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Office Procedures
Hospital Procedures
This is the fundamental exam that every patient will have at the obstetrician- gynecologist's office. The exam begins with inspection of the vulva (external genitalia). The physician will look for rashes or abnormal discoloration, masses (e.g. from infection, non- cancerous and cancerous tumors) and scaliness or dryness of the skin. Occasionally the physician will feel for areas of particular tenderness on the vulva too. A warm speculum will be placed in the vagina for inspection of the vagina and cervix. Any discharge can be collected, tumors noted and assessment undertaken for pelvic relaxation and tenderness. If needed, a pap smear will be done. After the speculum exam, the physician will do a bimanual exam. During this part of the exam, the doctor places one or two fingers into the vagina up to the cervix; the doctor's other hand goes over the lower abdomen. The space occupying the physician's two hands is where the uterus will be. The doctor is able to tell how large the uterus is and what the shape it is depending on how far apart the doctor's two hands are. Besides feeling for the uterus, the doctor will also feel for each ovary during this part of the exam. Many patients will have a breast exam as well as a general physical exam. While the pelvic exam is uncomfortable, it should not be painful. Extreme discomfort or pain is often a sign of some sort of pathology. Return to top of page
Endometrial biopsy (EMB) is an office procedure used to:
The procedure begins with the physician placing a speculum in the vagina and viewing the cervix. The cervix is washed with an antiseptic. A thin plastic instrument is passed through the cervix and into the uterus to obtain material that lines the inside of the uterus. This material is the endometrium, which is what a woman sheds with her menses. Sometimes a physician will place another instrument on the cervix to help straighten the cervix. This cases passage of the biopsy instrument through the cervix. Endometrial biopsy frequently causes pain similar to a menstrual cramp. I usually ask patients to take medication one hour prior to coming to the office. The most common complication from endometrial biopsy is bleeding after the biopsy. This usually subsides by itself over time. Another complication includes inability to do the biopsy. Occasionally the cervix may be very small. In this case, a dilator may by used to open the cervix to allow passage of the biopsy instrument. If this is unsuccessful the patient my need to have a D&C (dilation and curettage) at a hospital. At the hospital the physician has access to very small dilators and the benefit of good pain control from an anesthesiologist. Return to top of page
A colposcopy is performed in the doctor's office under
local anesthesia with a special microscope called a colposcope. By looking
through the microscope the doctor can see changes that cause an abnormal Pap
test result and take biopsies when necessary. Only slight discomfort may
occur. Return to top of page A high-intensity beam of light is used to remove
abnormal tissue or growths. The procedure is performed in the doctors office
under local anesthesia with only slight discomfort. Return to top of page A test in which sound waves are used to examine internal
structures including the uterus, ovaries and fallopian tubes. This is done
by moving a device (called a transducer) across the abdomen or placing a
special device in the vagina. One of the most common uses for ultrasound is
to examine a fetus during pregnancy to confirm a diagnosis, age or size of a
fetus. Return to top of page
Loop Electrode Excision Procedure (LEEP)
A thin wire loop carrying an electrical current is used to remove abnormal
areas of the cervix. The LEEP procedure is performed in the office or
out-patient surgery with local anesthesia injected into the cervix. Slight
discomfort for a few seconds may be experienced. Return to top of page
Laparoscopy is a surgical procedure usually performed at a hospital on an outpatient basis. It can be used for diagnostic purposes (e.g. evaluation of chronic pelvic pain) or for therapeutic purposes such as for tubal sterilization or removal of ectopic pregnancy (pregnancy in the Fallopian tube). Complications from this surgery are similar to those of nearly any surgery: anesthesia risk, bleeding, infection, and unintentional injury to pelvic organs. These are not the only complications. Often, a patient will have laparoscopy on a Friday and return to work the following Monday if she works outside the home. The patient usually sees the doctor about 4 weeks after surgery. During this visit, the doctor could examine her to see if she is healing well, review any pathology reports from specimens removed at surgery, and discuss further management of the medical problem peculiar to her. Return to top of page
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