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GYN-Oncology Clinic Procedures

Pelvic Exam

A pelvic exam is considered part of a woman's yearly health maintenance exam. The patient is placed on the exam table with her feet in the stirrups and asked to slide all the way down to the edge of the table, this puts the woman in a better position to get the best and most accurate exam possible. A speculum (a plastic or metal tool) is placed in the vagina to get a better look at the cervix. A pelvic exam allows the clinician to visually examine the vagina and cervix; it also lets the examiner feel or "palpate" the female organs to evaluate for any abnormalities. Once the speculum is removed, the clinician will put some lubricant on their gloved hand and gently insert one to two fingers into the woman's vagina while using the other hand to put gentle pressure on the woman's abdomen so the uterus, tubes, and ovaries can be better felt between the examiner's fingers in the vagina and those on top of the abdomen or pelvis. Pelvic exams usually cause little to no discomfort to the patient. A rectal exam is part of the pelvic exam. The doctor will apply lubricant and insert a finger into the rectum to better "palpate" the female organs and to determine if there is any blood in the patient's stool.

Pap Smear

A Pap smear is a test used as a screening tool for cervical cancer. A screening tool is a test or exam done on a person with no symptoms of a certain disease in the hopes of finding any abnormality before it becomes a bigger problem. A Pap smear is a test done on cells from a woman's cervix and therefore, will not screen for other types of gynecologic cancers from other organs, such as ovarian or uterine cancer. The test is often done right before a pelvic examination. The woman is placed in the same position as if she was getting a pelvic exam. Once the speculum is in the correct position, a sample of cervical cells is taken by swabbing the cervix, as well as from the endocervical canal (the opening through the cervix and into the womb or uterus). After which, the cells are transferred to a glass slide, treated so they will not dry out, and sent to the laboratory for analysis under a microscope.

A Pap smear usually causes little to no discomfort to the patient and the results are available in about 10 days. Patients are notified by mail when the results are normal. A nurse will call if the result shows any abnormal cells and further follow-up is needed. Pre-cancerous cells or cancer cannot be diagnosed with a Pap smear alone; this requires a biopsy (see below). A Pap smear cannot be done if the patient is having a period.

A Pap smear is not always done with a pelvic exam and there is really no way to tell unless the examiner tells the woman or she asks. A woman should always ask whether a Pap smear was taken with the exam, rather than simply assuming that one was done. Pap smears are also performed on the wall of the vagina, if a woman's cervix has been removed, as the same abnormalities which occur on the cervix, can also occur on/in the vagina.

Colposcopy

Colposcopy is done when a Pap smear comes back showing abnormal cells and further examination of the cervix or vagina is necessary. It is the next step in evaluating an abnormal Pap smear. The patient is placed in the same position, as she would be for a regular pelvic exam. The cervix/vagina is wiped with a vinegar solution to help identify any abnormal areas. An instrument called a colposcope is used by the clinician to magnify and focus a light on the cervix/vagina, allowing the examiner to look at the area in greater detail. The colposcope is placed close to the speculum. A colposcopy helps identify any abnormal areas needing to be biopsied (see below). If the areas examined look normal under colposcopy - biopsies may not be done. It is best to have this procedure done when the patient is not having a period. It is not unusual for patients to need repeat colposcopies to monitor their cervix for abnormal cells, especially with a history of abnormal pap smears.

Biopsy

A biopsy is done when, during a pelvic exam, colposcopy, or Pap smear, the clinician sees an area that they would like to have further evaluated by a pathologist (a doctor who specializes in studying samples under a microscope). Biopsies can be taken from the vagina, uterus and/or cervix. Biopsies are very small pieces of tissue and usually the patient will experience only mild to moderate discomfort similar to menstrual cramps during the procedure. A patient may need to wear a pad after a biopsy due to a small amount of vaginal bleeding ("spotting"). It may be necessary to use Advil or Tylenol for the cramping. The doctor may even have the patient limit sex, use of tampons, douches or tub baths for two weeks after a biopsy is done. Biopsy results are available in about 7-10 days; the patient will be contacted by either the nurse or the doctor depending on what the biopsy shows. Follow-up care will then be recommended and arranged.

LEEP (Loop Electrosurgical Excision Procedure)

A LEEP procedure may be recommended when a biopsy or colposcopy has shown there to be abnormal cells on the cervix and the clinician would like to remove the area of abnormality. This procedure is done in the outpatient clinic using a LEEP device. The patient is put in the same position as they would be for a regular pelvic exam. A special type of covered speculum is placed in the vagina. The covering is necessary due to the electrical current being used during the LEEP. A local anesthetic (numbing medicine) is injected into the cervix. A slight pinching sensation and some pressure are commonly experienced when this is done (in much the same way as when a dentist injects medicine to numb a tooth). Once the cervix is numb, the LEEP device will be used to remove a part of the cervix, like a biopsy, except that the goal is to remove all the abnormal tissue, not just a small piece for examination. As with a Pap smear, and biopsy, the tissue sample will be sent to the lab for careful examination by a pathologist.

After the LEEP, the patient will be given written instructions about what to expect, precautions to take, and when to call the nurse/doctor if there is a problem. Some cramping and vaginal discharge is common. To keep this to a minimum, it is recommended that 2 - 3 Advil (Ibuprofen) tablets (200mg each) be taken a half to one hour before the planned procedure. Further doses should be taken on an as needed basis. A follow-up appointment is usually scheduled for 3-4 months after the LEEP procedure. At this time, a repeat Pap smear and, possibly, colposcopy will be performed in order to make sure the abnormal cells have all been removed. This time frame is important to allow the cervix to heal completely before it is re-evaluated or examined.