Here we discuss some of the diagnostic procedures that may be carried out on you when you go for your pelvic examinations, and things need to be examined further due to an abnormal finding or suspicion.
A biopsy means a small piece of suspicious flesh is plucked off and examined under a microscope. Your uterine lining, vulva, vagina or cervix can be biopsied.
The cervical or vaginal biopsy is done when a condition is more likely to lead to cancer, which means you have a precancerous condition. This is most often due to an abnormal Pap test. Colposcopy is the usual route for cervical or vaginal biopsies, explained later. The sensation is like a sharp pinch or a cramp, and is done without anaesthetic.
Vulvar biopsies can be done in your doctor’s office and require local anaesthetic.
Uterine biopsy means actually an endometrial biopsy, which is the lining of your uterus, not the uterus itself, which is a muscle. This is mostly used to determine the cause of unusual vaginal bleeding, but can be used to figure out if ovulation is occurring normally, and if the uterus is fit for implantation by an embryo. A speculum is used to open the vaginal walls gently, and a plastic or metal tube is inserted through the cervix into the uterus. The tube then sucks the endometrium from the uterus. It feels like strong menstrual cramps and can be quite sore and uncomfortable.
A colposcopy is where a magnifying lense is used to inspect the cervix for signs of cancer, typically after abnormal cells have been found during a Pap test. A speculum is used to keep the vaginal walls separated gently, and the cervix is inspected. A sample may be removed (biopsy). Colposcopies without biopsies are painless, since you are only being examined. The biopsy may cause a pinch or crampy feeling that is over quickly.
Endocervical curettage is a procedure whereby a small, sharp scoop (curette) is inserted into the cervix to collect tissue via scraping high inside the cervical canal. A cervical biopsy is likely to be done at the same time. Tissue is examined later for cancerous changes. It does not usually require anaesthetic.
Dilation and curettage (D and C) is remove endometrial lining. A speculum is inserted, then metal rods open the cervix up so that the curette can be inserted into the uterus. The curette then removes the endometrial tissue from the uterus using a scoop-shaped sharp tool (like a sharp spoon). This is often done when a miscarriage has failed to remove the foetal tissue completely, or to identify endometrial lining problems when biopsy has proved inconclusive. A general anaesthetic may be used and it is done in hospital, but an overnight stay is usually not required.
Hysterosalpingography is actually an imaging technique using x-rays and a special dye that the x-ray can pick up. The dye is injected through the cervix so the uterus and fallopian tubes are visible. This procedure helps ascertain the cause of infertility or to double check sterilisation (tube-tying) has been successful. It is usually done in a hospital or office with x-ray facilities. This procedure causes cramps and discomfort.
Hysteroscopy is used to view the inside of the uterus. A hysteroscope (1/4 inch thin viewing tube) is inserted through the vagina and cervix and into the uterus. The hysteroscope has lights and cables, and may also include a biopsy tool (electrocautery) or surgery tool. Abnormal bleeding or other growths or conditions of the uterus can be seen and sampled, sealed off using heat, or removed. This may be done in conjunction with other procedures, in both a doctor’s office or hospital, possibly with general anaesthetic.
Laparoscopy is a procedure done to take a closer look at the uterus, fallopian tubes or ovaries on the ‘outside’ (in the abdomen) using a laparoscope. This device is attached to a thin cable that contains flexible plastic or glass rods that transmit light, which is then inserted into the abdominal cavity via a small cut below the belly button. The probe is then inserted via the vagina into the uterus. The probe allows your organs to be moved around to get a better look. Carbon dioxide is sent through the laparoscope to cause your abdomen to inflate so that each organ can be clearly seen.
This procedure is most often done to see what is causing pelvic pain, infertility or other disorders. It can also be used to perform surgery (biopsy, sterilisation, ectopic pregnancy or cyst removal). General anaesthetic is most often used, but without staying overnight in hospital. Pain is likely to be encountered, and restrictions on movement for a few days as the site of incision heals.
Loop electrical excision procedure (LEEP) is where a thin wire loop that has electricity running through it is used to remove flesh for later examination. This is for areas bigger than a cervical biopsy. This is usually done after an abnormal Pap test, and can be used to actually remove the abnormal tissue. Local or general anaesthetic is used, and it is quick – five or 10 minutes in a doctor’s office. It is uncomfortable afterwards with some bleeding.
Large loop excision of the transformation zone (LLETZ) Procedure is a procedure that uses a loop with electricity running through it to remove tissue. This is performed when your pap test, colposcopy/biopsy has shown abnormal cervical cells, and these cells need to be removed. The transformation zone is the area of your cervix where the neck of the cervix connects to the outside section of the cervix (cervical os). See the diagram. It takes a few hours in hospital, and may be done under general anaesthetic. Crampy pain may be felt in the days afterwards, but it heals up quickly and there should be no more abnormal cells on the cervix. Small bits of burnt tissue may come out for a few days.
Sonohysterography requires fluid to be loaded into the uterus via a catheter (a small tube) via the vagina and cervix, so that an ultrasound can be done. The fluid fills and stretches the uterus so that any abnormalities can be seen more clearly, usually polyps or fibroids. A doctor can do this in the office and it may require a local anaesthetic.
Ultrasounds are done via the outside of the body using ultrasound waves that are out of human hearing range. The device is used by hand on the abdomen, or inside the vagina, with the sound pattern showing what the insides look like on a monitor. Ultrasounds are done to find ectopic pregnancies, tumours, cysts or other abnormalities in the ovaries, fallopian tubes, uterus, and vagina. Pregnancy is the most common use of ultrasounds, since it is done as a matter of course to check the foetus. Ultrasounds are painless.