Procedures

Here at Mt. Auburn OBGYN, we care about your well being. Our highly skilled and experienced physicians are well prepared to give you the care you need through various methods and procedures. Schedule an appointment today and we will work with you to find the best option that works for you.

Colposcopy (in-office)

What is a colposcopy??
A colposcopy is an outpatient procedure to view the cervix and the vagina through a high-powered microscope called a colposcope. The colposcope looks like a pair of binoculars attached to a stand. It does not enter the vagina. Direct examination through the colposcope allows the detection of abnormalities on the cervix that can not be seen with the naked eye.

Is There Any Preparation for the Test??
We suggest that one hour before your appointment you take a non-steroidal anti-inflammatory medication such as Ibuprofen or Naproxen Sodium. Make your appointment for a time when you will not be menstruating (on your period). Refrain from intercourse, the use of spermicidal jelly, vaginal medications, douches, or tampons for at least 24 hours before the procedure as they can interfere with the accuracy of the test.

How is the Examination Performed??
You will lie on the examining table with your feet in the stirrups, just like a regular pelvic exam. Your doctor will use a speculum to separate the walls of the vagina, just like during a normal Pap test. The speculum will remain in the vagina throughout the procedure, causing you to feel a little pressure.

A vinegar solution (called acetic acid) will be applied to the cervix to remove mucous and debris. The colposcope will be placed near the vaginal opening. Your doctor will be able to see your vagina and cervix under magnification.

Any areas showing abnormal cells will be biopsied. In a biopsy, a tiny sample of tissue will be removed from the area with a tweezer-like instrument. An endocervical scraping from the os (the opening in the middle of the cervix) may be taken as this is often where abnormal cells begin. You may feel a pinch or cramping when the tissue samples are taken. The samples will be sent to a pathology lab to be examined.

What Should I Expect After the Procedure??
If a biopsy was taken, you may have slight bleeding or spotting for a few days following the procedure. Additionally, you may notice a coffee ground or mustard-like discharge. This is normal. You may use pads, but no tampons for one week following the procedure. You should also refrain from douching or having sexual intercourse. If you have any cramping after the procedure, you may continue the Ibuprofen or Naproxen Sodium for relief.

Laparoscopy

A laparoscopy is a procedure which allows your physician to look directly at your reproductive organs using an instrument called a laparoscope. This diagnostic procedure allows your doctor to see problems that could not be seen with a pelvic exam, x-rays, or ultrasound.

Many times a problem can also be treated during the procedure. You can usually go home the same day the procedure is performed.

What Is a Laparoscope?

A laparoscope is a long, narrow tube with a fiber optic light at one end. It is inserted into the abdomen through an incision in or under the navel. It can be maneuvered in any direction to allow views of the internal organs. Additional small incisions may be made to allow surgical instruments or a laser to be inserted into the lower abdomen.

When Is the Laparoscope Used?

A laparoscope may be used for any of the following conditions.

Adhesions?
A laparoscope may be used to separate adhesions, also called scar tissue, which form when tissues in the abdomen stick together. Adhesions can result from infection, previous pelvic surgery, or?endometriosis. They can be a cause of pelvic pain.

Endometriosis?
Endometriosis is diagnosed by laparoscopy and many times can be treated through the laparoscope. Endometriosis is when uterine tissue, endometrium, is found outside the uterus. This tissue bleeds each month with the menstrual cycle. This can result in pelvic pain and adhesions.

Infertility?
If a woman is having trouble conceiving, the physician may perform a laparoscopy to look for endometriosis and to look at the fallopian tubes. If the tubes are blocked, the egg and the sperm cannot meet.

Ectopic Pregnancy?
An?ectopic pregnancy?is a pregnancy that has implanted outside of the uterus. Most of the time, it has implanted in a fallopian tube. A laparoscopy can be used to diagnose, and many times treat, an ectopic pregnancy.

Ovarian Cysts?
An ovarian cyst, a pouch containing fluid or solid material attached to or around the ovary, can often be treated through the laparoscope, if the cyst does not resolve on its own. These cysts may be painful.

Fibroids
Fibroids are tumors made up of fibrous tissue that can grow inside, outside, or within the walls of the uterus. Sometimes a laparoscope is used to diagnose fibroids.

What Happens During a Laparoscopic Procedure?

A laparoscopy is usually an “outpatient” procedure, which means that you will arrive and go home on the same day. The procedure is usually performed under general anesthesia. You will be asked not to eat or drink anything for at least 8 hours before the surgery.

The surgeon will make a one inch incision just below or inside the navel, and then will insert a needle and inject carbon dioxide gas into the abdomen. This harmless gas will lift the abdominal wall away from the internal organs, creating a space to allow the surgeon to see the organs. The needle will be removed and the laparoscope will be inserted into the incision. Other incisions may be made above the pubic area to allow other instruments or a laser to be inserted. Usually, the laparoscope projects the images onto a television screen. This makes the images larger and easier for the surgeon to see. Sometimes pictures are taken during the surgery or a video is made.

After the procedure is over, the instruments will be removed and the gas released. The incisions are usually closed with a few dissolvable stitches. You will be sent to the recovery room until you are awake and alert.

Following the surgery, you may have some abdominal cramping or shoulder discomfort due to the carbon dioxide gas. This will gradually go away over the next few days.

**Not done in-office

LOOP ELECTROSURGICAL EXCISION PROCEDURE (LEEP)

What Is a LEEP Procedure?

LEEP is a procedure to treat abnormal cells, also called dysplasia, on your cervix.

Cells on your cervix are constantly growing and changing. Sometimes these cells grow and change abnormally. These abnormal cells are usually first noticed on a Pap test. Once your Pap test or cervical biopsies have come back showing dysplasia, a LEEP may be recommended as treatment for these cells.

Dysplasia is not cancer, but can lead to cervical cancer if not treated. During a LEEP, your doctor can remove the affected tissue, including the transformation zone where abnormal cells develop. The specimen is sent to a pathologist to be sure that the dysplastic cells have been completely removed and that there is not cancer.

About 95% of patients are cured of their problem following a LEEP.

What Happens During a LEEP Procedure?

It is best to schedule a LEEP during the first half of the menstrual cycle, after you have stopped bleeding. The procedure begins like a Pap test. You will put your feet in stirrups and a speculum will be inserted into your vagina and opened. Now your doctor can see the cervix. Your cervix will be numbed with a local anesthetic. A mild vinegar solution, called acetic acid, will be applied to your cervix. This solution turns the affected cells white. Your doctor will place a?colposcope, a binocular-like instrument outside your vagina to look at your cervix microscopically.

A fine wire loop is used to remove the abnormal tissue from your cervix. The loop will cut and seal blood vessels, decreasing bleeding. To further decrease bleeding, a medicated paste or solution may be applied to your cervix. This solution often causes a dark coffee-ground like vaginal discharge for a few days after the procedure. The tissue removed will be sent to a pathologist for diagnosis.

What Precautions Should I Take Following a LEEP?

Following the procedure, you may feel a few mild cramps and you will have a vaginal discharge. You should not put anything in your vagina, such as tampons, or have sexual intercourse for three to four weeks after your procedure. You should also avoid heavy lifting and vigorous exercise for three to four weeks.

Your doctor will want to monitor your Pap test more frequently for at least two years following your LEEP. To catch any problems early, it is very important that you see your doctor.

Call Your Doctor if You Notice:

  • Heavy bleeding or bleeding with clots (a “coffee ground” discharge is normal)
  • Severe abdominal pain
  • Fever
  • Foul-smelling discharge

**Not done in-office

Pap Test (in-office)

What Is a Pap Test?

The Pap test, or Pap smear, is a screening test for cervical cancer. The test can detect changes in the cells on the cervix. These changes may be cancerous, pre-cancerous, or caused by inflammation.

Why Is a Pap Smear Needed Every 3-5 Years??
Even though cervical cancer is almost 100% curable when diagnosed and treated in the early stages, nearly 5,000 women die of it each year. Deaths from cervical cancer have declined more than 70% since the Pap test was invented 50 years ago.

Who Should Get a Pap Test??
Every woman should have regular pelvic exams and Pap tests beginning at age 18, or younger if they have had sexual intercourse.

How Do I Prepare for a Pap test??
You should not douche 24 to 48 hours before a Pap test. The solution may wash away cells shed from the cervix. You should not use any vaginal creams or gels (including medicinal creams) or have vaginal intercourse 24 to 48 hours before a Pap test. The creams, gels, or seminal fluids may hide cervical cells.

You should schedule your exam for after your period, as blood can also obscure cells.

Pap TestHow Is a Pap Test Preformed??
The Pap test is a very simple and quick test. During the pelvic exam, the doctor will insert a speculum into your vagina, then gently open it so the cervix can be seen. A thin brush and a wooden or plastic spatula are used to collect a sample of cells from the cervix. These cells are sent to the lab to be analyzed by a cytotechnologist.

Will the Pap Test Hurt??
Many women report the most uncomfortable part of the exam is the pressure caused by the opening of the speculum. You may feel the scraper or brush being wiped across your cervix. You can help make the exam more comfortable by breathing deeply and trying to relax the muscles at the opening of your vagina.

How Are the Results Reported??
The laboratory will contact our office with the results of your Pap smear. Most results come back “negative,” which means the cells sampled were normal. Abnormal results are reported following a system that describes the level of change in the cells. These changes range from very minor to severe.

Can a Pap Test Detect Infections??
Ganerella is the most commonly found vaginal bacteria detected by a Pap test. Candida (yeast) and Trichomonas are among pathogens recognized by a Pap test. You can have any of these infections without symptoms. Your doctor may offer treatment or further testing.

Rarely, the Pap test will show cells invaded by the Herpes virus. However, a Pap test is not a reliable test for Herpes. If this happens, your physician will take a culture specifically for Herpes.

What Causes Reactive or Repair-related Changes?
These changes are benign and are most commonly seen in women who are menopausal (lack of estrogen can cause the cervical and vaginal linings to thin and become inflammed), who have had a recent vaginal infection or biopsy, and women who use an IUD or diaphragm for birth control. Women who have had radiation to the pelvis may also show reactive changes on their Pap test.

What Are the Various Types of Squamous Cell Abnormalities?

  • Atypical Cells of Undetermined Significance?- This means the cytologist has seen cells that are abnormal, but the cause of the abnormality is not clear. Your doctor will recommend a repeat Pap test after a short period of time.
  • Low-grade Squamous Intraepithelial Lesion (LGSIL)?- These cells are undergoing a transformation with distinct characteristics. These changes may also be called dysplasia. If the cells are low-grade, the changes are mild. In about half of the cases of LGSIL, the cells will spontaneously return to normal. Further evaluation of a LGSIL is recommended though, because 25% of the lesions will progress to a high-grade lesion, and 25% will persist as LGSIL. These changes have been linked to the?Human Papilloma Virus (HPV).
  • High-grade Squamous Intraepithelial Lesion (HGSIL)?- These cervical changes are moderate to severe. If left untreated, 50 to 75% will progress to cervical cancer. If your report shows HGSIL, your doctor will recommend a biopsy.
  • Cancer?- If the cells appear to be cancer, your doctor will want to do a biopsy to confirm the diagnosis.

What Happens After an Abnormal Pap Smear?

After the initial Pap test your doctor may recommend one of the following follow up procedures.

  • Repeat Pap Smear?- A repeat Pap smear may be recommended within a certain time frame, depending on your medical history. (Generally 2 months to 6 months).
  • Colposcopy?- During this procedure, the doctor inserts a speculum into the vagina so the cervix can be seen. A colposcope is used to view the cervix under magnification. A biopsy may be taken from this area and sent to a pathologist for definitive diagnosis. This pinch may feel like a menstrual cramp.
  • An?ECC?may be taken to sample the cells in the endocervical canal. This is an area of the cervix which cannot be viewed through a colposcope.

Who is at Increased Risk for Cervical Cancer?

  • Women who have more than one sexual partner, or who are with a partner who has had more than one sexual partner.
  • Women who have a history of genital warts (condyloma) or?Human Papilloma Virus (HPV)
  • Women who smoke
  • Women who began having sexual intercourse at an early age (before age 18)

Surgery

More information for this section is coming soon. If you have questions or need some more information, please don’t hesitate to contact us!

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