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.
Cryosurgery is done only after a colposcopy confirms the presence of abnormal cervical cells.
Cyrotherapy is also used for the treatment of cervicitis or inflammation of the cervix.
Cryosurgery is not a treatment for cervical cancer.

What happens during cryosurgery?

Cryosurgery is performed in your doctor's office while you are awake. It is similar to a pelvic
exam:

• you will be asked to undress from the waist down,

• lay on an exam table with your feet in stirrups,
• a speculum is inserted into your vagina to hold the vaginal canal open so that your
cervix can be seen.

However, that's where the similarity ends.

• Cryotherapy uses special instruments called cryo probes.

• During cryosurgery the cyro probes are inserted into your vagina until they firmly
cover the abnormal areas of cervical tissue.
• Next, liquid nitrogen begins to flow through the cryo probes at a temperature of
approximately -50 degrees Celsius.
• This causes the metal cryo probes to freeze and destroy superficial abnormal cervical
tissue.
• The most effective treatment result is obtained by freezing for three minutes, letting
the cervix thaw, and repeating the treatment for three more minutes.

How will I feel during cryosurgery?

• You may feel some slight cramping.

• You may experience either a sensation of cold or of heat.

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. However, when the cervical changes
are located in the upper section of the cervix a cone biopsy, rather than cryotherapy, is
recommended.

What happens after cryosurgery?

You can return to most normal activities the day after cryosurgery; however, 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. This is caused
by the sloughing of dead cervical tissue.
• Do not insert anything into the vagina for at least two to three weeks. This means no
tampons, no douches, and no sexual intercourse.

You should call your health care provider if any of the following occur:
 o Fever. Your doctor should inform you before you leave the office what
amount of fever is cause for alarm following cryosurgery.
o Vaginal bleeding that is heavier than you normally experience during your
menstrual cycle.
o Pain. Some slight cramping is normal, however, any severe or increasing
pelvic pain should be reported to your doctor immediately.
o Foul smell or yellowish vaginal discharge. These can indicate an infection
which may need immediate treatment.

Cryosurgery is relatively risk-free, producing fewer complications than any other

gynecological procedure. After cryosurgery you will need Pap tests every three to six months
for a period of time. Once you have had several normal Pap smears in a row, your doctor will
discuss with you how often you need future screening for cervical cancer.

LEEP Procedure- The loop electrosurgical excision procedure (LEEP) is used

when there is an indication of abnormal cells on the surface of the cervix. If your
doctor has told you that you need to have a LEEP procedure, it's because your annual Pap
smear indicated the presence of abnormal cervical cells, or cervical dysplasia. While the loop
electrosurgical excision procedure, or LEEP procedure, may make you wonder if your doctor
wants you to jump. The LEEP procedure has nothing to do with jumping. The LEEP
procedure is one of several procedures your doctor has available to help diagnose and treat
abnormal cervical cells. Other procedures your doctor may want you to have either before or
during the LEEP procedure include, a colposcopy and / or a cone biopsy.

LEEP uses a thin wire loop electrode which is attached to an electrosurgical generator. The
generator transmits a painless electrical current that quickly cuts away the affected cervical
tissue in the immediate area of the loop wire. This causes the abnormal cells to rapidly heat
and burst, and separates the tissue as the loop wire moves through the cervix.

This technique allows your physician to send the excised tissue to the lab for further
evaluation which insures that the lesion was completely removed, as well as allowing for a
more accurate assessment of the abnormal area.

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. Never take any drug before any
medical procedure without explicitly asking your doctor about it. Always follow your doctors
instructions for preparation for the LEEP.

What happens during the LEEP procedure?

The LEEP procedure takes about 20-30 minutes and is usually performed in your physician's
office. 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 colposcope will be used to guide your doctor to
the abnormal area. Unlike a normal colposcopy, a tube will be attached to the speculum to
remove the small amount of smoke caused by the procedure.

An electrosurgical dispersive pad will be placed on your thigh. The pad is a gel-covered
adhesive electrode which provides a safe return path for the electrosurgical current. A single-
use, disposable loop electrode will be attached to the generator hand piece by your physician.
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. Next a local anesthetic will be injected
into the cervix; the electroloop will be generated and the wire loop will pass through the
surface of your cervix.

After the lesion is removed your physician will use a ball electrode to stop any bleeding that
occurs; he may also use a topical solution to prevent further bleeding. You can leave your
physician's office soon after the procedure.

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. Other symptoms that should be reported to your physician include
any heavy vaginal discharge or strong vaginal odor.

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, treatment of the abnormal area is imperative to prevent abnormal
cervical cells from developing into cervical cancer

After the LEEP procedure, make sure to follow your doctor's instructions precisely. Your
doctor will tell you when to return for follow up Pap smears, and / or colposcopies. Keeping
these follow up appointments is necessary to verify that all of the abnormal cervical tissues
have been removed, as well as to make sure that if abnormal cervical cells redevelop they are
caught early and treated appropriately.

Hysteroscopy- Hysteroscopy provides a way for your physician to look inside

your uterus. A hysteroscope is a thin, telescope-like instrument that is
inserted into the uterus through the vagina and cervix. This tool often
helps a physician diagnose or treat a uterine problem. What is
hysteroscopy?
Hysteroscopy provides a way for your physician to look inside your uterus. A hysteroscope is
a thin, telescope-like instrument that is inserted into the uterus through the vagina and cervix.
This tool often helps a physician diagnose or treat a uterine problem. Hysteroscopy is minor
surgery which is performed either in your physician's office or in a hospital setting. It can be
performed with local, regional, or general anesthesia--sometimes no anesthesia is needed.
There is little risk involved with this procedure for most women.

When is hysteroscopy used?

Hysteroscopy may be either diagnostic or operative.

Diagnostic hysteroscopy is used to diagnose some uterine abnormalities, and may also be
used to confirm the results of other tests such as hysterosalpingography (HSG). Other
instruments or techniques, such as dilation and curettage (D&C) and laparoscopy, are
sometimes used in conjunction with the hysteroscopy. Diagnostic hysteroscopy can be used
to diagnose certain conditions such as abnormal uterine bleeding, infertility, repeated
miscarriages, adhesions, fibroid tumors, polyps, or to locate displaced intrauterine devices
(IUDs).

An operative hysterocopy may be used, instead of open abdominal surgery, to both diagnose
and treat certain conditions such as uterine adhesions, septums, or fibroids which can often be
removed through the hysteroscope.

The hysteroscope is sometimes used with other instruments such as the resectoscope to treat
some cases of abnormal bleeding; however after this procedure, known as endometrial
ablation, women can no longer have children so it is not an option for women who wish to
have future pregnancies. Endometrial ablation is a procedure which destroys the lining of the
uterus. The resectoscope is a telescope-like instrument with a wire loop, a rollerball, or a
roller cylinder tip at the end. Electric current at the end of the tip is used to destroy the uterine
lining. This procedure is usually performed in an outpatient setting.

When should hysteroscopy be performed?

The best time for hysteroscopy is during the first week or so after your period. During this
time your physician is best able to view the inside of the uterus.

How will I be prepared for hysteroscopy?

If you are having general anesthesia in the hospital, 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. Routine lab tests may be ordered as well for women having a hysteroscopy in the
hospital. You will be asked to empty your bladder and your vaginal area will be cleansed
with an antiseptic. Sometimes a drug to help you relax is ordered. Next you will be prepared
for anesthesia:

• Local anesthesia: You will receive an injection of anesthetic around the cervix to
numb it, with this type of anesthesia you remain awake and may feel some cramping.

• Regional anesthesia: A drug is injected, through a needle or tube in your lower back,
that blocks the nerves that receive sensation from the pelvic region. You are awake
 with this type of anesthetic, but feel no discomfort. Regional anesthesia is also called
a spinal or epidural.

• General anesthesia: You will not be conscious during your hysteroscopy when
general anesthesia is used. A mask over your mouth and nose allows you to breathe a
mixture of gases. Once you are under anesthesia, a tube may be inserted down your
throat to help you breathe.

Your physician will determine which type of anesthesia is best for you based on the reason
for your hysteroscopy. Remember to ask questions if anything is about your procedure or
anesthesia is unclear.

What happens during the hysteroscopy procedure?

1. The opening of your cervix may need to be dilated or made wider with special
instruments.

2. The hysteroscope is inserted through your vagina and cervix, and into your uterus.

3. 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.

4. 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.

5. If surgery is required, small instruments are inserted through the hysteroscope.

Sometimes a laparoscope is used at the same time to view the outside of the uterus. When this
happens a gas such as carbon dioxide or nitrous oxide is allowed to flow into the abdomen.
The gas expands the abdomen so that the physician can see the organs easier. Most of the gas
is removed at the end of the procedure. A laparoscopic procedure will be done in a hospital
setting.

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, but can usually go home on the same day.

How will I feel after a hysteroscopy?

Some patients may experience shoulder pain following laparoscopy or when gas is used to
expand the uterus. Once the gas is absorbed the discomfort should subside quickly. You may
feel faint or sick, or you may have slight vaginal bleeding and cramps for 1-2 days following
the procedure.

Contact your Doctor if you develop any of the following after your hysteroscopy:

• Fever
 • Severe abdominal pain

• Heavy vaginal bleeding or discharge

Is hysteroscopy safe?

Hysteroscopy is a fairly safe procedure. Problems that can occur happen in less than 1% of
cases, but include:

• Injury to the cervix or uterus

• Infection

• Heavy bleeding

• Side effects from the anesthesia

Although general anesthesia is sometimes used, in the majority of cases it is not necessary.
Hysteroscopy allows your physician to see inside your uterus and aids in the accurate
diagnosis of some medical problems. The procedure and recovery time are usually short.

Pelvic laparoscopy- Laparoscopy is usually performed under general

anesthesia; however, it can be performed with other types of anesthesia that
permit the patient to remain awake. The typical pelvic laparoscopy involves a
small (1/2" to 3/4") incision in the belly button or lower abdomen. Laparoscopy is a
minimally invasive surgical technique used in procedures such as tubal ligation, gallbladder
removal or hiatal hernia repair. It is normally performed in the outpatient surgery unit of a
hospital. In most cases, patients can return home a few hours after a laproscopic procedure.

What happens during laparoscopy?

Laparoscopy is usually performed under general anesthesia; however it can be performed

with other types of anesthesia that permit the patient to remain awake.

The typical pelvic laparoscopy involves a small (1/2" to 3/4") incision in the belly button or
lower abdomen. The abdominal cavity is filled with carbon dioxide. Carbon dioxide causes
the abdomen to swell, which lifts the abdominal wall away from the internal organs. That
way, the doctor has more room to work.

Next, a laparoscope (a one-half inch fiber-optic rod with a light source and video camera) is
inserted through the belly button. The video camera permits the surgeon to see inside the
abdominal area on video monitors located in the operating room.

Depending on the reason for the laparoscopy, the physician may perform surgery through the
laparoscope by inserting various instruments into the laparoscope while using the video
monitor as a guide. The video camera also allows the surgeon to take pictures of any problem
areas he discovers.
In some cases, 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. However, if this is a
possibility in your case, your physician will discuss this with you prior to surgery, and the
surgical consent form will include this possibility.

Is there any risk associated with laparoscopy?

Certain women face an increased risk with any surgical procedure including women who
smoke, are overweight, who have pulmonary diseases or cardiovascular diseases, as well as
women in the late stages of pregnancy or who use certain drugs. If you think you may fall
into any of these categories, be sure to discuss your surgical risks with your physician.
Although rare, perforation of the bowel or liver are possible complications that may occur
during laparoscopy.

What is the recovery period following laparoscopy?

Laparoscopy results in relatively little pain, and a quick recovery for most patients. 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. Although prescription pain killers
are often ordered, Tylenol or Advil is usually sufficient for pain relief after this procedure.

Often patients have the procedure on a Friday and are able to return to light work by Monday.
Barring complications, most patients are fully recovered and ready to return to full activity
one week after laparoscopy.

When should you call the doctor?

When you leave the hospital, you will receive personalized instructions about when to call
the doctor. Generally, you should call the doctor if you experience fever above 100 F,
excessive pain (not controlled by pain killers), swelling or discharge from the wound.

If your doctor has ordered a laparoscopy for you, be sure that you fully understand the reason
he is recommending this procedure and how you can expect to benefit. Always ask questions
before agreeing to any surgical procedure.

D&C- Often used to diagnose or treat abnormal uterine bleeding, the D&C is one
of the most common GYN operative procedures. Dilation and Curettage also
provides important information about whether uterine cancer is present. Often
used to diagnose or treat abnormal uterine bleeding, the D&C is one of the most common
surgical procedures performed on women. Dilation and Curettage also provides important
information about whether uterine cancer is present.

Before you can understand D&C you need to know a little about the uterus and cervix. The
uterus is a pear-shaped, muscular organ that sits in the lower abdomen. The top of the uterus
is wide and it narrows like the neck of a bottle at the bottom. The lower third portion of the
uterus is its neck which is called the cervix. 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 -- an instrument used to separate the walls of the vagina.
The inner wall of the uterus is lined by endometrial tissues. The endometrial tissues thicken
during the first part of your menstrual cycle. Once ovulation occurs progesterone acts to stop
this thickening, and changes the endometrial lining so that it is ready to accept a pregnancy
should it occur. If pregnancy doesn't occur, hormone production ceases and the endometrium
breaks up and is shed as menstrual blood.

Who Needs A D&C?

A D&C may be required to diagnosed and/or treat a problem such as heavy or prolonged
menstruation, as well as unexplained bleeding between periods. The are many possible causes
for these menstrual abnormalities, one of the most common being a hormonal imbalance.
Hormonal imbalance causes a thickening of the endometrium which sometimes causes
irregular or prolonged menstrual cycles. Although this can happen at any age it most
commonly occurs in young women just starting menstruation and in older pre-menopausal
women.

Abnormal uterine bleeding is also a warning of various types of growths, which are most
often non-cancerous. 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. Polyps inside the uterus can usually
be removed by D&C. Fibroid tumors are another common benign growth that occurs in the
uterus. Fibroids can be silent causing no symptoms, or they can cause heavy bleeding and
painful cramping. Although fibroid tumors are sometimes detected during dilation and
curettage, another surgical procedure is necessary to remove them.

Abnormal bleeding is sometimes a sign of endometrial cancer, particularly in women over

40. Women over 40, especially those past menopause, may have a D&C or another procedure
called an endometrial biopsy. Occasionally a hysteroscopy is performed at the same time as a
D&C, allowing the doctor a better view of inside the cervix, vagina, and uterus.

Dialation and curettage is also commonly performed following miscarriage or abortion in

cases where the uterus fails to fully empty its content. Abortions induced before the 12th
week of pregnancy are performed in a manner which is similar to the D&C.

Where Is Dilation and Curettage Performed?

Where your D&C takes place depends on individual factors about your health. It can be
performed in a hospital setting using general anesthesia or in your doctor's office using a
local anesthetic. An injection around the cervix will minimize pain or discomfort from the
procedure and produce numbness in the area.

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.
• Before the surgery starts an antiseptic will be used to cleanse the skin around the
vagina and cervix.

Be sure to ask your doctor if there are any additional preparations that you should make
before your dilation and curettage.
What Are The Steps For Dilation And Curettage?

• The doctor completely inspects the pelvic reproductive organs for any abnormal
changes.
• Next, a speculum is inserted into the vagina to open the walls so the doctor can see the
cervix.
• A clamp-like instrument holds the cervix in place.
• The cervix is dialated with a series of tapered rods of increasing widths which are
inserted into the cervical opening (the OS).
• A curette is passed through the uterus and used to scrape the uterine walls. This
loosens pieces of the lining which are removed and sent to a lab for microscopic
examination. Another method of obtaining a sample of the uterine lining is by
applying suction through a narrow tube.

What To Expect After Surgery

You may have some discomfort from general anesthesia which can include nausea, vomiting,
and a sore throat that can last a few days. 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. Your next period
may be early or late.

You will need a friend or family member to accompany you home a few hours after your
D&C. The affects of anesthesia wear off at different rates for each individual; however you
should be able to drive and return to normal activities within a few days.

Points To Remember After D&C

• To prevent bacteria from entering the cervix following D&C, you should refrain from
sexual intercourse, tampon use, and douches for at least a week.
• Showering, bathing, or swimming is permitted as soon as you feel well enough.
• Notify your doctor if fever, abdominal pain, heavy bleeding, or a vaginal discharge
with a bad odor occur.
• Make sure you follow up with your doctor as recommended after the surgery.

Complications of Dilation and Curettage

As with any surgical procedure it's important for you to understand any possible
complications or risks. Although complications with D&C are rare they can include:

• A perforation of the uterine wall caused by the tip of the surgical instrument. This
injury rarely requires treatment (additional surgery) and heals on its own.
• Excessive bleeding is always a risk during surgery.
• Another rare complication is infection with pain and fever.