for signs of chronic pain. Further research is needed into the transition from dysmenorrhoea to CPP, and effective early interventions.

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Women with chronic pelvic pain have often experienced pain since adolescence as well as self-doubt, which often results in difficulties in personal development, relationships and sexual confidence. The management approach outlined in this article can help to improve outcomes for these patients.

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This study presents an independently-assessed comparison of the laparoscopic view obtained using a 2mm versus 10mm laparoscope in women with suspected pelvic pathology. Fifteen female volunteers booked for laparoscopy with clinical evidence of pelvic abnormality according to clinical findings and/or pelvic ultrasound were recruited for this study. Sequential observations were carried out by independent observers for clinically significant differences. Although discrepancies were noted in 3 patients the view obtained with the 2mm microendoscope was considered to be comparable to that obtained with the 10mm telescope. The cases with discordant findings included mild or minimal endometriosis and distal tubal disease. The results of this study suggest that microendoscopy is likely to be entirely adequate for many routine laparoscopic procedures and sterilization.

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This article further describes the relationship between androgens, endometriosis and pain. It also proposes a novel theory linking dysmenorrhoea, endometriosis and chronic pelvic pain to the Uterus-Central Nervous System neuroimmune circuit.

Evans S et al. Androgens, Endometriosis and Pain. frph-03-792920

This review summarizes the major known contributions of glia and neuroimmune interactions in pain, which has been determined principally in male rodents and in the context of somatic pain conditions.

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We aimed to develop a questionnaire that assesses the impact of pelvic pain on women, regardless of diagnosis, that has high utility, sound psychometric performance, easy scoring, and high reliability. Two studies, with 3 separate cohorts, were undertaken. Both studies were completed online. Studies included women with self-reported pelvic pain. Women were eligible to participate regardless of whether their pelvic pain was undiagnosed, self-diagnosed, or diagnosed by a clinician.

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Practical framework for clinical management of persistent pelvic pain (PPP) in girls and women. General Practitioners (GPs) will see the majority of the 15-25% of women that suffer from PPP, but do not have the framework to support them with the breadth of complex issues within this area.

The complex issues faced include the four main parts of PPP: pain from pelvic organs; the musculoskeletal response to pain; central sensitisation of nerve pathways; and the psychological sequelae of chronic pain.

This article aims to provide the framework for GPs to address PPP with confidence.

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Botulinum toxin (BoNT) injections have been used to reduce muscle spasm in the presence of severe pelvic pain. However, while pubococcygeus is easily accessed vaginally, injection to obturator internus is more complex – with variation in operative technique and needle placement confounding the ability to assess outcomes. We describe a simplified technique for BoNT injection to obturator internus using neurostimulation under ultrasound guidance.

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MicroRNAs (miRNAs) regulate gene translation and create disease-specific profiles in blood and tissues. We recently screened 667 miRNAs in plasma of women with and without endometriosis and identified 23 differentially regulated miRNAs. This study aims to evaluate the diagnostic potential of this miRNA panel in an independent cohort.

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Women look to gynaecologists when they have pelvic pain and appreciate a complete care approach. By improving our own skills, the majority of cases can be managed without the need for pain specialist referral.

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Although Australia does not recognise Chronic Pelvic Pain on a national level, Australian and New Zealand researchers have made several breakthroughs. There is scope for further research into gender specific research which may look further at hormones and Chronic Pelvic Pain.

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Endometriosis is the most common cause of Chronic Pelvic Pain in women. Dr Susan Evans outlines the cause and symptoms of endometriosis and explores potential social implications.

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