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Diagnostic procedures in gynecology

Last updated: December 3, 2019

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A complete gynecological examination includes inspection of the vagina with the aid of a speculum and, if needed, colposcopy and bimanual palpation. Speculum examination is also used to facilitate obtaining smears for cytological and microbiological studies. Depending on the clinical presentation, other laboratory diagnostics and imaging procedures may be indicated. MRI scans and/or ultrasounds of the breast, for example, may supplement standard screening tests such as mammography. Unexplained pelvic symptoms may require transvaginal ultrasonography or more invasive diagnostic procedures such as endometrial sampling and hysteroscopic or laparoscopic examination.

  • Insertion of a speculum device facilitates the inspection of the vaginal wall and ectocervix
  • Evaluate the quality of vaginal discharge to determine whether a smear should be acquired

Speculum examination is virtually never indicated in preadolescent patients! If absolutely necessary (e.g., vaginal bleeding, trauma, abuse), it is usually performed under general anesthesia!

References:[1]

  • Colposcope: a type of microscope used to acquire a magnified view of the ectocervix or vaginal wall
  • Allows for assessment of the ectocervix under magnification (6–40 x)
  • Application of acetic acid or iodine facilitates the colposcopic detection of precancerous and cancerous lesions
  • Colposcopy-directed cervical smears and biopsies
  • Surgical procedures under colposcopic guidance

Benign lesions

Abnormal findings

References:[2][3][4][5]

  • Normal findings: cylindrical Lactobacilli (Doderlein's bacilli)
  • Pathological findings:
Finding Diagnosis
Pseudomycelia and/or yeast cells Vaginal candidiasis
Motile flagellated protozoa Trichomoniasis
Clue cells and whiff test (adding KOH to vaginal smear elicits a fishy odor) Bacterial vaginosis

References:[6][7][8]

Depending on the clinical presentation, other laboratory tests may be indicated:

Always perform a pregnancy test if a woman of child-bearing age presents with lower abdominal pain!References:[9][10]

Transabdominal ultrasound

Transvaginal ultrasound

Breast ultrasound

Breast ultrasound can be used to assess breast lesions which were detected by palpation, mammography, and/or breast MRI scans. Ultrasound can also be used to assess the axilla for lymph node involvement if there is suspicion for breast cancer.

References:[11]

References:[12]

  1. Carusi DA, Barbieri RL, Falk SJ. The Gynecologic History and Pelvic Examination. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/the-gynecologic-history-and-pelvic-examination.Last updated: March 27, 2017. Accessed: July 3, 2017.
  2. Feltmate CM, Feldman S, Goff B, Falk SJ. Colposcopy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/colposcopy.Last updated: September 26, 2016. Accessed: July 3, 2017.
  3. Cervical Polyps. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/benign-gynecologic-lesions/cervical-polyps. Updated: March 1, 2017. Accessed: April 17, 2018.
  4. Nabothian Cyst. https://radiopaedia.org/articles/nabothian-cyst. Updated: January 1, 2018. Accessed: April 17, 2018.
  5. Kleppa E, Holmen SD, Lillebø K, et al. Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa. Sex Transm Infect. 2014; 91 (2): p.124-129. doi: 10.1136/sextrans-2014-051674 . | Open in Read by QxMD
  6. Bradley LD. Overview of Hysteroscopy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-hysteroscopy.Last updated: November 6, 2017. Accessed: April 17, 2018.
  7. Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol. 2004; 24 (5): p.558-565. doi: 10.1002/uog.1704 . | Open in Read by QxMD
  8. Hainer BL, Gibson MV. Vaginitis: diagnosis and treatment. Am Fam Physician. 2011; 83 (7): p.807-815.
  9. Reichert RA. Diagnostic Gynecologic and Obstetric Pathology. Lippincott Williams & Wilkins ; 2012
  10. Pfenninger JL, Fowler GC. Pfenninger and Fowler's Procedures for Primary Care. Elsevier Health Sciences ; 2010
  11. Chourin S, Georgescu D, Gray C, et al. Value of CA 15-3 determination in the initial management of breast cancer patients. Ann Oncol. 2009; 20 (5): p.962-964. doi: 10.1093/annonc/mdp061 . | Open in Read by QxMD
  12. Gadducci A, Cosio S, Carpi A, Nicolini A, Genazzani AR. Serum tumor markers in the management of ovarian, endometrial and cervical cancer. Biomed Pharmacother. 2004; 58 (1): p.24-38.