Diagnostic procedures for the vulva, vagina and reproductive organs

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.

Cervical, vulvar or uterine biopsies

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.​1​

Vulvar biopsies can be done in your doctor’s office and require local anaesthetic.​2​

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.​3​

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.

Colposcopy

A colposcopy is the procedure whereby a magnifying lense is used to inspect the cervix for signs of cancer, typically after abnormal cells have been found during a Pap test.​4​

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

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.​5​

Dilation and curettage (D & C)

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.​6​

The curette then removes the endometrial tissue from the uterus using a scoop-shaped sharp tool (like a sharp spoon). This procedure 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 a hospital, but an overnight stay is usually not required.

Hysterosalpingography

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.​7​

Hysteroscopy

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.

A hysteroscopy may be performed in conjunction with other procedures, in both a doctor’s office or hospital, possibly with general anaesthetic.​8​

Laparoscopy

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.​9​

The laparoscopy 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.​10​

Loop electrical excision procedure (LEEP)

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 procedure is for areas bigger than a cervical biopsy.​11​

LEEP 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. The area is uncomfortable afterwards with some bleeding.

Read more about LEEP excisions. 

Large loop excision of the transformation zone (LLETZ) Procedure

Large loop excision of the transformation zone (LLETZ) Procedure is a procedure that uses a loop with electricity running through it to remove tissue.​12​

LLETZ is performed when your pap test, colposcopy/biopsy has shown abnormal cervical cells, and these cells need to be removed. The transformation zone of the cervix is the area of your cervix where the neck of the cervix connects to the outside section of the cervix (cervical os).

The procedure takes a few hours in hospital, and may be performed 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

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.​13​

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.

Ultrasound

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 performed 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.​14​

References

  1. 1.
    Valls J, Baena A, Venegas G, et al. Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study. The Lancet Global Health. Published online March 2023:e350-e360. doi:10.1016/s2214-109x(22)00545-9
  2. 2.
    Panez S, Sattler S, Dobry AS, Kraus CN. A survey of practices and perceptions of vulvar biopsies in academic dermatology. International Journal of Women’s Dermatology. Published online December 2021:763-765. doi:10.1016/j.ijwd.2021.10.011
  3. 3.
    Al-Jefout M, Dezarnaulds G, Cooper M, et al. Diagnosis of endometriosis by detection of nerve fibres in an endometrial biopsy: a double blind study. Human Reproduction. Published online August 18, 2009:3019-3024. doi:10.1093/humrep/dep275
  4. 4.
    Parween S, Prasad D, Sinha A, Mishra U, Raman R, Goel N. Colposcopic evaluation of cervix in symptomatic women and its correlation with Pap smear. A prospective study at a tertiary care centre. J Family Med Prim Care. Published online 2021:2923. doi:10.4103/jfmpc.jfmpc_1208_20
  5. 5.
    Wei B, Li Q, Seery S, Qiao Y, Jiang Y. Endocervical curettage for diagnosing high-grade squamous intraepithelial lesions or worse in women with type 3 transformation zone lesions: a retrospective, observational study. BMC Women’s Health. Published online May 9, 2023. doi:10.1186/s12905-023-02297-0
  6. 6.
    Azumaguchi A, Henmi H, Ohnishi H, Endo T, Saito T. Role of dilatation and curettage performed for spontaneous or induced abortion in the etiology of endometrial thinning. J of Obstet and Gynaecol. Published online January 26, 2017:523-529. doi:10.1111/jog.13254
  7. 7.
    Hindocha A, Beere L, O’Flynn H, Watson A, Ahmad G. Pain relief in hysterosalpingography. Cochrane Database of Systematic Reviews. Published online September 20, 2015. doi:10.1002/14651858.cd006106.pub3
  8. 8.
    Abdollahi F, Mostafa G, Montazeri F, Mashrabi O. Hysteroscopy as a minimally invasive surgery, a good substitute for invasive gynecological procedures. Iran J Reprod Med. 2012;10(4):377-382. https://www.ncbi.nlm.nih.gov/pubmed/25246901
  9. 9.
    Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. WJM. Published online 2015:238. doi:10.5662/wjm.v5.i4.238
  10. 10.
    Brichant G, Denef M, Tebache L, et al. Chronic pelvic pain and the role of exploratory laparoscopy as diagnostic and therapeutic tool: a retrospective observational study. Gynecol Surg. Published online July 20, 2018. doi:10.1186/s10397-018-1045-5
  11. 11.
    Leung SOA, Vitonis AF, Feldman S. Loop Electrosurgical Excision Procedure in Managing Persistent Low-Grade Abnormality or Human Papillomavirus Positivity. J Low Genit Tract Dis. Published online July 20, 2021:281-286. doi:10.1097/lgt.0000000000000619
  12. 12.
    Pecourt M, Gondry J, Foulon A, Lanta-Delmas S, Sergent F, Chevreau J. Value of large loop excision of the transformation zone (LLETZ) without histological proof of high-grade cervical intraepithelial lesion: Results of a two-year continuous retrospective study. Journal of Gynecology Obstetrics and Human Reproduction. Published online June 2020:101621. doi:10.1016/j.jogoh.2019.08.004
  13. 13.
    Kumar K, Pajai S, Baidya GR, Majhi K. Utility of Saline Infusion Sonohysterography in Gynecology: A Review Article. Cureus. Published online February 24, 2023. doi:10.7759/cureus.35424
  14. 14.
    Recker F, Gembruch U, Strizek B. Clinical Ultrasound Applications in Obstetrics and Gynecology in the Year 2024. JCM. Published online February 22, 2024:1244. doi:10.3390/jcm13051244


Original price was: USD $9.95.Current price is: USD $0.00. ex GST/VAT/TAX
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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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