Tests for Gynecologic Disorders

Tests used to screen for cervical cancer Cervical Cancer Cervical cancer develops in the cervix (the lower part of the uterus). Most cervical cancers are caused by human papillomavirus (HPV) infection. Cervical cancer usually results from infection... read more include the following:

In both the Pap test and HPV test, doctors collect a sample from the cervix. Doctors collect the sample by inserting a speculum (a metal or plastic instrument) into the vagina to spread the walls of the vagina apart and using a plastic brush to remove some cells from the surface of the cervix and from the passageway through the cervix (cervical canal). The samples are sent to a laboratory, where they are examined under a microscope to look for abnormal cells, which may indicate precancerous changes or, rarely, cervical cancer.

Usually, the Pap test feels scratchy or crampy, but it is not painful and takes only a few seconds.

Pap tests identify most cervical cancers, even very early-stage cancer. They can also detect precancerous changes in cervical cells. These changes, called cervical intraepithelial neoplasia (CIN), can be treated, thus helping prevent cancer from progressing and spreading.

Pap tests are most accurate if the woman is not having her period and does not douche or use vaginal creams for at least 24 hours before the test.

Experts now recommend that the first Pap test be done in most women after the age of 21 years. Women with an HIV (human immunodeficiency virus) infection may be tested at a younger age.

How often testing is needed depends mainly on the woman’s age and the results of previous Pap tests:

Pap tests in older women may be resumed or continued if a woman has a new sex partner or if she has several sex partners.

Women who have had their uterus completely removed (total hysterectomy) and have not had any abnormal Pap test results do not need to be screened for cervical cancer. However, if the hysterectomy left cervix in place, screening is needed. (The cervix is the lower part of the uterus that opens into the vagina.)

Women at risk of sexually transmitted infections Overview of Sexually Transmitted Infections (STIs) Sexually transmitted infection (STI) refers to an infection that is passed through blood, semen, vaginal fluids, or other body fluids during oral, anal, or genital sex with an infected partner... read more should be screened yearly for these diseases, even if they have no symptoms. At-risk women include the following:

Women who think they may have a sexually transmitted infection can request screening.

For most sexually transmitted infections, the doctor uses a swab to obtain a small amount of cervical discharge from the cervix. The sample is sent to a laboratory for analysis. Testing for gonorrhea Gonorrhea Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, or throat, or the membranes that cover... read more and chlamydial infection Chlamydia and Other Nongonococcal Infections Chlamydial infections include sexually transmitted infections of the urethra, cervix, and rectum that are caused by the bacteria Chlamydia trachomatis. These bacteria can also infect... read more can also be done using a urine specimen or a sample from inside the vagina obtained by the woman with a swab.

A doctor may consider screening women for HPV if any of the following are present:

HPV can cause genital warts Human Papillomavirus (HPV) Infection Human papillomavirus (HPV) can be sexually transmitted and causes changes in cells, which can lead to genital warts or to precancer or cancer of the cervix, vagina, vulva, anus, or throat. Different... read more and may increase the risk of cervical cancer Cervical Cancer Cervical cancer develops in the cervix (the lower part of the uterus). Most cervical cancers are caused by human papillomavirus (HPV) infection. Cervical cancer usually results from infection... read more . A sample of vaginal discharge, obtained with a swab, is used for the HPV test. Normal results of an HPV test indicate that cervical cancer and precancerous conditions are highly unlikely. For women at high risk of HPV infection, the HPV test can be done at the same time as a Pap test. If results of a Pap test and an HPV test are normal in women older than 30, neither test needs to be repeated for at least 3 years.

If women are having problems with becoming pregnant, doctors may take a sample of mucus from cervix and examine it. Based on the appearance of the mucus, doctors may recommend additional tests to evaluate fertility Diagnosis Infertility is usually defined as the inability to achieve a pregnancy after 1 year of regular sexual intercourse without birth control. Frequent intercourse without birth control usually results... read more fully.

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.

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

Women usually feel some discomfort when the speculum in 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.

D and C may be used to treat women who have had an incomplete (partial) miscarriage Miscarriage A miscarriage is the loss of a fetus before 20 weeks of pregnancy. Miscarriages may occur because of a problem in the fetus (such as a genetic disorder or birth defect) or in the woman (such... read more . 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

Usually, it is done during colposcopy and does not require an anesthetic.

For hysterosalpingography Hysterosalpingography If a fallopian tube is blocked or damaged, women may have fertility problems. A blocked or damaged fallopian tube can prevent the sperm from reaching the egg or prevent the egg or fertilized... read more , 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:

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 as ibuprofen, 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:

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:

Laparoscopy can detect structural abnormalities too small to be detected by imaging, as well as abnormalities on the surfaces of organs, such as endometriosis Endometriosis In endometriosis, patches of endometrial tissue—normally occurring only in the lining of the uterus (endometrium)—appear outside the uterus. Why endometrial tissue appears outside the uterus... read more (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

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 as ibuprofen, 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 tested for pregnancy Detecting and Dating a Pregnancy Pregnancy begins when an egg is fertilized by a sperm. For about 9 months, a pregnant woman’s body provides a protective, nourishing environment in which the fertilized egg can develop into... read more . 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 Sonohysterography If a fallopian tube is blocked or damaged, women may have fertility problems. A blocked or damaged fallopian tube can prevent the sperm from reaching the egg or prevent the egg or fertilized... read more ), 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 as ibuprofen, 20 minutes before the procedure may help relieve discomfort.

Ultrasonography Ultrasonography Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. A device called a transducer converts electrical current into sound waves... read more (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:

Ultrasonography Ultrasonography Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more is commonly done during pregnancy for the following reasons:

Ultrasonography is painless and has no known risks.