Gynecological In-Office Procedures
In-office procedures with descriptions
LARC or IUD Insertion/Removal
Saline Infusion Sonography
Colposcopy; a diagnostic procedure used to provide an illuminated, magnified view of the cervix, vagina, and vulva
Colposcopy is a diagnostic procedure in which a colposcope (a dissecting microscope with various magnification lenses) is used to provide an illuminated, magnified view of the cervix, vagina, and vulva. This is often the next step in the evaluation process that follows an abnormal pap smear. During this procedure, vinegar will be applied to the cervix, and the gynecologist will then examine the cervical tissue with the microscope. There are certain changes the cervix undergoes once vinegar is applied that can be suggestive of HPV (human papillomavirus) or other precancerous lesions. At this point, the physician may elect to take a small biopsy from a specific area that appears abnormal. This will help determine the proper treatment and follow up for the patient. The results from any biopsy are usually available to the physician in about 7-10 days. There is usually little or no pain during this procedure. We recommend that the patient take 600mg of over the counter pain reliever 30 minutes prior to the procedure. We advise that the patient abstain from intercourse or anything in the vagina for 2 weeks following the procedure. There is often a brown/mustard/ black discharge that can be present on and off for 2-3 weeks. The patient should call the office if there is a fever greater than 100.4, intense pelvic pain not relieved by an over the counter pain reliever or heavy bleeding (soaking a pad in an hour or less).
Contraceptive IUD Placement or Removal; quick and effective procedures
Insertion or removal of long acting reversible contraception (LARC, i.e. IUD or Nexplanon arm insert). Two types of intrauterine devices (IUDs) are placed at The Woman’s Group. Every patient who is having an IUD inserted will need to have cultures of the cervix to rule out a current infection. The actual insertion of the IUD should only take a few minutes. Some patients will experience no pain, while others may experience intense menstrual cramps during the insertion. It is recommended that patients take 600mg of an over the counter pain reliever 30 minutes prior to the appointment time. Once the IUD is placed, the strings attached will be cut typically to a length of 3cm. If the patient continues to have cramping after the procedure, it is recommended to take an over the counter pain reliever every 4-6 hours for the next 24 hours. Heavy bleeding or intense pain not relieved by over the counter medications is not considered normal, and you must call the doctor’s office. A follow-up appointment is scheduled 6 weeks after the procedure to check the IUD’s placement.
Cryotherapy; a refrigerant gas used to freeze and destroy abnormal lesions in the ectocervix
Cryotherapy uses a refrigerant gas to cool the ectocervix with a metal cryoprobe. The ectocervix must be cooled to -20ºC to cause crystallization of intracellular water and destroy the lesion. This can be achieved by forming an ice ball in the cervical tissue that is at least 5 mm from the tip of the probe. The technique traditionally uses a “freeze and thaw” method by which the cryotherapy is performed for 3 minutes, 3 minutes off and freezing again for another 3 minutes. There is at times cramping during the procedure, so the patient is advised to take 600mg of over the counter pain reliever prior to the appointment time. The most common complaint after the procedure is a copious watery discharge that can last for up to 4 weeks. We also want you to abstain from intercourse, douching, swimming or tampons for 4 weeks. You should call the office after your procedure if you have a temperature greater than 100.4, heavy vaginal bleeding (soaking a pad in an hour or less), or pain not relieved by over the counter pain reliever.
Endometrial Biopsy; a quick procedure producing an endometrial tissue sample
At times it is the recommendation from the gynecologist to undergo an endometrial biopsy if abnormal or heavy bleeding, post-menopausal bleeding, or an abnormal pap smear are present. A suction device is used to perform endometrial sampling. This device consists of a plunger within a sheath. This is a very thin instrument only 3mm in diameter and appears to be a long thin “straw”. When the sheath is inserted into the uterus, the plunger is retracted, creating negative pressure that draws tissue into the sampling device. This tissue is then sent to the pathology laboratory for diagnosis. The total time for this procedure is less than 20 seconds. Although some patients experience no pain at all, others will complain of intense menstrual cramping. It is recommended to take 600 mg of non prescription pain reliever prior to the appointment time. The cramping should resolve before the patient leaves the office. There are no specific restrictions or instructions after having a endometrial biopsy. Pathology from the sample will be available in about 7-10 days.
LEEP procedure; a loop electrosurgical excision procedure used to remove pre-cancerous lesions of the cervix
Loop electrosurgical excision procedure, or LEEP, is used to treat pre-cancerous lesions of the cervix. The patient is encouraged to take 600mg of an over the counter pain reliever prior to her appointment time. Once a speculum is placed into the vagina to provided visibility into the cervix, a local anesthetic is injected. There is usually little pain associated with this injection. At this point, a wire loop attached to an electrosurgical generator is used to remove the abnormal tissue. This typically takes less than 30 seconds. A second portion of the procedure is then done when a wand, also connected to heat, is used to treat the remaining cervical tissue. This process helps with bleeding along with treating any remaining HPV (human papillomavirus). The patient will be provided with instructions as to post-procedure care, which includes pelvic rest for 6 weeks, including avoidance of intercourse, douching, swimming, tub baths or the use of tampons. It is normal to experience a discharge that may be mustard/brown/black in color, light vaginal bleeding, and/or light cramping. The patient needs to call the office for fevers greater than 100.4, pain not relieved by over the counter pain relievers, or heavy bleeding (using more than a pad/tampon per hour). Pathology collected from the LEEP will typically be available in 7-10 days. Once the results are reviewed by the physician, the timing for follow up pap smears will be determined
Minor Biopsies or Removals; small punch biopsies or mole removals sent to the lab
There are a times when a patient may need to have a minor office procedure or biopsy. This can include a variety of skin biopsies, or the removal of a mole. It is common to use an instrument called a punch biopsy to perform this task. When the patient is going to have an area biopsied, there is typically local anesthesia injected into the site. The biopsy is then done. There are times when a small amount of suture may be needed for adequate hemostasis. The results from any biopsy are typically available in about 7-10 days.
Saline Infusion Sonography (SIS); a procedure looking for intrauterine abnormalities
Saline infusion sonography, or SIS, is a procedure which looks for intrauterine abnormalities. During the procedure a speculum is placed in the vagina, and a thin catheter is gently placed through the cervix. At this point, the speculum is removed, and the transvaginal ultrasound probe is introduced. While the sonogram images are being obtained, the saline is injected through the catheter. This allows for discrete evaluation of the uterine cavity and lining for abnormalities such as fibroids, polyps, or scar tissue. There is usually only minor cramping associated with the procedure, and it is recommended to take 600mg of an over the counter pain releiver prior to the appointment time.
Urodynamics; in-office testing that determines the cause or causes of incontinence
Urodynamics is testing that determines the cause or causes of incontinence. The testing includes two separate visits, the first lasting about 15 minutes and the second from 30 to 45 minutes. On the first visit, the patient will need to arrive with a comfortably full bladder. A urine sample will be taken and the nurse will review instructions on preparation for the second visit. The actual urodynamics test will be conducted on the second visit. During this visit, catheters will be inserted to record the pressure in and around the bladder and to allow for measurement of any leaking that may occur during the filling process. Throughout the test the patient will be asked to describe bladder sensations and to cough as to put pressure on the bladder as to cause a leak. There are no restrictions after having a urodynamic test. Upon completion of the test, the results will be evaluated by the physician, who will discuss with the patient the results and discuss treatment options, if necessary.