Colposcopy- Colposcopy is a diagnostic tool used for further evaluation of abnormal Pap smears.

This procedure provides a non-surgical way for your physician to visualize your cervix.

One of the most frightening times in a woman's life is when the gynecologist calls and says her Pap smear results are abnormal. Although you might think an abnormal Pap smear means you have cervical cancer, the fact is that the majority of abnormal Pap smears are not caused by cervical cancer. The more likely cause of abnormal Pap smear results is inflammation or a vaginal infection. Because the Pap smear is a screening tool and not a diagnostic tool, your gynecologist may want to take a closer look at your cervix to determine the cause of your abnormal Pap smear results. He will perform an examination called a colposcopy. Your doctor may order this procedure if you have Pap smear results which:
• • •

indicate dysplasia or cancer show evidence of HPV show atypical squamous cells of undetermined significance (ASCUS) or repeated (ASCUS)

Your gynecologist may also order a colposcopy because your cervix appears abnormal during your pelvic exam and Pap smear, or if you have a history of prenatal DES exposure. Colposcopy is a simple and painless procedure performed in a gynecologist's office that takes 10 to 15 minutes. You are positioned on the examination table like you are for a Pap smear, and an acetic acid (such as common table vinegar) is placed on the cervix. This causes the cervical cells to fill with water so light will not pass through them. Your physician will use a colposcope to view your cervix. A colposcope is a large, electric microscope that is positioned approximately 30 cm from the vagina. A bright light on the end of the colposcope lets the gynecologist clearly see the cervix. During the colposcopy, the gynecologist focuses on the areas of the cervix where light does not pass through. Abnormal cervical changes are seen as white areas -- the whiter the area, the worse the cervical dysplasia. Abnormal vascular (blood vessel) changes are also apparent through the colposcope. Typically, the worse that the vascular changes are, the worse the dysplasia. If your physician can view the entire abnormal area through the colposcope, a tissue sample or biopsy is taken from the whitest abnormal areas and sent to the lab for further evaluation.
Cryosurgery- Cervical cryosurgery or cryotherapy is a gynecological treatment that freezes a section of the cervix. Cryosurgery destroys abnormal cervical cells that show changes that may lead to cancer. These changes are called precancerous cells. Your gynecologist may use the term cervical dysplasia to describe your condition. Cervical cryosurgery or cryotherapy is a gynecological treatment

that freezes a section of the cervix. Cryosurgery of the cervix is most often done to destroy abnormal cervical cells that show changes that may lead to cancer. These changes are called precancerous cells. Your gynecologist will probably use the term cervical dysplasia.

Next. when the cervical changes are located in the upper section of the cervix a cone biopsy. This causes the metal cryo probes to freeze and destroy superficial abnormal cervical tissue. What happens during cryosurgery? Cryosurgery is performed in your doctor's office while you are awake. Cryosurgery is not a treatment for cervical cancer. no douches. You may experience either a sensation of cold or of heat. there are a few things you should take note of for the first two to three weeks following treatment: • • It is normal to experience a watery discharge for the first few weeks. Do not insert anything into the vagina for at least two to three weeks. You should call your health care provider if any of the following occur: . This means no tampons. however.Cryosurgery is done only after a colposcopy confirms the presence of abnormal cervical cells. and no sexual intercourse. How will I feel during cryosurgery? • • You may feel some slight cramping. It is similar to a pelvic exam: • • • you will be asked to undress from the waist down. liquid nitrogen begins to flow through the cryo probes at a temperature of approximately -50 degrees Celsius. • • • • • Cryotherapy uses special instruments called cryo probes. a speculum is inserted into your vagina to hold the vaginal canal open so that your cervix can be seen. that's where the similarity ends. letting the cervix thaw. However. This is caused by the sloughing of dead cervical tissue. rather than cryotherapy. lay on an exam table with your feet in stirrups. and repeating the treatment for three more minutes. However. What happens after cryosurgery? You can return to most normal activities the day after cryosurgery. The most effective treatment result is obtained by freezing for three minutes. How effective is cryosurgery for cervical dysplasia? Cryosurgery is an adequate treatment for most cases of cervical dysplasia destroying all of the abnormal cervical tissue in over 85 percent of cases. During cryosurgery the cyro probes are inserted into your vagina until they firmly cover the abnormal areas of cervical tissue. Cyrotherapy is also used for the treatment of cervicitis or inflammation of the cervix. is recommended.

may make you wonder if your doctor wants you to jump. or cervical dysplasia. Some slight cramping is normal. This causes the abnormal cells to rapidly heat and burst. The LEEP procedure has nothing to do with jumping. Cryosurgery is relatively risk-free. Your doctor should inform you before you leave the office what amount of fever is cause for alarm following cryosurgery. however. your doctor will discuss with you how often you need future screening for cervical cancer. After cryosurgery you will need Pap tests every three to six months for a period of time. and separates the tissue as the loop wire moves through the cervix. Vaginal bleeding that is heavier than you normally experience during your menstrual cycle. a colposcopy and / or a cone biopsy. Never take any drug before any medical procedure without explicitly asking your doctor about it. Once you have had several normal Pap smears in a row. You may want to ask your doctor if it's OK to take an over-the-counter pain reliever such as ibuprofen before your procedure to help minimize any pain. LEEP Procedure. The LEEP procedure is one of several procedures your doctor has available to help diagnose and treat abnormal cervical cells. LEEP uses a thin wire loop electrode which is attached to an electrosurgical generator. A single- . The generator transmits a painless electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire. If your doctor has told you that you need to have a LEEP procedure.o o o o Fever. Foul smell or yellowish vaginal discharge. Always follow your doctors instructions for preparation for the LEEP. While the loop electrosurgical excision procedure. it's because your annual Pap smear indicated the presence of abnormal cervical cells. A colposcope will be used to guide your doctor to the abnormal area. What happens during the LEEP procedure? The LEEP procedure takes about 20-30 minutes and is usually performed in your physician's office. Unlike a normal colposcopy.The loop electrosurgical excision procedure (LEEP) is used when there is an indication of abnormal cells on the surface of the cervix. The pad is a gel-covered adhesive electrode which provides a safe return path for the electrosurgical current. In some ways it may seem much like a normal pelvic exam because you will lie on the exam table with your feet in the stirrups. a tube will be attached to the speculum to remove the small amount of smoke caused by the procedure. any severe or increasing pelvic pain should be reported to your doctor immediately. These can indicate an infection which may need immediate treatment. Other procedures your doctor may want you to have either before or during the LEEP procedure include. producing fewer complications than any other gynecological procedure. Pain. or LEEP procedure. This technique allows your physician to send the excised tissue to the lab for further evaluation which insures that the lesion was completely removed. An electrosurgical dispersive pad will be placed on your thigh. as well as allowing for a more accurate assessment of the abnormal area.

Your cervix will be prepared with acetic acid and iodine solutions that enable your physician to more easily see the extent of the abnormal area.Hysteroscopy provides a way for your physician to look inside your uterus. This tool often helps a physician diagnose or treat a uterine problem. telescope-like instrument that is inserted into the uterus through the vagina and cervix. disposable loop electrode will be attached to the generator hand piece by your physician. the electroloop will be generated and the wire loop will pass through the surface of your cervix. Keeping these follow up appointments is necessary to verify that all of the abnormal cervical tissues have been removed. make sure to follow your doctor's instructions precisely. Other symptoms that should be reported to your physician include any heavy vaginal discharge or strong vaginal odor. Hysteroscopy. Next a local anesthetic will be injected into the cervix. and / or colposcopies. as well as to make sure that if abnormal cervical cells redevelop they are caught early and treated appropriately. Are there any complications associated with the LEEP? Complications are usually mild but can include: • • mild pain or discomfort bleeding You should call your physician if you experience bleeding that is heavier than a normal period. or if pain is severe. Your doctor will tell you when to return for follow up Pap smears. he may also use a topical solution to prevent further bleeding. After the LEEP you should not: • • • • • Have sexual intercourse for as long as recommended by your physician Lift heavy objects Use tampons Douche Take tub baths--take showers only to prevent infection It's important for you to remember that having cervical dysplasia does not mean that you have cervical cancer. However. After the lesion is removed your physician will use a ball electrode to stop any bleeding that occurs. treatment of the abnormal area is imperative to prevent abnormal cervical cells from developing into cervical cancer After the LEEP procedure. You can leave your physician's office soon after the procedure. A hysteroscope is a thin.use. What is hysteroscopy? .

Regional anesthesia: A drug is injected. How will I be prepared for hysteroscopy? If you are having general anesthesia in the hospital. are sometimes used in conjunction with the hysteroscopy. or fibroids which can often be removed through the hysteroscope. and may also be used to confirm the results of other tests such as hysterosalpingography (HSG). An operative hysterocopy may be used. You are awake • . Endometrial ablation is a procedure which destroys the lining of the uterus. women can no longer have children so it is not an option for women who wish to have future pregnancies. Diagnostic hysteroscopy can be used to diagnose certain conditions such as abnormal uterine bleeding. you will be told not to eat or drink anything for a certain period of time (usually after midnight the night before) before the procedure. such as dilation and curettage (D&C) and laparoscopy. Next you will be prepared for anesthesia: • Local anesthesia: You will receive an injection of anesthetic around the cervix to numb it. infertility. to both diagnose and treat certain conditions such as uterine adhesions. The resectoscope is a telescope-like instrument with a wire loop. adhesions. It can be performed with local. fibroid tumors. known as endometrial ablation. septums. or a roller cylinder tip at the end. The hysteroscope is sometimes used with other instruments such as the resectoscope to treat some cases of abnormal bleeding. or general anesthesia--sometimes no anesthesia is needed. telescope-like instrument that is inserted into the uterus through the vagina and cervix. with this type of anesthesia you remain awake and may feel some cramping. This tool often helps a physician diagnose or treat a uterine problem. regional. Electric current at the end of the tip is used to destroy the uterine lining. When is hysteroscopy used? Hysteroscopy may be either diagnostic or operative. Hysteroscopy is minor surgery which is performed either in your physician's office or in a hospital setting. There is little risk involved with this procedure for most women. A hysteroscope is a thin. or to locate displaced intrauterine devices (IUDs). instead of open abdominal surgery. however after this procedure.Hysteroscopy provides a way for your physician to look inside your uterus. Diagnostic hysteroscopy is used to diagnose some uterine abnormalities. Routine lab tests may be ordered as well for women having a hysteroscopy in the hospital. Sometimes a drug to help you relax is ordered. polyps. a rollerball. repeated miscarriages. Other instruments or techniques. through a needle or tube in your lower back. During this time your physician is best able to view the inside of the uterus. This procedure is usually performed in an outpatient setting. that blocks the nerves that receive sensation from the pelvic region. You will be asked to empty your bladder and your vaginal area will be cleansed with an antiseptic. When should hysteroscopy be performed? The best time for hysteroscopy is during the first week or so after your period.

a tube may be inserted down your throat to help you breathe. The opening of your cervix may need to be dilated or made wider with special instruments. You may feel faint or sick. Sometimes a laparoscope is used at the same time to view the outside of the uterus. but can usually go home on the same day. A mask over your mouth and nose allows you to breathe a mixture of gases. A laparoscopic procedure will be done in a hospital setting. Regional anesthesia is also called a spinal or epidural.with this type of anesthetic. small instruments are inserted through the hysteroscope. How will I feel after a hysteroscopy? Some patients may experience shoulder pain following laparoscopy or when gas is used to expand the uterus. and into your uterus. Remember to ask questions if anything is about your procedure or anesthesia is unclear. 2. A light source shone through the hysteroscope allows your physician to see the inside of the uterus and the openings of the fallopian tubes into the uterine cavity. When will I be able to go home? Patients who received a local anesthetic can usually go home soon after the procedure. Those who had regional or general anesthesia require a longer observation period before they are released. Most of the gas is removed at the end of the procedure. Your physician will determine which type of anesthesia is best for you based on the reason for your hysteroscopy. When this happens a gas such as carbon dioxide or nitrous oxide is allowed to flow into the abdomen. Next a liquid or gas is usually released through the hysteroscope to expand your uterus so your physician will have a better view of the inside. If surgery is required. Contact your Doctor if you develop any of the following after your hysteroscopy: • Fever . What happens during the hysteroscopy procedure? 1. 5. The gas expands the abdomen so that the physician can see the organs easier. • General anesthesia: You will not be conscious during your hysteroscopy when general anesthesia is used. or you may have slight vaginal bleeding and cramps for 1-2 days following the procedure. but feel no discomfort. Once the gas is absorbed the discomfort should subside quickly. Once you are under anesthesia. The hysteroscope is inserted through your vagina and cervix. 4. 3.

Laparoscopy is usually performed under general anesthesia. Next. however it can be performed with other types of anesthesia that permit the patient to remain awake. Problems that can occur happen in less than 1% of cases. in the majority of cases it is not necessary. The typical pelvic laparoscopy involves a small (1/2" to 3/4") incision in the belly button or lower abdomen. It is normally performed in the outpatient surgery unit of a hospital. a laparoscope (a one-half inch fiber-optic rod with a light source and video camera) is inserted through the belly button. the doctor has more room to work. What happens during laparoscopy? Laparoscopy is usually performed under general anesthesia. In most cases. That way. gallbladder removal or hiatal hernia repair. The video camera also allows the surgeon to take pictures of any problem areas he discovers. it can be performed with other types of anesthesia that permit the patient to remain awake. Pelvic laparoscopy. the physician may perform surgery through the laparoscope by inserting various instruments into the laparoscope while using the video monitor as a guide. however. but include: • • • • Injury to the cervix or uterus Infection Heavy bleeding Side effects from the anesthesia Although general anesthesia is sometimes used. The typical pelvic laparoscopy involves a small (1/2" to 3/4") incision in the belly button or lower abdomen. The procedure and recovery time are usually short. Laparoscopy is a minimally invasive surgical technique used in procedures such as tubal ligation. Depending on the reason for the laparoscopy. Carbon dioxide causes the abdomen to swell. .• • Severe abdominal pain Heavy vaginal bleeding or discharge Is hysteroscopy safe? Hysteroscopy is a fairly safe procedure. The abdominal cavity is filled with carbon dioxide. Hysteroscopy allows your physician to see inside your uterus and aids in the accurate diagnosis of some medical problems. patients can return home a few hours after a laproscopic procedure. which lifts the abdominal wall away from the internal organs. The video camera permits the surgeon to see inside the abdominal area on video monitors located in the operating room.

and a quick recovery for most patients. D&C. Generally. The top of the uterus is wide and it narrows like the neck of a bottle at the bottom. be sure that you fully understand the reason he is recommending this procedure and how you can expect to benefit. are overweight. perforation of the bowel or liver are possible complications that may occur during laparoscopy. Although rare. Is there any risk associated with laparoscopy? Certain women face an increased risk with any surgical procedure including women who instrument used to separate the walls of the vagina. The cervix is round and has a small opening called the OS. During your GYN exam your physician can see the cervix by using a speculum -.In some cases. Patients sometimes experience aches in the shoulders or chest following laparoscopy--this is from the carbon dioxide that was used to fill the abdominal cavity. If your doctor has ordered a laparoscopy for you. most patients are fully recovered and ready to return to full activity one week after laparoscopy. the physician may discover that he is unable to accomplish the goal of surgery through the laparoscope and a full abdominal incision will be made. who have pulmonary diseases or cardiovascular diseases. the D&C is one of the most common GYN operative procedures. The uterus is a pear-shaped.Often used to diagnose or treat abnormal uterine bleeding. Before you can understand D&C you need to know a little about the uterus and cervix. Often patients have the procedure on a Friday and are able to return to light work by Monday. . The lower third portion of the uterus is its neck which is called the cervix. as well as women in the late stages of pregnancy or who use certain drugs. you should call the doctor if you experience fever above 100 F. Barring complications. Often used to diagnose or treat abnormal uterine bleeding. your physician will discuss this with you prior to surgery. the D&C is one of the most common surgical procedures performed on women. Always ask questions before agreeing to any surgical procedure. However. Dilation and Curettage also provides important information about whether uterine cancer is present. If you think you may fall into any of these categories. Dilation and Curettage also provides important information about whether uterine cancer is present. be sure to discuss your surgical risks with your physician. When should you call the doctor? When you leave the hospital. excessive pain (not controlled by pain killers). muscular organ that sits in the lower abdomen. swelling or discharge from the wound. you will receive personalized instructions about when to call the doctor. What is the recovery period following laparoscopy? Laparoscopy results in relatively little pain. if this is a possibility in your case. Tylenol or Advil is usually sufficient for pain relief after this procedure. and the surgical consent form will include this possibility. Although prescription pain killers are often ordered.

Where Is Dilation and Curettage Performed? Where your D&C takes place depends on individual factors about your health. another surgical procedure is necessary to remove them. Occasionally a hysteroscopy is performed at the same time as a D&C. and uterus. Polyps inside the uterus can usually be removed by D&C. Abnormal uterine bleeding is also a warning of various types of growths. allowing the doctor a better view of inside the cervix. Fibroid tumors are another common benign growth that occurs in the uterus. Fibroids can be silent causing no symptoms.The inner wall of the uterus is lined by endometrial tissues. Although fibroid tumors are sometimes detected during dilation and curettage. The are many possible causes for these menstrual abnormalities. Women over 40. or they can cause heavy bleeding and painful cramping. Before the surgery starts an antiseptic will be used to cleanse the skin around the vagina and cervix. hormone production ceases and the endometrium breaks up and is shed as menstrual blood. The endometrial tissues thicken during the first part of your menstrual cycle. If pregnancy doesn't occur. An injection around the cervix will minimize pain or discomfort from the procedure and produce numbness in the area. vagina. Abortions induced before the 12th week of pregnancy are performed in a manner which is similar to the D&C. one of the most common being a hormonal imbalance. Dialation and curettage is also commonly performed following miscarriage or abortion in cases where the uterus fails to fully empty its content. and changes the endometrial lining so that it is ready to accept a pregnancy should it occur. Once ovulation occurs progesterone acts to stop this thickening. Although this can happen at any age it most commonly occurs in young women just starting menstruation and in older pre-menopausal women. Be sure to ask your doctor if there are any additional preparations that you should make before your dilation and curettage. . especially those past menopause. One of these benign growths are polyps which attach either by a stem or a stalk most often to the lining of the uterus or the cervix. Hormonal imbalance causes a thickening of the endometrium which sometimes causes irregular or prolonged menstrual cycles. Who Needs A D&C? A D&C may be required to diagnosed and/or treat a problem such as heavy or prolonged menstruation. Abnormal bleeding is sometimes a sign of endometrial cancer. It can be performed in a hospital setting using general anesthesia or in your doctor's office using a local anesthetic. may have a D&C or another procedure called an endometrial biopsy. particularly in women over 40. which are most often non-cancerous. as well as unexplained bleeding between periods. How Am I Prepared for D&C? • • Do not eat or drink anything before surgery for a time period to be determined by your doctor.

This loosens pieces of the lining which are removed and sent to a lab for microscopic examination. a speculum is inserted into the vagina to open the walls so the doctor can see the cervix. Although complications with D&C are rare they can include: • • • A perforation of the uterine wall caused by the tip of the surgical instrument. The cervix is dialated with a series of tapered rods of increasing widths which are inserted into the cervical opening (the OS). Complications of Dilation and Curettage As with any surgical procedure it's important for you to understand any possible complications or risks. Excessive bleeding is always a risk during surgery. and douches for at least a week. You will need a friend or family member to accompany you home a few hours after your D&C. Make sure you follow up with your doctor as recommended after the surgery. What To Expect After Surgery You may have some discomfort from general anesthesia which can include nausea. heavy bleeding. Another method of obtaining a sample of the uterine lining is by applying suction through a narrow tube. Showering. The affects of anesthesia wear off at different rates for each individual. or a vaginal discharge with a bad odor occur. you should refrain from sexual intercourse. however you should be able to drive and return to normal activities within a few days. abdominal pain. A clamp-like instrument holds the cervix in place. . or swimming is permitted as soon as you feel well enough. vomiting. Many women will notice mild cramping for a few days following D&C. as well as spotting or slight bleeding for up to a week. tampon use. and a sore throat that can last a few days. Your next period may be early or late. Another rare complication is infection with pain and fever. Points To Remember After D&C • • • • To prevent bacteria from entering the cervix following D&C. Next. This injury rarely requires treatment (additional surgery) and heals on its own. bathing.What Are The Steps For Dilation And Curettage? • • • • • The doctor completely inspects the pelvic reproductive organs for any abnormal changes. Notify your doctor if fever. A curette is passed through the uterus and used to scrape the uterine walls.

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