Gynaecologist in Latviawhere to get treatment, how to verify certification, what this doctor does

This page explains who handles breast health in Latvia and why there is no "mammologist" specialty in the register. It sets out how the state-funded breast cancer screening works and how long the invitation letter lasts. It also shows where to go with symptoms and how to complain about care.

The Centre for Disease Prevention and Control states that in its early stages breast cancer causes no complaints or symptoms, which is why regular preventive screening mammography in healthy women matters, to find changes as early as possible.

A National Health Service information leaflet states that breast cancer is the most common malignant tumour among women in Latvia, with more than 1,000 women newly diagnosed each year. It is also among the most treatable cancers, particularly when found early.

Breast cancer presents differently in different women, and not every sign means cancer. A tumour can also develop without visible or palpable symptoms. If you notice a change, do not ignore it, and see a doctor as soon as possible.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• Residency in one of the relevant specialties: diagnostic radiology, surgery, obstetrics and gynaecology, or medical oncology.
• Breast disease is not a separately certified specialty in Latvia, and its practitioners come together in a sector association.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• The invitation letter. With a letter you may attend any provider offering state-funded screening, so the nearest one will do.
• Mobile mammography. In the regions, check the mobile unit's schedule, since it may be closer than a hospital.
• Age and dense tissue. Ultrasound is used more often in younger women and dense breast tissue, so agree the method with the doctor.
• Earlier images. Using the same provider makes comparison with previous scans easier.
• Second opinion. Patients may freely choose the doctor and institution.

• During mammography the breast is placed on a plate and imaged from several angles, then the process is repeated on the other breast.
• The breast is briefly compressed while the image is taken, which can be uncomfortable, but only for a moment.
• The mammography examination itself takes a few minutes.
• The result is collected in person at the provider where the examination was done, so you need to follow it up yourself.
• If anything suspicious is found, further tests are arranged at a specialist provider.

Breast cancer screening with an invitation letter is state-funded, and no referral is needed. Tests ordered after state cancer screening carry no patient co-payment. Mammography done on your own initiative outside the screening programme is either private or carries a co-payment, depending on the referral.

• Screening mammography with an invitation letterPrice EUR: 0.00Source: SPKC
• Tests following state cancer screeningPrice EUR: 0.00Source: NVD
• Patient co-payment for a specialist visitPrice EUR: 4.00Source: NVD
• Mammography outside the screening programmePrice EUR: per provider price listSource: Veselības centrs 4

The sector body is the association "Latvijas Krūts slimību asociācija" (Latvian Breast Disease Association), registration number 50008140521, registered address Hipokrāta iela 4, Rīga, LV-1079, contact Andrejs Srebnijs, email andrejs.srebnijs@aslimnica.lv.

Certificates are issued by the Certification Council of the Latvian Medical Association. The sector regulator is the Health Inspectorate, while the National Health Service runs the screening programme.

If you have doubts about the quality of care, raise them first with the provider's management. If that does not resolve it, a written submission goes to the Health Inspectorate no later than two years after the alleged infringement, and is reviewed within 30 days, extendable to four months in complex cases. The procedure is set out on the Health Inspectorate site. Questions about the screening letter or service availability go to the National Health Service.

This page explains when a girl needs a paediatric gynaecologist and how to book a state-funded visit. It sets out the age from which a teenager can attend alone. It describes what a visit involves and why vaginal ultrasound is usually not performed. It also lists where these specialists practise in Latvia.

A paediatric gynaecologist advises on questions relating to girls' genital health and development. Veselības centru apvienība states that consultations happen both preventively and in response to symptoms:

• Genital anomalies
• Inflammation, itching, rash, discharge or bleeding
• Infections, including sexually transmitted infections
• Irregular or painful periods, or periods that have not started
• Choosing suitable contraception
• Questions about development and puberty

One of the most common problems in young girls is labial adhesion, known as synechiae. Paediatric and adolescent gynaecologist Lāsma Līdaka explains that this is not a congenital condition, that behind the adhesion the vagina and uterus are almost always normal, and that treatment is applying a special cream, after which the problem usually resolves within a few weeks. The cream can be prescribed by a family doctor or a gynaecologist.

Paediatric and adolescent gynaecologist Lāsma Līdaka explains that paediatric and adolescent gynaecologists fall into two groups. Some hold a contract with the National Health Service, in which case no family doctor referral is needed and the visit is free up to age 18. Many tests and investigations, including ultrasound, are also free. These doctors work at the Children's Clinical University Hospital and other hospitals, and reception desks generally know which applies.

A child may attend a specialist consultation, including a gynaecologist, alone without a parent once they have turned 14.

Some providers state the age from which they see girls, for example from 12, so it is worth checking in advance.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• Residency in obstetrics and gynaecology. RSU states that the programme prepares the doctor for certification in obstetrics and gynaecology, with theory based on seminars and problem lectures and practical training divided into courses by year of study.
• Paediatric and adolescent gynaecology is an area of practice within that specialty.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• NVD contract. For a free visit up to age 18, choose a doctor or provider contracted with the National Health Service.
• Age threshold. Some doctors see girls from birth, others from 12, so check when booking.
• Experience with adolescents. For a girl's first gynaecology visit, an adolescent gynaecologist is the recommended choice.
• Languages. The teenager needs to understand the doctor, so confirm the language in advance.
• Second opinion. A child's legal representative may freely choose the doctor and institution.

• Gynaecology is a sensitive area, and children and teenagers may feel uneasy before and during the visit. Veselības centru apvienība recommends discussing what will happen beforehand and preparing a list of questions.
• Both the parent and the patient may have questions, particularly in adolescence.
• The first preventive visit is recommended between ages 13 and 15, to discuss questions relevant to adolescence and learn breast self-examination.
• Vaginal ultrasound is usually not performed at such a visit. Other ultrasound approaches are used for diagnosis.
• Questions about contraception can be discussed with the doctor during the visit.

Children under 18 are exempt from patient co-payments. If the doctor or provider holds a contract with the National Health Service, the visit is free up to age 18 and no referral is needed. Many tests and investigations, including ultrasound, are also free.

• Visit to an NVD-contracted doctor, under 18Price EUR: 0.00Source: Dr. Lāsma Līdaka
• Tests and ultrasound at a state-funded visitPrice EUR: 0.00Source: Dr. Lāsma Līdaka
• Patient co-payment for a child under 18Price EUR: 0.00Source: NVD
• Private paediatric gynaecology consultationPrice EUR: per clinic price listSource: Veselības centrs 4

The field is represented by the Latvian Association of Gynaecologists and Obstetricians, registration number 40008061658, whose president Lāsma Līdaka is a paediatric and adolescent gynaecologist and doctor of medical science.

The association president has said in a public interview that free contraception methods are being introduced with the National Health Service for women and young women at particularly high risk, and that the aim is to widen eligibility.

Certificates are issued by the Certification Council of the Latvian Medical Association. The sector regulator is the Health Inspectorate.

If you have doubts about the care a child received, raise them first with the provider's management. If that does not resolve it, the child's legal representative may submit a written complaint to the Health Inspectorate no later than two years after the alleged infringement. It is reviewed within 30 days, extendable to four months in complex cases. The procedure is set out on the Health Inspectorate site.