women s health issues
Tests for Gynecologic Disorders
Diagnostic Procedures
Occasionally, more extensive diagnostic procedures are needed. A biopsy consists of removing a small sample of tissue for examination under a microscope. Biopsy of the vulva, vagina, cervix, or lining of the uterus can be done. A cervical biopsy is done when A condition likely to eventually lead to cancer (precancerous condition) or cancer is suspected, usually because a Pap test result was abnormal. A biopsy of the cervix or vagina is usually done during Colposcopy . During colposcopy, doctors can identify the area that looks most abnormal and take tissue samples from it. Usually, biopsy of the cervix or vagina does not require an anesthetic, although this procedure typically feels like a sharp pinch or a cramp. Taking a nonsteroidal anti-inflammatory drug (NSAID), such asibuprofen, 20 minutes before the procedure may help relieve any discomfort during the procedure. A biopsy of the vulva (the area around the opening of the vagina) is done when A diagnosis cannot be made based on the woman’s symptoms and results of a physical examination. Cancer of the vulva is suspected. Biopsy of the vulva can usually be done in the doctor's office and requires use of a local anesthetic. A biopsy of the lining of the uterus (endometrial biopsy) is usually done to Determine the cause of Abnormal Uterine Bleeding (AUB) None Check for Cancer of the Uterus (endometrial cancer) when this cancer is suspected Also, infertility specialists use this procedure to determine whether ovulation is occurring normally and whether the uterus is ready for implantation of embryos. For an endometrial biopsy (endometrial aspiration), a speculum is used to spread the walls of the vagina, and a small plastic tube is inserted through the cervix into the uterus. The tube is used to suction tissue from the uterine lining. An endometrial biopsy can be done in a doctor's office and usually does not require an anesthetic. Typically, it feels like strong menstrual cramps. Taking an NSAID, such asibuprofen, 20 minutes before the procedure may help relieve discomfort during the procedure. For colposcopy, a speculum is used to spread the walls of the vagina and a binocular magnifying lens (similar to that of a microscope) is used to inspect the cervix for signs of cancer. Often, a sample of tissue is removed for examination under a microscope (biopsy). Colposcopy is often done when Results of a Papanicolaou (Pap) test are abnormal. Women usually feel some discomfort when the speculum is inserted, but colposcopy alone (without biopsy) is painless and thus requires no anesthetic. The biopsy procedure is typically described as causing a crampy sensation and also does not require an anesthetic. The procedure usually takes 10 to 15 minutes. For dilation and curettage (D and C), conscious sedation or a general anesthetic is usually used. (With conscious sedation, people can respond to directions but do not feel pain.) Then, a speculum is used to spread the walls of the vagina, and the cervix is widened (dilated) using thin rods of increasing size. Sometimes a drug is used to help dilate the cervix. Then a small, sharp, scoop-shaped instrument (curet) can be inserted to remove tissue from the lining of the uterus. Sometimes a plastic tube attached to a suction machine (suction curet) is used to remove tissue from the uterus. After the speculum is in place, tapered curved metal rod (dilators—not shown) are used to stretch open the cervix so that the curet can be inserted into the uterus. The curet is used to remove tissue from the lining of the uterus. D and C may be used to treat women who have had an incomplete (partial) Miscarriage . D and C is sometimes used to identify abnormalities of the uterine lining when biopsy results are inconclusive, but it is no longer commonly used for this purpose because biopsies usually provide as much information and can be done in the doctor’s office. D and C is often done in a hospital. However, most women do not have to stay overnight in the hospital. Endocervical curettage consists of inserting a small, sharp, scoop-shaped instrument (curet) into the passageway through the cervix (cervical canal) to obtain tissue. The curet is used to scrape a small amount of tissue from high inside the cervical canal. A cervical biopsy (to remove a smaller piece of tissue from the surface of the cervix) is typically done at the same time. The tissue samples are examined under a microscope by a pathologist. Endocervical curettage is done when Endometrial or cervical cancer is suspected or needs to be ruled out. Usually, it is done during colposcopy and does not require an anesthetic. For Hysterosalpingography , x-rays are taken after a radiopaque contrast agent, which can be seen on x-rays, is injected through the cervix to outline the interior of the uterus and fallopian tubes. Hysterosalpingography is often used to do the following: To help determine the cause of infertility To confirm that a sterilization procedure to block the tubes is successful The procedure is done in a place where x-rays can be taken, such as a hospital or the radiology suite of a doctor's office. Hysterosalpingography usually causes discomfort, such as cramps. Taking an NSAID, such asibuprofen, 20 minutes before the procedure may help relieve discomfort. To view the interior of the uterus, doctors can insert a thin viewing tube (hysteroscope) through the vagina and cervix into the uterus. The tube is about 1/4 inch in diameter and contains cables that transmit light. Instruments used for a biopsy, electrocautery (heat), or surgery may be threaded through the tube. The site of abnormal bleeding or other abnormalities can usually be seen and can be sampled for a biopsy, sealed off using heat, or removed. Hysteroscopy may be used to do the following: To look for abnormalities inside the uterus when cancer of the uterine lining ( Cancer of the Uterus ) is suspected To look for abnormalities in the uterus (such as Uterine Fibroids ) if women are having problems becoming pregnant To prevent pregnancy permanently by blocking or otherwise disrupting the fallopian tubes ( Permanent Contraception ) Hysteroscopy may be done in a doctor's office, or it may be done in a hospital with a general anesthetic at the same time as dilation and curettage. To directly examine the uterus, fallopian tubes, or ovaries, doctors use a viewing tube called a laparoscope. The laparoscope is attached to a thin cable containing flexible plastic or glass rods that transmit light. The laparoscope is inserted into the abdominal cavity through a small incision just below the navel. A probe is inserted through the vagina and into the uterus. The probe enables doctors to manipulate the organs for better viewing. Carbon dioxide is pumped through the laparoscope to inflate the abdomen, so that organs in the abdomen and pelvis can be seen clearly. Often, laparoscopy is used to do the following: To determine the cause of Pelvic Pain in Women , To do some surgical procedures (such as biopsies, sterilization procedures, and removal of an Ectopic Pregnancy in a fallopian tube) using instruments threaded through the laparoscope Laparoscopy can detect structural abnormalities too small to be detected by imaging, as well as abnormalities on the surfaces of organs, such as Endometriosis (endometrial tissue outside the uterus), inflammation, and scarring. Additional incisions may be required if surgical procedures, such as removal of an ovarian cyst or the uterus (hysterectomy), are needed. Laparoscopy is done in a hospital and requires an anesthetic, usually a general anesthetic. An overnight stay in the hospital is usually not required. Laparoscopy may cause abdominal pain, but normal activities can usually be resumed in 3 to 5 days, depending on the extent of the procedure that is done through the laparoscope. In a loop electrical excision procedure (LEEP), a thin wire loop that conducts an electrical current is used to remove a piece of tissue. Typically, this piece of tissue is larger than that obtained in a biopsy of the cervix. This procedure may be done after an abnormal Pap test result To evaluate the abnormality more accurately To remove the abnormal tissue (and thus treat early-stage cancer, including Screening for Cervical Cancer ) LEEP requires an anesthetic (often a local one), takes about 5 to 10 minutes, and can be done in a doctor's office. Afterward, women may feel mild to moderate discomfort and have a small amount of bleeding. Taking an NSAID, such asibuprofen, 20 minutes before the procedure may help relieve discomfort during the procedure. Most women who are of childbearing age and who have gynecologic symptoms are Detecting and Dating a Pregnancy . Doctors take a sample of urine or sometimes blood from the woman and test it to determine whether she is pregnant. These tests are more than 99% accurate. For saline sonography ( Sonohysterography ), fluid is placed in the uterus through a thin tube (catheter) that is inserted through the vagina and then the cervix. Then ultrasonography is done. The fluid fills and stretches (distends) the uterus so that abnormalities inside the uterus, such as polyps or fibroids, can be more easily detected. The procedure is done in a doctor's office and may require a local anesthetic. Taking an NSAID, such asibuprofen, 20 minutes before the procedure may help relieve discomfort. Ultrasonography (sonography) uses ultrasound waves, produced at a frequency too high to be heard. The ultrasound waves are emitted by a handheld device that is placed on the abdomen (called abdominal ultrasonography) or inside the vagina (called transvaginal ultrasonography). The waves reflect off internal structures, and the pattern of this reflection can be displayed on a monitor. Ultrasonography can detect the following: An Ectopic Pregnancy None Tumors, cysts, and other abnormalities in the internal reproductive organs (ovaries, fallopian tubes, uterus, and vagina) Ultrasonography is commonly done during pregnancy for the following reasons: To determine the condition and size of the fetus To monitor the fetus To guide the placement of instruments during Amniocentesis or Ultrasonography is painless and has no known risks. 